Optimization of the Therapeutic Approach to Patients with Sarcoma: Delphi Consensus
Table 1
Treatment recommendations for localized high-risk soft tissue sarcomas.
Recommendation
Phase
Type of consensus (% agreement)
Tumor must be G3, >5 cm, and deep-seated for classification as high-risk extremity or truncal STS
1
Yes (mode: 70%)
Treatment for high-risk extremity or truncal STS consists in the administration of the following:
(i) 3 cycles of perioperative chemotherapy with full-dose epirubicin + ifosfamide
1
Yes (mode: 75%)
(ii) Preferably in the neoadjuvant setting
1
Yes (mode: 60%)
Use of preoperative (vs. postoperative) radiation therapy is recommended for high-risk extremity or truncal STS, provided that the possibility of resection is marginal (increased risk of R1)
1
Yes (mode: 70%)
The recommended perioperative chemotherapy regimen for high-risk extremity or truncal STS is as follows: epirubicin 60 mg/m2/day as a 20 min infusion on days 1-2 and ifosfamide 3 g/m2/day as a 3-hour infusion on days 1–3 or equivalent regimens
1
Yes (mode: 100%)
Patients with a soft tissue mass >5 cm that have experienced recent growth or are deep-seated should be referred to a tertiary care facility or one renowned for its expertise
1
Yes (mode: 90%)
Adequate surgical margins should be prioritized over limb function in patients with high-risk extremity or truncal STS
1
Yes (mode: 90%)
If positive margins are confirmed, reoperation to widen surgical margins should always be attempted in patients with high-risk extremity or truncal STS
1
Yes (mode: 85%)
Standard treatment for retroperitoneal sarcoma is surgery carried out after proper planning at a tertiary care facility or one renowned for its expertise
1
Yes (mode: 50%)
Before administering perioperative chemotherapy to patients with high-risk extremity or truncal STS, the following risk factors must be considered:
