Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2020

01-06-2020 | Metastasis | Sarcoma

Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma

Authors: David A. J. Wilson, MD, MSc, FRCSC, Aaron Gazendam, MD, Julia Visgauss, MD, FACS, David Perrin, MD, FRCSC, Anthony M. Griffin, MSc, Peter W. Chung, MD, FRCPC, Charles N. Catton, MD, FRCPC, David Shultz, MD, FRCPC, Peter C. Ferguson, MD, MSc, FRCSC, Jay S. Wunder, MD, MSc, FRCSC

Published in: Annals of Surgical Oncology | Issue 6/2020

Login to get access

Abstract

Purpose

The risk of tumor recurrence after resection of soft tissue sarcoma (STS) necessitates surveillance in follow-up. The objective of this study was to determine the frequency/timing of metastasis and local recurrence following treatment for soft tissue sarcoma, and to use these data to justify an evidence-based follow-up schedule.

Methods

Utilizing a prospective database, a retrospective single center review was performed of all patients with minimum 2-year follow-up after resection of a localized extremity STS. Kaplan–Meier estimates were used to calculate the incidence of local recurrence and metastases on an annual basis for 10 years.

Results

We identified a total of 230 low-grade, 626 intermediate-grade and 940 high-grade extremity STS and a total of 721 events, 150 local recurrences and 571 metastases. Based on tumor size and grade, follow-up cohorts were developed that had similar metastatic risk. Using pre-determined thresholds for metastatic event, a follow-up schedule was established for each cohort.

