After initial treatment of sarcoma, disease progression may occur in the form of local recurrence, pulmonary metastases, or extrapulmonary metastases. As such, surveillance is an important aspect of management, but no universally accepted practice standards are found. In the absence of strong evidence, and to allow for individualized care, existing guidelines contain flexibility in terms of both the frequency and modality of surveillance. In general, they agree that follow-up should be more intense in the early years after treatment, especially for high-grade sarcomas, and continue for at least 10 years. For local recurrence, data suggest that physical examination is usually sufficient for monitoring; in addition, some guidelines endorse imaging routinely, whereas others only as clinically indicated. For pulmonary metastasis, either radiograph or CT is recommended, with the latter having theoretical advantages but no proven survival benefit to date. Extrapulmonary metastases are rare in most sarcoma types, so the literature only supports extrapulmonary surveillance for certain diagnoses. This topic is complicated by the diversity of sarcomas, the limited evidence, and the indefinite, often conflicting recommendations; therefore, it is critical for providers to understand the existing research and guidelines to determine optimal surveillance strategies for their patients.
From the Washington University in St Louis (Dr. Cipriano), St Louis, MO, and Columbia University Medical Center (Dr. Jang and Dr. Tyler), New York, NY.
None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cipriano, Dr. Jang and Dr. Tyler.