<b>Extremity</b>

A good complete physical exam and an initial CT scan of chest and abdomen/pelvis would be wise to rule out the possibility that this tumor is actually a metastasis from a primary at another site.

Extremity LMS can recur locally, and can metastasize to the lungs.  
<b>The SARCOMA ONCOLOGIST who is following you should be the actual expert on the most current and cost effective care for you, as are the NCCN guidelines. </b>  

The usual intervals of three monthly for two years then six monthly for the next three years then yearly would generally also apply.  Attention paid would be interim history, physical exam, and chest X-ray at each appointment.  A yearly scan of the primary site is still recommended.  However, CT scans of chest, and/or MRI scans of extremity, might be laid on should there be any question of abnormality or symptoms.

See the quote below, which is Roswell Park's experience:

"We reviewed the effectiveness of a surveillance program for primary extremity STS in an effort to provide an evidence-based rationale for follow-up of STS. We concluded that clinical assessment of patient symptoms, chest X-ray imaging, and physical examination are effective strategies for follow-up of extremity STS."
"Chest X-ray imaging also appears to be cost-effective, at least for high-grade extremity STS. Imaging of the primary extremity site by computed tomography (CT) scan or magnetic resonance imaging (MRI) on an annual basis and routine laboratory blood tests were ineffective strategies for recurrence detection. However, certain patient characteristics such as body habitus, previous radiation therapy, and location of the primary tumor site may require the use of CT scans and MRI for adequate clinical assessment." [1]



And MD Anderson's Experience:

Cost-effectiveness of staging computed tomography of the chest in patients with T2 soft tissue sarcomas

"Six hundred consecutive patients with primary, nonthoracic, T2 (> 5 cm) STS underwent both chest X-ray (CXR) and chest CT scanning to evaluate the presence of pulmonary metastatic disease (M1). The authors constructed a decision tree that modeled the outcomes of diagnostic testing for two hypothetical diagnostic strategies: 1) routine chest CT (rCT) or 2) CXR and selective chest CT (sCT). " [2]

"For patients with T2 STS, ROUTINE Chest CT scan was most cost-effective in patients with high-grade lesions or extremity lesions. The findings of this study do not support the routine use of chest CT scanning in all patients with T2 STS." [2]

______________________________________

1. Semin. Surg. Oncol. 17:83-87, 1999.
[Effective follow-up strategies in soft tissue sarcoma. 
(Special Issue: Soft Tissue Sarcoma . Issue Edited by Raphael E. Pollock.) Published Online: 30 Jun 1999
Copyright (c) 1999 Wiley-Liss, Inc.          Online ISSN: 1098-2388    Print ISSN: 8756-0437
 email: William G. Kraybill (kraybill@sc3103.med.buffalo.edu)
*Correspondence to William G. Kraybill, Chief of Soft Tissue-Melanoma and Bone 
Department, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 
14263

2. Cancer 2002;94:197-204. (c) 2002 American Cancer Society.
 Cost-effectiveness of staging computed tomography of the chest in patients
with T2 soft tissue sarcomas
Geoffrey A. Porter, M.D. 1, Scott B. Cantor, Ph.D. 1, Syed A. Ahmad, M.D., et.al.
Multidisciplinary Sarcoma Center, The University of Texas M. D. Anderson
Cancer Center, Houston, Texas
email: Peter W. T. Pisters (ppisters@mdanderson.org)
*Correspondence to Peter W. T. Pisters, Department of Surgical Oncology, Box
444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe
Boulevard, Houston, TX 77030-4009
Conference: 36th American Society of Clinical Oncology, Louisiana, 20 May
2000 to 23 May 2000.