Conclusion

Based on our results we recommend that patients with small low-grade tumors undergo annual follow-up for 5 years following definitive local treatment. Patients with large low-grade tumors, small intermediate-grade and small high-grade tumors should have follow-up every 6 months for the first 2 years, then yearly to 10 years. Only patients with large intermediate- or high-grade tumors require follow-up every 3 months for the first 2 years, then every 6 months for years 3–5, followed by annually until 10 years.
Literature
1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA: A Cancer J Clin. 2017;67(1):7–30.
2.
Zahm SH, Fraumeni J. The epidemiology of soft tissue sarcoma. In: Paper presented at: Seminars in oncology, 1997.
3.
Italiano A, Cesne A, Mendiboure J, et al. Prognostic factors and impact of adjuvant treatments on local and metastatic relapse of soft‐tissue sarcoma patients in the competing risks setting. Cancer. 2014;120(21):3361–3369.PubMed
4.
Brennan MF, Antonescu CR, Moraco N, Singer S. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg 2014;260(3):416.PubMedPubMedCentral
5.
Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016;17(5):671–80.PubMed
6.
Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol. 1997;15(2):646–52.PubMed
7.
Eilber FC, Rosen G, Nelson SD, et al. High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality. Ann Surg. 2003;237(2):218.PubMedPubMedCentral
8.
Sawamura C, Matsumoto S, Shimoji T, Tanizawa T, Ae K. What are risk factors for local recurrence of deep high-grade soft-tissue sarcomas? Clin Orthop Relat Res. 2012;470(3):700–05.PubMed
9.
Biau DJ, Ferguson PC, Chung P, et al. Local recurrence of localized soft tissue sarcoma. Cancer. 2012;118(23):5867–77.PubMed
10.
Biau DJ, Ferguson PC, Turcotte RE, et al. Adverse effect of older age on the recurrence of soft tissue sarcoma of the extremities and trunk. J Clin Oncol. 2011;29(30):4029–35.PubMed
11.
Goel A, Christy ME, Virgo KS, Kraybill WG, Johnson FE. Costs of follow-up after potentially curative treatment for extremity soft-tissue sarcoma. Int J Oncol. 2004;25(2):429–35.PubMed
12.
Casali P, Blay J-Y. Soft tissue sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(suppl 5):v198–203.PubMed
13.
Puri A, Gulia A, Hawaldar R, Ranganathan P, Badwe RA. Does intensity of surveillance affect survival after surgery for sarcomas? Results of a randomized noninferiority trial. Clin Orthop Relat Res 2014;472(5):1568–75.PubMed
14.
von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 2016;14(6):758–86.
15.
Gerrand C, Billingham L, Woll P, Grimer R. Follow up after primary treatment of soft tissue sarcoma: a survey of current practice in the United Kingdom. Sarcoma. 2007;2007:6.
16.
Beitler AL, Virgo KS, Johnson FE, Gibbs JF, Kraybill WG. Current follow‐up strategies after potentially curative resection of extremity sarcomas. Cancer. 2000;88(4):777–85.PubMed
17.
Royce TJ, Punglia RS, Chen AB, et al. Cost-effectiveness of surveillance for distant recurrence in extremity soft tissue sarcoma. Ann Surg Oncol. 2017;24(11):3264–70.PubMed
18.
Patel SA, Royce TJ, Barysauskas CM, Thornton KA, Raut CP, Baldini EH. Surveillance imaging patterns and outcomes following radiation therapy and radical resection for localized extremity and trunk soft tissue sarcoma. Ann Surg Oncol. 2017;24(6):1588–95.PubMed
19.
Davis A, O’sullivan B, Bell R, et al. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20(22):4472–77.PubMed
20.
Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75(1):48–53.PubMed
21.
Friedmann D, Wunder JS, Ferguson P, et al. Incidence and severity of lymphoedema following limb salvage of extremity soft tissue sarcoma. Sarcoma. 2011;2011:6.
22.
Holt GE, Griffin AM, Pintilie M, et al. Fractures following radiotherapy and limb-salvage surgery for lower extremity soft-tissue sarcomas: a comparison of high-dose and low-dose radiotherapy. JBJS. 2005;87(2):315–9.
23.
Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol. 2018;36(7):704–9.PubMed
24.
Puri A, Ranganathan P, Gulia A, Crasto S, Hawaldar R, Badwe R. Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? Updated results of the randomized TOSS study. Bone Joint J. 2018;100(2):262–8.PubMed
25.
Cipriano C, Griffin AM, Ferguson PC, Wunder JS. Developing an evidence-based followup schedule for bone sarcomas based on local recurrence and metastatic progression. Clin Orthop Relat Res. 2017;475(3):830–8.PubMed
26.
Ries Z, Gibbs Jr CP, Scarborough MT, Miller BJ. Pulmonary surveillance strategies following sarcoma excision vary among orthopedic oncologists: a survey of the Musculoskeletal Tumor Society. Iowa Orthop J. 2016;36:109.PubMedPubMedCentral
27.
Greenberg DD, Crawford B. Surveillance strategies for sarcoma: results of a survey of members of the Musculoskeletal Tumor Society. Sarcoma. 2016;2016:5.
28.
Schneider PJ, Evaniew N, McKay P, Ghert M. Moving forward through consensus: a modified delphi approach to determine the top research priorities in orthopaedic oncology. Clin Orthop Relat Res. 2017;475(12):3044–3055.PubMedPubMedCentral
29.
Aljubran A, Griffin A, Pintilie M, Blackstein M. Osteosarcoma in adolescents and adults: survival analysis with and without lung metastases. Ann Oncol. 2009;20(6):1136–41.PubMed
30.
Billingsley KG, Burt ME, Jara E, et al. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of disease and postmetastasis survival. Ann Surg. 1999;229(5):602.PubMedPubMedCentral
31.
Cho HS, Park I-H, Jeong WJ, Han I, Kim H-S. Prognostic value of computed tomography for monitoring pulmonary metastases in soft tissue sarcoma patients after surgical management: a retrospective cohort study. Ann Surg Oncol. 2011;18(12):3392–98.PubMed
32.
Whooley BP, Mooney MM, Gibbs JF, Kraybill WG. Effective follow‐up strategies in soft tissue sarcoma. In: Paper presented at: seminars in surgical oncology, 1999.
33.
Cool P, Grimer R, Rees R. Surveillance in patients with sarcoma of the extremities. Eur J Surg Oncol. 2005;31(9):1020–24.PubMed
34.
O’donnell PW, Griffin AM, Eward WC, et al. The effect of the setting of a positive surgical margin in soft tissue sarcoma. Cancer. 2014;120(18):2866–75.PubMed
35.
Gorelik N, Reddy SMV, Turcotte RE, et al. Early detection of metastases using whole-body MRI for initial staging and routine follow-up of myxoid liposarcoma. Skelet Radiol. 2018;47(3):369–79.
36.
Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20(3):791–6.PubMed
37.
Mariani L, Miceli R, Kattan MW, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three‐grade system. Cancer. 2005;103(2):402–8.PubMed
38.
van Praag VM, Rueten-Budde AJ, Jeys LM, et al. A prediction model for treatment decisions in high-grade extremity soft-tissue sarcomas: personalised sarcoma care (PERSARC). Eur J Cancer. 2017;83:313–23.PubMed
39.
Gundle KR, Gupta S, Kafchinski L, et al. An analysis of tumor- and surgery-related factors that contribute to inadvertent positive margins following soft tissue sarcoma resection. Ann Surg Oncol. 2017;24(8):2137–44.PubMed
40.
Traub F, Griffin AM, Wunder JS, Ferguson PC. Influence of unplanned excisions on the outcomes of patients with stage III extremity soft‐tissue sarcoma. Cancer. 2018;124(19):3868–75.PubMed
41.
Woll PJ, Reichardt P, Le Cesne A, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54.PubMed
42.
Choi LE, Healey JH, Kuk D, Brennan MF. Analysis of outcomes in extraskeletal osteosarcoma: a review of fifty-three cases. J Bone Joint Surg Am. 2014;96(1):e2.PubMedPubMedCentral
43.
Fan Z, Patel S, Lewis VO, Guadagnolo BA, Lin PP. Should high-grade extraosseous osteosarcoma be treated with multimodality therapy like other soft tissue sarcomas? Clin Orthop Relat Res. 2015;473(11):3604–11.PubMedPubMedCentral
Metadata
Title
Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma
Authors
David A. J. Wilson, MD, MSc, FRCSC
Aaron Gazendam, MD
Julia Visgauss, MD, FACS
David Perrin, MD, FRCSC
Anthony M. Griffin, MSc
Peter W. Chung, MD, FRCPC
Charles N. Catton, MD, FRCPC
David Shultz, MD, FRCPC
Peter C. Ferguson, MD, MSc, FRCSC
Jay S. Wunder, MD, MSc, FRCSC
Publication date
01-06-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08240-z

Other articles of this Issue 6/2020

Annals of Surgical Oncology 6/2020 Go to the issue

ASO Author Reflections

ASO Author Reflections: Clinical Implication of Nomograms in the Breast Oncology Field

Peritoneal Surface Malignancy

The Chicago Consensus on Peritoneal Surface Malignancies: Management of Colorectal Metastases

Hepatobiliary Tumors

A Textbook Answer to the Debate About Medicare’s Prospective Payment System Exemption?

Peritoneal Surface Malignancy

The Chicago Consensus on Peritoneal Surface Malignancies: Standards

ASO Author Reflections

ASO Author Reflections: How Far Should We Go in Local Management for a Localized Malignant Phyllodes Tumor of the Breast?

Peritoneal Surface Malignancy

The Chicago Consensus on Peritoneal Surface Malignancies: Management of Peritoneal Mesothelioma