|
| Recommendation | Phase | Type of consensus (% agreement) |
|
| Performance of core needle biopsy for the diagnosis of retroperitoneal sarcoma (RS) | | |
| (i) Must always be carried out if neoadjuvant therapy is planned (radiation therapy and/or chemotherapy) | 1 | Yes (95) |
| (ii) It must not be replaced by FNA, as it provides little diagnostic information and can cause delays in starting potential treatment | 1 | Yes (90) |
| (iii) Has minimal risk of dissemination in the needle tract, so this should not be a reason for not performing this procedure | 1 | Yes (75) |
| Patients with RS should always be referred to a tertiary care facility or one renowned for its expertise and known to have a multidisciplinary team/committee with extensive surgical experience in the management of tumors at this location | 1 | Yes (mode: 85) |
| The procedure to be followed in patients who are referred for assessment after inadequate RS surgery (no en-bloc resection, R0, etc.) performed at a hospital center lacking the necessary experience depends on the grade: | | |
| (i) Low-grade RS: performance of CT TAP scan and follow up closely in the absence of clear disease data until development of macroscopic lesions, at which time a new surgery should be performed | 1 | Yes (mode: 50%) |
| (ii) High-grade RS: treatment should be tailored to each case, as there are no clear recommendations in this regard | 1 | Yes (mode: 50%) |
| Rescue surgery should be considered as treatment for local RS recurrence in cases in which the disease is resectable and R0 can be achieved | 1 | Yes (mode: 80%) |
| Complementary radiation therapy cannot be used as standard treatment for patients who have potentially resectable RS; if after individualized assessment it is indicated, preoperative radiation therapy will be administered in every case as long as it is possible to meet the radiation field requirements | 2 | Yes (93.8) |
| Neoadjuvant chemotherapy should be considered for high-grade RS with potential sensitivity to chemotherapy (leiomyosarcoma, angiosarcoma, synovial sarcoma, etc.) that are at the limits of resectability | 1 | Yes (75) |
| Given the absence of evidence to show increase in survival, adjuvant chemotherapy cannot be considered standard treatment for resected RS; hence, if considered as an option in individual cases, the factors that should be assessed are (in decreasing order of importance) as follows: | | |
| (i) Risk of relapse | 2 | Yes (mean: 4.0; CV: 28.9%) |
| (ii) Histology | 2 | Yes (mean: 3.9; CV: 22.8%) |
| (iii) Histological grade | 2 | Yes (mean: 3.3; CV: 32.5%) |
| In the event that the decision is made to treat resected RS with adjuvant chemotherapy, the regimen to be administered would consist of a combination of an anthracycline and ifosfamide | 1 | Yes (mode: 50%) |
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