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1、Version 4 2019 09 12 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Soft Tissue Sarcoma Version
2、 4 2019 September 12 2019 Continue NCCN org NCCN Guidelines for Patients www nccn org patients NCCN Guidelines Version 4 2019 Soft Tissue Sarcoma Version 4 2019 09 12 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in
3、 any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Medical oncology Hematology Hematologic oncology Surgery Surgical oncology Orthopedics Orthopedic oncology Pathology Bone marrow transplantation Internal medicine Pediatric oncology Radiothera
4、py Radiation oncology Discussion writing committee member Margaret von Mehren MD Chair Fox Chase Cancer Center John M Kane III MD Vice Chair Roswell Park Comprehensive Cancer Center Robert S Benjamin MD The University of Texas MD Anderson Cancer Center Marilyn M Bui MD PhD Moffitt Cancer Center Edwi
5、n Choy MD PhD Massachusetts General Hospital Cancer Center Kristen N Ganjoo MD Stanford Cancer Institute Suzanne George MD Dana Farber Brigham and Women s Cancer Center Ricardo J Gonzalez MD Moffitt Cancer Center Martin J Heslin MD O Neal Comprehensive Cancer Center at UAB Vicki Keedy MD Vanderbilt
6、Ingram Cancer Center Ciara M Kelly MD Memorial Sloan Kettering Cancer Center Edward Kim MD Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance David Liebner MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Martin McCarter MD
7、 University of Colorado Cancer Center Sean V McGarry MD Fred October 12 23 2018 Oral Presentation is a new reference corresponding to entrectinib Printed by Maria Chen on 9 15 2019 11 36 34 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network In
8、c All Rights Reserved NCCN Guidelines Version 4 2019 Soft Tissue Sarcoma Version 4 2019 09 12 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines
9、Index Table of Contents Discussion EXTSARC 3 Primary Treatment 5th column modified Consider RT boost adjuvant chemotherapy Footnote Footnote s Patients with stage III tumors with lymph node involvement should undergo regional lymph node dissection at the time of primary tumor resection RT has been r
10、emoved from this page because stage III no longer includes lymph node involvement for extremity sarcomas Footnote y has been deleted For residual gross disease or microscopically positive margins EXTSARC 4 This page has been extensively modified EXTSARC 5 Primary Treatment Modified 2nd bullet chemot
11、herapy has been added to Stereotactic body radiation therapy SBRT Also for EXTSARC 6 Footnotes A corresponding footnote bb has been added to Metastasectomy Metastasectomy is the historical standard for patients with oligometastatic disease and is preferred if feasible the choice of local control mod
12、ality may depend on factors such as performance status patient preference lesion location accessibility ability to preserve normal tissue function and anticipated morbidity of a treatment modality Also for EXTSARC 6 Footnote aa modified Patients with stage III tumors with lymph node involvement incl
13、uding isolated regional nodal metastastic disease should undergo regional lymph node dissection at the time of primary tumor resection RT Also for EXTSARC 6 RETSARC 1 Work Up The following bullets have been modified or deleted Deleted Biopsy is necessary for patients receiving preoperative RT or che
14、motherapy Modified Image guided core needle biopsy should be performed if preoperative therapy is being given or for suspicion of malignancy other than sarcoma is preferred over open surgical biopsy Modified Preresection biopsy is not necessarily required for well differentiated liposarcoma consider
15、 biopsy if there is suspicion of malignancies other than sarcoma Footnotes Footnote b has been deleted See Principles of Pathologic Assessment of Sarcoma Specimens SARC B RETSARC 3 Postoperative Treatment For R2 surgical outcomes modified the following Consider re resection if technically feasible f
16、or low grade disease or well differentiated liposarcoma GIST 1 Heading changed from Workup at Primary Presentation to Mass Suspicious for GIST Results of Initial Diagnostic Evaluation This section has been extensively modified GIST 6 Postoperative Treatment Top pathway now sends the reader to GIST A for risk assessment GIST 7 Treatment for Progressive Disease Bottom pathway Added If progression on sunitinib then regorafinib category 1 after change to sunitinib 4th column modified If disease is p
