Follow-up

The goal of follow up is the early detection of local recurrence and metastasis. Currently there are not published data from randomized trials that can lead the clinicians on the choice of the more appropriate laboratory test and imaging examinations for STS patients, follow up is still based on the experience of specialized medical center.
The risk of relapse of STS (low, intermediate and high grade) is defined by the pathologist based on differentiation, size and location of the tumor. The histological grade of malignity influence the rate of relapse and the time to relapse.
High risk patients usually relapse within 2-3 years from the end of the treatment. For low risk patients relapse is a less likely event and it generally happens later. Italians, European and American guidelines suggest that the follow up program should last 10 years from the treatment, with different schedules for low, intermediate and high grade STS. Whereas guidelines agree on the timing of follow up, it remains still controversial what are the optimal test to detect a relapse. The Italian Association of Medical Oncology (AIOM) suggest a clinical and instrumental examination as it follows:

• Low-grade STS : every 4-6 months for 5 years, then every 12 months for 5 more years;

• High-grade STS: every 3 months for 2 years, then every 4-6 months for 3 years, and every 12 months for 5 more years.

Suggested instrumental test are US and/or CT scan and/or NMRI for the abdominal area. To study the lungs, a chest X-Ray or a CT scan are recommended.

The European Society of Mediacl Oncology (ESMO) suggest a clinical and instrumental examination as it follows:

• Low-grade STS : every 4-6 months for 3 to 5 years, then every 12 months till the 10th year after surgery;

• High-intermediate grade STS: every 3-4 months for 2 to 3 years, then every 6 months till the fifth year after surgery, and every 12 months for 5 more years.
Suggested instrumental test are NMRI for dectection of local recurrence, and CT scan for lung metastasis detection.
The NCCN (National Comprehensive Cancer Center) guidelines suggest:

• Low-grade STS : every 3-6 months for 2 to 3 years, then every 12 months till the 10th year after surgery;

• High-intermediate grade STS: every 3-6 months for 2 to 3 years, then every 6 months till the fifth year after surgery, and every 12 months for 5 more years.

For STS of arms, legs and trunk the American guidelines recommend a clinical examination of the area where the tumor first arise, and to request instrumental test (US, NMRI, CT) only in selected cases. For the early diagnosis of lung metastasis a chest X-ray or a CT scan is recommended. For STS of the retroperitoneum a full body CT scan is recommended for local relapse detection and metastasis detection.