Clinical practice guidelines in sarcoma in Scandinavia
On behalf of the Scandinavian Sarcoma Group (SSG)
Kirsten Sundby Hall
Clinical guidelines
SSG tradition: Current protocols define standard treatment in Scandinavia
• Clinical trials • Treatment recommendations:
SSG XVII, SSG XIX • Registration : SSG VII , SSG XVI
1986 – 2004: 6 908 patientsAll sarcoma centers in Sweden (5) and Norway (3) register patients, Finland 1 Population based for Norway and Sweden.
Referral pattern, treatment, prognosis
www.ssg-org.net
SSG Registry
Guidelines for referral of soft-tissue
tumors to tumor center
• Deep tumors of any size
• Subcutaneous tumors size > 5cm
• All other tumors supected of being malignant
Referral before biopsy %
1986-89 58
1990-94 58
1995-99 63
2000-03 73
Referral before biopsy %
Sc Deep
1986-89 36 77
1990-94 43 78
1995-99 42 84
2000-03 58 93
Improvement for both sc and deep located tumors!
Biopsy method before surgical treatment %
NoneCytology
FNATrue-cut
Open
1986-99 9 73 4 142000-03 3 64 28 5
More than 1 type of biopsy: from 1% to 15%
Smeland, Stuttgart 2005
Increased use of radiotherapy %
All Sc Deep
1986-99 21 11 24
2000-03 33 24 44
Guidelines for referral of bone lesions to tumor center
• Lesions that can simulate bone tumors
osteosarcoma GCT GCT with ABC
Referral before biopsy (bone lesions) %
All bone
1986-92 81
1993-03 88
Biopsy method (bone lesions) %
None CytologyTrue-cut
Open
1986-92 11 14 20 55
1993-03 5 36 24 35
More than 1 type of biopsy: from 8% to 13%
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 !
Concluding statement
Guidelines for clinical practice should be
• continuously evaluated and revised according to register data
• subject to increasing international collaboration
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