8 FOLLOW-UP


8.1 General principles and objectives

8.1.1
In disease free, adequately treated patients with low grade sarcomas, the physician will mainly have to look for signs of local relapse, and follow-up will need to be continued for at least ten years, given the slow natural history of these diseases.

8.1.2
In disease free, adequately treated patients with high grade sarcomas, the physician will have to search both for the local relapse and for a distant relapse to the lungs. Isolated relapses to the lungs can in fact be rescued in >20of completely resectable patients by means of surgery of lung metastases. The risk of distant metastases will be higher in the first two to five years, depending on the tumor grade. Follow-up of high grade sarcomas could therefore be shorter than low grade sarcomas, but they should be followed for at least five years.


8.2 Suggested protocols

8.2.1
In asymptomatic patients treated for low grade soft tissue sarcomas, physicial exam, and ultrasonography if physical exam is difficult, are used to detect local relapses. Routine clinical examinations and possibly ultrasonograms may therefore be carried out at six-month intervals or more. Chest X-rays can be done at wider intervals, given the low risk of systemic spread. Follow-up will need to be continued for at least ten years. The patient must be taught of the risk of a local relapse.

8.2.2
In asymptomatic patients treated for high grade soft tissue sarcomas, in addition to local clinical examination and, possibly, ultrasonograms, regular chest X-rays every 2-3 months for 2-3 years, and thereafter less frequently, may be recommended on a type R basis (8.2.I) in that lung relapse is asymptomatic and potentially curable.


References

8.2.I
Casali P, Licitra L, Bertulli R, Balzarini L, Laffranchi A, Mariani L, et al. Routine follow-up chest X-ray for high grade soft tissue sarcomas: a decision analytical approach. Ann Oncol 1994; 5(Suppl 8): 171.



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European School of Oncology, 1996

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