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Current Oncology
Volume 20
Issue 3
10.3747/co.20.1308
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline

by
R. Kandel
1,*,
N. Coakley
2,
J. Werier
3,
J. Engel
4,
M. Ghert
5,
S. Verma
6 and
the Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care
1
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
2
Cancer Care Ontario, Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON, Canada
3
Department of Surgery, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
4
Department of Surgery and Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
5
Department of Orthopedic Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
6
Department of Medical Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2013, 20(3), 247-254; https://doi.org/10.3747/co.20.1308
Submission received: 2 March 2013 / Revised: 3 April 2013 / Accepted: 4 May 2013 / Published: 1 June 2013

Abstract

Background: Surgery is the primary treatment for extremity STS. The combination of radiotherapy with surgery allows for limb salvage by using radiation to biologically “sterilize” microscopic extensions of tumour and to spare neurovascular and osseous structures. Adjuvant chemotherapy in STS—except for rhabdomyosarcoma and Ewing sarcoma—continues to be controversial. Methods: The MEDLINE and EMBASE databases (1975 to June 2011) and the Cochrane Library were searched for pertinent studies. The Web sites of the main guideline organizations and the American Society of Clinical Oncology conference proceedings (2007–2010) were also searched. Results and Conclusions: Thirty-three papers, including four guidelines, one protocol, and one abstract, were eligible for inclusion. The data suggest that patients with clear margins have a better prognosis, but no prospective studies have indicated how wide margins should be. In limb-salvage surgery for extremity STS, the procedure should be planned to achieve a clear margin. However, to preserve functionality, surgery may result in a very close (<1 cm) or even microscopically positive margin. In this circumstance, the use of preoperative or postoperative radiation should be considered. No studies described the optimal number of tissue sections required to assess adequacy of excision nor the appropriate handling of surgical resection specimens. The Sarcoma Disease Site Group made its recommendations based on expert opinion and consensus.
Keywords: clinical practice guideline; handling; soft-tissue sarcoma; extremity; surgical margins; systematic review clinical practice guideline; handling; soft-tissue sarcoma; extremity; surgical margins; systematic review

Share and Cite

MDPI and ACS Style

Kandel, R.; Coakley, N.; Werier, J.; Engel, J.; Ghert, M.; Verma, S.; , the Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline. Curr. Oncol. 2013, 20, 247-254. https://doi.org/10.3747/co.20.1308

AMA Style

Kandel R, Coakley N, Werier J, Engel J, Ghert M, Verma S, the Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline. Current Oncology. 2013; 20(3):247-254. https://doi.org/10.3747/co.20.1308

Chicago/Turabian Style

Kandel, R., N. Coakley, J. Werier, J. Engel, M. Ghert, S. Verma, and the Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. 2013. "Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline" Current Oncology 20, no. 3: 247-254. https://doi.org/10.3747/co.20.1308

APA Style

Kandel, R., Coakley, N., Werier, J., Engel, J., Ghert, M., Verma, S., & , the Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. (2013). Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline. Current Oncology, 20(3), 247-254. https://doi.org/10.3747/co.20.1308

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