Sarcoma Surveillance: A Review of Current Evidence and Guidelines

Cara A. Cipriano, MD, MS; Eugene Jang, MD, MS; Wakenda Tyler, MD, MPH


J Am Acad Orthop Surg. 2020;28(4):145-156. 

In This Article


The various guidelines for sarcoma surveillance that have been issued by the international medical community contain several similarities (Figure 5). Common themes include more intense surveillance in the early years after treatment, especially for high-grade sarcomas. The literature suggests that physical examination is sufficient to detect LR in most cases; some guidelines recommend advanced imaging routinely, whereas others leave this to the discretion of the clinician. Evidence and recommendations for the optimal pulmonary surveillance modality remain divided between radiograph and CT, with the latter having theoretical advantages but no proven survival benefit to date. Length of follow-up is also not clearly defined, although most guidelines recommend surveillance for at least 10 years; after this time frame, disease progression does occur, but at a negligible rate.[5] Additional considerations that are not specifically addressed in the published guidelines include cost to healthcare systems (monetary and time expenditures) and issues affecting patient quality of life (logistical challenges and anxiety related to testing and false-positive results). Finally, as new therapies become available, targeted surveillance strategies may be indicated based on the relative ability to effectively treat different types of metastatic sarcoma. For example, more intense chest imaging may be justified in patients who are eligible for curative treatments when PMs are detected early.

Figure 5.

Summary of surveillance protocols recommended by the NCCN,42,43 ESMO,45,46 and BSG,47,48 with suggested frequencies for obtaining history and physical examination (H&P), local imaging (LI), and chest imaging (CI) according to years since initial treatment (q = every __ months). BSG = British Sarcoma Group, ESMO = European Society for Medical Oncology, NCCN = National Comprehensive Cancer Network

Further studies investigating these topics can be anticipated; however, even with increasing data to inform protocols, determining appropriate surveillance strategies will always rely to some extent on individualized decision making. Therefore, it remains important for physicians to understand the associated risks and benefits to apply published evidence and guidelines accordingly.