Background
Main text
Surgery
I. Surgical procedure
Primary tumour | Regional Lymph Nodes | Distant metastasis | Gradea
| |
---|---|---|---|---|
Stage IA | T1a | N0 | M0 | G1, GX |
T1b | N0 | M0 | G1, GX | |
Stage IB | T2a | N0 | M0 | G1, GX |
T2b | N0 | M0 | G1, GX | |
Stage IIA | T1a | N0 | M0 | G2, G3 |
T1b | N0 | M0 | G2, G3 | |
Stage IIB | T2a | N0 | M0 | G2 |
T2b | N0 | M0 | G2 | |
Stage III | T2a, T2b | N0 | M0 | G3 |
Any T | N1 | M0 | Any G | |
Stage IV | Any T | Any N | M1 | Any G |
II. Factors influencing choice of margin
Parameter | Criterion |
---|---|
Tumour Differentiation | |
Score 1 | Sarcoma closely resembling normal adult mesenchymal tissue (e.g., well-differentiated liposarcoma) |
Score 2 | Sarcomas for which histologic typing is certain (e.g. myxoid liposarcoma) |
Score 3 | Embryonal and undifferentiated sarcomas; sarcomas of uncertain type |
Mitosis Count | |
Score 1 | 0-9/10 HPF |
Score 2 | 10-19/10 HPF |
Score 3 | ≥20/10 HPF |
Tumour Necrosis (Microscopic) | |
Score 0 | No necrosis |
Score 1 | ≤50 % tumour necrosis |
Score 2 | >50 % tumour necrosis |
Histologic Grade | |
Grade 1 | Total score 2,3 |
Grade 2 | Total score 4,5 |
Grade 3 | Total score 6,7,8 |
III. Impact of surgical margin on outcome
Radiotherapy
I. Types of radiation therapy
II. Timing
Advantages | Disadvantages | |
---|---|---|
Preoperative Radiotherapy | • Smaller RT volume • Easier resection • Better oxygenations and vascularization of the area = > larger effect • Reduction of late complications | • Wound complications • Postponing surgery • Fibrosis that could hamper surgery |
Postoperative Radiotherapy | • Better staging • Less scar complications | • Large RT Volumes • More late complications (fibrosis, joint stiffness, oedema) • Need for demarcation of the operation field (clips) |