Soft tissue sarcoma of the extremity (localised and advanced)
Prepared with OnCo (onco.cc/prep/extremity-soft-tissue-sarcoma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
18 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example FNCLCC grade, size over 5 cm and depth, Histological subtype by expert pathology and molecular testing, Margin status after resection, Lung CT staging and surveillance), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (localised, resectable), which of the standard options do you recommend and why?
- 6.For my situation (high-risk localised (large, deep, high grade)), which of the standard options do you recommend and why?
- 7.Am I a candidate for Doxorubicin, Ifosfamide, and what side effects should I expect?
- 8.How do the results of ISG-STS 1001 apply to someone like me?
- 9.For my situation (advanced, first line), which of the standard options do you recommend and why?
- 10.Am I a candidate for Doxorubicin, Ifosfamide, Trabectedin, and what side effects should I expect?
- 11.How do the results of EORTC 62012 and LMS-04 apply to someone like me?
- 12.For my situation (later lines and oligometastatic), which of the standard options do you recommend and why?
- 13.Am I a candidate for Gemcitabine, Docetaxel, Pazopanib or related drugs, and what side effects should I expect?
- 14.Are there clinical trials I could join, for example of LMS-04, ISG-STS 1001, Trabectedin, Pembrolizumab?
- 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 17.I read that “A third to a half of high-risk limb sarcomas still metastasise to the lungs”. How does that affect my plan?
- 18.I read that “Chemotherapy prolongs control but rarely survival in advanced disease”. How does that affect my plan?
The words I may hear
- Histotype-tailored therapy: Histotype-tailored therapy means choosing treatment by the specific sarcoma subtype (there are more than 70) rather than treating all sarcomas alike.
- FNCLCC grade (soft-tissue sarcoma): The FNCLCC grade is a 1-to-3 score for soft-tissue sarcomas based on how abnormal, how fast-dividing, and how much dead tissue the tumour shows; grade drives whether chemotherapy is considered.
Tests and results to bring
Biomarker results to ask for: FNCLCC grade, size over 5 cm and depth (Sarculator risk), Histological subtype by expert pathology and molecular testing, Margin status after resection, Lung CT staging and surveillance.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Localised, resectable: Limb-sparing wide resection with preoperative (50 Gy) or postoperative (66 Gy) radiotherapy for high-grade or deep tumours over 5 cm; surgery alone for small superficial low-grade tumours. (Limb-salvage surgery and endoprosthetic reconstruction, IMRT / IGRT (modern external beam), Brachytherapy, FNCLCC grade (soft-tissue sarcoma))
- High-risk localised (large, deep, high grade): Neoadjuvant anthracycline-ifosfamide (ISG-STS 1001) in fit patients; regional hyperthermia with chemotherapy or isolated limb perfusion for borderline resectable tumours. (ISG-STS 1001, Doxorubicin, Ifosfamide, Hyperthermia, Isolated limb perfusion and infusion)
- Advanced, first line: Doxorubicin alone, or doxorubicin plus ifosfamide when shrinkage is needed (EORTC 62012); doxorubicin plus trabectedin for leiomyosarcoma (LMS-04); olaratumab withdrawn after ANNOUNCE. (Doxorubicin, Ifosfamide, EORTC 62012, Trabectedin, LMS-04, ANNOUNCE)
- Later lines and oligometastatic: Gemcitabine-docetaxel, pazopanib, trabectedin, eribulin (liposarcoma); pulmonary metastasectomy or stereotactic radiotherapy for limited lung disease; histology-directed agents and trials. (Gemcitabine, Docetaxel, Pazopanib, Trabectedin, Eribulin, SBRT / SABR (stereotactic radiotherapy), Histotype-tailored therapy)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.