scandinavian sarcoma group
TRANSCRIPT
Ongoing collaborative projects
Prospective for collaborative projects
Kirsten Sundby Hall
Oslo CTOS 4. Nov - 06
Orthopedic Orthopedic SurgerySurgery
Viseral and Viseral and Retroperitoneal Retroperitoneal
SurgerySurgery
RadiotherapyRadiotherapy
ChemotherapyChemotherapy
Skeletal Skeletal metastasismetastasis
MorphologyMorphology(Pathology and (Pathology and
Cytology) Cytology) Tumorbiology Tumorbiology
Diagnostic Diagnostic Radiology and Radiology and
Nuclear medicineNuclear medicine
Scandinavian Sarcoma Group (SSG)Organization – Subcommittees
www.ssg-org.net
2 Chairmen 2 Vice chairmen 1 Secretary 1 Vice secretary 1 Publication ombudsman
Meeting once a year Working committee groups meeting once a year
Central RegisterCentral Register
SecretariatSecretariatOncological CenterOncological Center
LundLundSwedenSweden
SSG Registry
1986–2005: 8 126 patientsAll sarcoma centers in Sweden (6) and Norway (3) register patients, Finland (1) Population based for Norway and Sweden.
Referral pattern, treatment, prognosis
www.ssg-org.net
www.ssg-org.net
Current thesis projects based on SSG registry
Leiomyosarcoma C. Svarvar, Helsinki
LiposarcomaK. Engström, Gothenburg
ChondrosarcomaB. Widhe, Stockholm
OsteosarcomaC. Müller, Oslo
Quality of lifeL. H. Aksnes, Oslo
Skeletal metastasesB. H. Hansen, Århus
Radiation therapy and local recurrence in STS N. L. Jebsen, Bergen
www.ssg-org.net
Guidelines for treatment of metastatic soft-tissue sarcomas in adult patients
Proposals for treatment• With a curative intent
• With a palliative intent
• Chemotherapy-Surgery-Radiotherapy
Guidelines for treatment of abdominal sarcomas
• Preoperative diagnosis and planning
• Surgery
• Chemotherapy, radiotherapy
• Follow-up
• Centralized management!
Osteosarcoma
SSG II Combination therapy in OS 1982 – 1990
SSG VIII Therapy of OS 1990 – 1998
ISG/SSG I An Italian-Scandinavian treatment and 1997 – 2000research protocol for high-grade osteosarcoma of the extremities
ISG/SSG II Treatment of metastatic and pelvic 1998 – 2003osteosarcoma
SSG XIV A Scandinavian treatment research 2000 – 2004protocol for extemity localized high-grade osteosarcoma
Euroboss I A European treatment protocol for bone 2003sarcoma in patients older than 40 years
Euramos I An American/European treatment protocol 2004for OS in patients <40 years
www.ssg-org.net
Pan-European/American Cooperation
EURAMOS
SSG
COG
EOI
COSS
EURAMOSTreatment outline
Good response
Poor response
A M PA M P
A M PA M P
A M PA M P
A M PA M P + IE + IE
R
a
n
d
A M PA M P
IF-maintenanceIF-maintenance
www.ssg-org.net / www.euramos.org
Current status of SSG contribution to EURAMOS I
Total of registered patients 18
Total of randomized patients 13
30/9 2006
Ewing´s sarcoma
SSG IV Combined modality therapy in EWS 1984 – 90
SSG IX Therapy of EWS 1990 – 99
ISG/SSG III ISG/SSG treatment protocol for 1999non-metastatic EWS
ISG/SSG IV ISG/SSG treatment protocol for 1999
high-risk EWS
www.ssg-org.net
RANDOMIZE
Imatinib Follow-up12 months 48 months
Imatinib Follow-up36 months 24 months
SSG/AIO (SSG XVIII)Adjuvant study for high-risk GIST
Primary objective:
To investigate the recurrence-free survival in GIST patients with a high (>50%) risk of disease recurrence within the first 5 years following the diagnosis and treated with adjuvant imatinib mesylate either for 12 or 36 months.
Arm 1
Arm 2
www.ssg-org.net
SSG XVIII SSG/AIO – adjuvant study for high risk GIST
Participating hospitals
SSGCountry Hospital Responsible
physician
Finland Helsinki Heikki JoensuuPikonlinna Tuula LehtinenOulu Raija KallioTurku Paula Lindholm
Norway Bergen Odd MongeOslo Kirsten Sundby HallTromsø Eivind SmelandTrondheim Ragnhild Klepp
Sweden Gothenburg Håkan AhlmanLinköping Najme WallLund Mikael ErikssonStockholm Jonas BerghUppsala Ingela Turesson
AOICountry Hospital Responsible
physician
Germany Berlin Peter ReichardtDüsseldorf Hans Joachim SchütteEssen Peter EberlingFrankfurt Elke JaegerGöttingen Giuliano RamadoriMannheim Peter HohenbergerMünchen Thomas LichtTübingen Joerg Thomas Hartmann
Number of randomized patients sept 30 2006: 222
www.ssg-org.net
SSGXX-a new adjuvant STS protocol 2007
“A Scandinavian Sarcoma Group (SSG)
treatment protocol for adult patients with non-metastatic high-risk STS of the
extremities and trunk wall”
* 2 or 3 risk (SIN) factors
•Size>8cm
•Presence of necrosis
•Presence of vascular invasion
(Opened 1998-closed 31.12.05)
Introduction of a novel risk factor assessment
•Peripheral tumor growth pattern
Infiltrative growth of a STS is a strong factor for both local recurrence and metastases
Vascular invasion
Yes
No
Eligible in Group A
2 or 3 risk-factors
- Size >8 cm
- Infiltrative growth
- Necrosis
Yes
No Not included in study
Decision algoritm for adjuvant treatment in group A
Group ASSG XX Adjuvant therapy arm
For high-risk STS in extremities and trunk wall with primary surgery
SurgeryWide margin for subcutaneous tumors or radically amputated patients CT1 CT2 CT3 CT4 CT5 CT6 Max 12 weeks
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 weeks
SurgeryMarginal, for all tumors, wide margin for deep tumors
RT 36 Gy CT1 CT2 CT3 (1.8 x 2/d x 10d) CT4 CT5 CT6
Max 12 weeks
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 weeks
SurgeryIntralesional margin, regardless of tumor depth
RT 45Gy CT1 CT2 CT3 (1.8 x 2/d x 12.5d) CT4 CT5 CT6
Max 12 weeks
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 weeks CT regimenDoxorubicin: 60mg/m2 as 4 hours infusionIfosfamide: 2g/m2 as a 2 hours infusion (with Mesna) on 3 consecutive daysG-CSF routinely
Group B SSG XX Preoperative therapy
For high-risk STS in extremities and trunk wall when primary resection carries an obvious risk of an intralesional margin
RT MR Surgery
CT1 CT2 (1.8 x 2/d x 10d) CT3 CT4 CT5 CT6
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
CT regimen
Doxorubicin: 60 mg/m2 as 4 hours infusion
Ifosfamide: 2g/m2 as a 2 hours infusion (with Mesna) on 3 consecutive days
G-CSF routinely
Surgery: 2.5 weeks after start of the third cycle.
weeks
SSG policy
- to continuously work for more international collaboration on treatment protocols and research
www.ssg-org.net
• End