What are the NCCN treatment guidelines for stage II-III soft tissue sarcoma (STS) of the extremities, superficial trunk, or head and neck?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

For stage II-III disease, the NCCN recommends that treatment options should be decided on the basis of the patient’s age, performance status, and comorbidities, as well as the location and histologic subtype of the tumor. NCCN treatment recommendations for these cases (with acceptable functional outcomes) are as follows [1] :

  • Surgical resection and preoperative and postoperative radiation therapy (category 1 for stage IIA)
  • Adjuvant chemotherapy in addition to postoperative radiation therapy may be considered for stage IIB/III
  • Stage IIA: Preoperative radiation therapy and surgical resection is an alternative treatment option
  • Stage IIB/III: Preoperative radiation therapy or chemoradiation are options; postoperative radiation therapy boost with or without adjuvant chemotherapy may also be considered; Preoperative chemotherapy and postoperative radiation therapy with or without adjuvant chemotherapy is also an option
  • For high-grade resectable tumors > 8 cm, preoperative and postoperative therapy may be considered
  • Regional lymph node dissection for patients with stage III tumors with lymph node involvement
  • Evaluation for rehabilitation therapy to achieve maximal function
  • H&P every 3-6 months for 2-3 years and then annually thereafter; after 10 years, likelihood of recurrence is small and follow-up should be individualized by subtype
  • Consider chest imaging and baseline/follow-up imaging of primary site based on histology

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