Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Abstract

Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data.

Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS)

“…This result reinforces the need to refer patients to the RC before any biopsy procedure takes place. The message that early referral is the key to success in sarcoma survival outcome is included in the CPG of GEIS, as well as in all European CPGs on sarcomas . The first surgery is carried out with significantly better quality by an RC, where a multidisciplinary team definitively designs the best therapeutic strategy .…”

“…As a tool to guide specialists treating patients with sarcoma, several clinical practice guidelines (CPGs) for STS have been developed, their paramount aim being to improve the quality in diagnostic and therapeutic management of patients with STS. In Spain, CPGs for STS were agreed on by consensus and approved for the first time by the Spanish Group for Research in Sarcoma (GEIS) in 2004, and since that date these have been updated periodically . Assessing quality in the therapeutic process of patients with sarcoma is challenging.…”

Treatment Patterns and Survival among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France

“…Treatment guidelines for the management of patients with STS in Europe have been published by a number of organizations, including the European Society for Medical Oncology (ESMO), the British Sarcoma Group, and the Spanish Group for Research on Sarcoma [ 13 – 15 ]. Results reported here are generally consistent with these guidelines in that standard first-line chemotherapy should be anthracycline based, with ifosfamide as a first-line alternative for patients who are not able to receive an anthracycline.…”

Primary Cutaneous Leiomyosarcoma of the Lower Extremity: A Case Report and Literature Review

“…Due to inadequate studies, the role of adjuvant therapy has remained anecdotal, with the usage of either chemotherapy or radiation reserved primarily for distant metastases or recurrence [ 4 ]. Doxorubicin, ifosfamide, gemcitabine, or taxotere are effective in controlling progression, however, they are not effective at curing metastatic disease [ 19 ].…”