Management Strategy for Soft Tissue Sarcoma

Management Strategy for Soft Tissue Sarcoma - Flowchart Sarcoma Sarcoma

«Flowchart»

Mass identified symptomatic/asymptomatic

Excisional biopsy

Core needle biopsy

Complete excision with 1-2 cm margin

Sarcoma

Low grade

High grade

Limit use of adjuvant therapy even in close/positive margin

Consider enrollment in a clinical trial for adjuvant systemic therapy. Consider adjuvant radiation if:

Tumor >5 cm
Margin is close or positive on pathology and re-excision is not feasible
Recurrence would require morbid resection

Consider enrollment in a clinical trial for adjuvant systemic therapy. Consider adjuvant radiation if:

Tumor >5 cm
Margin is close or positive on pathology and re-excision is not feasible
Recurrence would require morbid resection

Consider enrollment in a clinical trial for adjuvant systemic therapy. Consider adjuvant radiation if:

Tumor >5 cm
Margin is close or positive on pathology and re-excision is not feasible
Recurrence would require morbid resection

End

Complete excision with goal of 1–2 cm margin

Consider neoadjuvant chemotherapy

History and physical examination
CT/MRI of primary lesion

Small (<5 cm)

Large (>5 cm)

Rhabdomyosarcoma or Ewing sarcoma (any size)
>10 cm other HG subtype excluding DDLPS
5-10 cm

Pleomorphic LPS
Synovial sarcoma
Round cell LPS

Rhabdomyosarcoma or Ewing sarcoma (any size)
>10 cm other HG subtype excluding DDLPS
5-10 cm

Pleomorphic LPS
Synovial sarcoma
Round cell LPS

Rhabdomyosarcoma or Ewing sarcoma (any size)
>10 cm other HG subtype excluding DDLPS
5-10 cm

Pleomorphic LPS
Synovial sarcoma
Round cell LPS

Rhabdomyosarcoma or Ewing sarcoma (any size)
>10 cm other HG subtype excluding DDLPS
5-10 cm

Pleomorphic LPS
Synovial sarcoma
Round cell LPS

Yes