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SSG - Scandinavian Sarcoma Group Kirsten Sundby
Hall Rikshospitalet-Radiumhospitalet Medical
Centre Oslo
www.ssg-org.net
NSGO 24th March, 2007
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Treatment protocols
Registration
Research
Total population 26 mill
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SSG Registry
Total population 26 mill

• 19862005 8 126 patients
• All sarcoma centers in Sweden (6) and
• Norway (3) register patients, Finland (1)
• Population based for Norway and Sweden.
• Referral pattern, treatment, prognosis

www.ssg-org.net
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www.ssg-org.net
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Current thesis projects based on SSG registry

• Leiomyosarcoma C. Svarvar, Helsinki
• Liposarcoma K. Engström, Gothenburg
• Chondrosarcoma B. Widhe, Stockholm
• OsteosarcomaC. Müller, Oslo
• Quality of life L. H. Aksnes, Oslo
• Skeletal metastases B. H. Hansen, Århus
• Radiation therapy and local recurrence in STS N.
  L. Jebsen, Bergen

www.ssg-org.net
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Pan-European/American CooperationEURAMOS
1-treatment protocol on osteosarcoma (2005)
SSG
COG
EOI
COSS
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Scandinavian-Italian treatment protocols on Ewing
sarcoma
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Scandinavian-German adjuvant study high-risk GIST
R A N D O M I Z E
Arm 1
Imatinib Follow-up 12 months 48
months Imatinib Follow-up 36 months 24
months
Arm 2
Primary objective To investigate the
recurrence-free survival in GIST patients with a
high (gt50) risk of disease recurrence within the
first 5 years following the diagnosis and treated
with adjuvant imatinib mesylate either for 12 or
36 months.
www.ssg-org.net
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SSG XX-a new adjuvant STS protocol 2007 A
Scandinavian Sarcoma Group (SSG) treatment
protocol for adult patients with non-metastatic
high-risk STS of the extremities and trunk
wall

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A treatment algorithm for histological high-grade
STS
2 or 3 risk-factors - Tumor size gt8 cm -
Infiltrative growth - Necrosis
No
Low-risk group - Not included in study
No
Vascular invasion
Yes
Yes
High-risk group eligible for adjuvant systemic
therapy
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Group ASSG XX Adjuvant therapy arm
For high-risk STS in extremities and trunk wall
with primary surgery

• Surgery
• Wide margin for subcutaneous tumors or radically
  amputated patients
• CT1 CT2
  CT3 CT4
  CT5 CT6
• Max 12 weeks
• 0 1 2 3 4
  5 6 7 8
  9 10 11 12 13
  14 15 16 weeks
• Surgery
• Marginal, for all tumors, wide margin for deep
  tumors
• RT 36 Gy
• CT1 CT2
  CT3 (1.8 x 2/d x 10d) CT4
  CT5
  CT6
• Max 12 weeks
• 0 1 2 3 4
  5 6 7 8
  9 10 11 12 13
  14 15 16 weeks
• Surgery

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Group B SSG XX Preoperative therapy
For high-risk STS in extremities and trunk wall
when primary resection carries an obvious risk of
an intralesional margin

• RT MR Surgery
  
• CT1 CT2 (1.8 x 2/d x 10d) CT3
  CT4
  CT5 CT6
• 0 1 2 3 4 5
  6 7 8 9 10 11
  12 13 14 15 16 17
  
• CT regimen
• Doxorubicin 60 mg/m2 as 4 hours infusion
• Ifosfamide 2g/m2 as a 2 hours infusion (with
  Mesna) on 3 consecutive days
• G-CSF routinely
• Surgery 2.5 weeks after start of the third
  cycle.

weeks
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• SSG and gynaecologic sarcomas?

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Guidelines for treatment of metastatic
soft-tissue sarcomas in adult patients

• Proposals for treatment
• With a curative intent
• With a palliative intent
• Chemotherapy-Surgery-Radiotherapy

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Guidelines for treatment of abdominal sarcomas

• Preoperative diagnosis and planning
  
  
• Surgery
• Chemotherapy, radiotherapy
• Follow-up
• Centralized management!

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SSG XVII Section 8.0 Centralized management

• In gynaecological sarcoma patients the need for
  centralised management is the same as for
  retroperitoneal tumours. Uterine sarcoma patients
  often undergo operations after none or
  insufficient primary diagnostic work up for a
  presumed clinical diagnosis of leiomyoma which is
  far more frequent than its sarcoma counterpart.
  Intralesional surgery, including open biopsies,
  enucleation of lesions, and debulking procedures,
  is frequently the case before patients are
  referred to centers of competence. This practice
  has to be strongly condemned. Closer co-operation
  between SSG and The Nordic Society of
  Gynecological Oncology (NSGO) will be necessary
  for improvement in diagnostic work-up and
  surgical treatment of these patients.

2002
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SSG XVII Section 6.0 Radiotherapy

• For gynaecological sarcomas, no studies so far
  have shown a benefit of either adjuvant
  radiotherapy or chemotherapy. Hence, the
  administration of adjuvant radiotherapy to
  patients with free resection margins outside
  randomised trials has been condemned by the
  Nordic Society of Gynaecological Oncology (NSGO)
  in this group of patients. A randomised trial on
  postoperative radiotherapy has recently been
  performed by the European Organisation of
  Research and Treatment of Cancer (EORTC), and
  patient accrual was terminated in May 2001. The
  NSGO has opted to await the results of that study
  before considering adjuvant radiation for
  gynaecological sarcomas within their confines.

2002
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• Skandinaviska arbetsgruppe for viscerale och
  retroperitoneala sarkom
• Gynaecologists
• Britta Nordström
• Gunnar B. Kristensen
• SSG meeting
• Bergen May 8-11th, 2007
• Registration www.ssg-org.net

To be reviced !
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SSG view

• Gynaecologic sarcomas should in principle be
  handled like sarcomas in other regions
• Proper diagnostic work-up permitting radical
  surgical treatment avoiding intralesional surgery
  
• Adjuvant chemotherapy/radiotherapy in the setting
  of multicenter studies

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Scandinavian Sarcoma Group (SSG)
Organization Subcommittees www.ssg-org.net
Orthopedic Surgery
Diagnostic Radiology and Nuclear medicine
Central Register Secretariat Oncological
Center Lund Sweden
Visceral and Retroperitoneal Surgery
Morphology (Pathology and Cytology)
Tumorbiology
Radiotherapy Chemotherapy
Skeletal metastasis
Gynaecologists!
2 Chairmen 2 Vice chairmen 1 Secretary 1 Vice
secretary 1 Publication ombudsman
Meeting once a year Working committee groups
meeting once a year
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• END