[Practice guideline 'Diagnostic techniques for soft tissue tumours and treatment of soft tissue sarcomas (revision)'].
Members of the Dutch working group on soft tissue tumours developed an up-to-standard evidence-based multidisciplinary clinical practice guideline for the diagnosis of soft tissue tumours and the treatment and follow-up of soft tissue sarcomas, in cooperation with the Dutch Association of Comprehensive Cancer Centres and the Dutch Institute for Healthcare Improvement. A soft tissue sarcoma is defined as every non-epithelial tumour that does not originate in haematopoietic or lymphatic system, central nervous system or bone. The guideline lists 'alarm signals' to raise awareness of malignancy and recommends consulting a multidisciplinary team. Non-invasive imaging has to be completed before proceeding to any invasive (diagnostic) procedure or assessment of dissemination. Aspiration cytology can be useful for differentiating between sarcoma and other malignancies. A definite diagnosis is obtained by means of image-guided needle biopsy. Tumours will be classified according to the World Health Organization and graded according to the Federation Nationale des Centres de Lutte Contre le Cancer. Surgical excision with a tumour free margin of 2 cm is the core of therapy, taking into account vital structures when necessary. In case of small superficial tumours (diameter < or = 3 cm) excision biopsy may be justified. Radiotherapy is almost always necessary and certainly indicated when wide margins are impossible even after re-resection. In the case of primary metastatic disease, an individual decision should be taken after multi-disciplinary consultation concerning the possibility of curative or palliative treatment. Neither neo-adjuvant nor adjuvant chemotherapy is standard. Chemotherapy may be useful in metastatic disease. The guideline advises referring patients who are eligible for chemotherapy to a centre and that they should be included in a study protocol.
van Geel
A N
AN
Afd. Heelkunde, Erasmus Medisch Centrum, locatie Daniel den Hoed, Rotterdam.
Wyrdeman
H K
HK
Seynaeve
C
C
Hogendoorn
P C W
PC
Bongaerts
A H H
AH
Molenaar
W M
WM
D003937:Diagnosis, Differential; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D009426:Netherlands; D012509:Sarcoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012955:Societies, Medical; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*