Optimization of the Therapeutic Approach to Patients with Sarcoma: Delphi Consensus
Table 4
Recommendations for metastasis surgery.
Recommendation
Phase
Type of consensus (% agreement)
Patients with advanced sarcoma should be managed at centers with a multidisciplinary team (radiologists, pathologists, surgeons/traumatologists, medical and radiation oncologists, psychologists, and physiotherapists) specializing in sarcoma treatment
1
Yes (100)
Primary tumor surgery should always be considered for patients with ECOG ≤2 who have resectable soft tissue sarcoma and multiple asymptomatic pulmonary metastases
1
Yes (mode: 50%)
Palliative surgery for metastases may be an option for patients with advanced sarcoma who are progressing on systemic treatment and who have symptomatic metastases
2
Yes (68.8)
The most reliable local treatment options for oligometastatic disease are as follows:
(i) Surgery
1
Yes (80)
(ii) Stereotactic body radiation therapy (SBRT)
2
Yes (87.5)
For the purpose of preventing symptoms or complications, palliative surgery for metastases from sarcoma should always be performed as long as it will be effective for palliation
2
Yes (mode: 85%)
Inclusion in a clinical trial should be considered for all patients with pulmonary metastases from STS when palliative treatment may be an option and it proves impossible to achieve an R0 resection
1
Yes (95)
Pulmonary metastasectomy should only be considered when the pulmonary metastases, whether unilateral or bilateral, are resectable, and always taking into account the following factors:
