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: patients All sarcoma centers in Sweden (5) and Norway (3) register patients, Finland 1 Population based for Norway and Sweden. Referral pattern, treatment, prognosis 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 %

Referral before biopsy % ScDeep Improvement for both sc and deep located tumors!

Biopsy method before surgical treatment % None Cytology FNA True- cut Open More than 1 type of biopsy: from 1% to 15%

Smeland, Stuttgart 2005

Increased use of radiotherapy % AllScDeep

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

Biopsy method (bone lesions) % NoneCytology True- cut Open 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