1. Clinical practice guidelines in sarcoma in Scandinavia On behalf of the Scandinavian Sarcoma Group (SSG) Kirsten Sundby Hall

2. Clinical guidelines SSG tradition: Current protocols define standard treatment in Scandinavia Clinical trials Treatment recommendations: SSG XVII, SSG XIX Registration : SSG VII, SSG XVI

3. 1986 – 2004: 6 908 patients All sarcoma centers in Sweden (5) and Norway (3) register patients, Finland 1 Population based for Norway and Sweden. Referral pattern, treatment, prognosis www.ssg-org.net SSG Registry

4. Guidelines for referral of soft-tissue tumors to tumor center Deep tumors of any size Subcutaneous tumors size > 5cm All other tumors supected of being malignant

5. Referral before biopsy % 1986-8958 1990-9458 1995-9963 2000-0373

6. Referral before biopsy % ScDeep 1986-893677 1990-944378 1995-994284 2000-035893 Improvement for both sc and deep located tumors!

7. Biopsy method before surgical treatment % None Cytology FNA True- cut Open 1986-99 973414 2000-03 364285 More than 1 type of biopsy: from 1% to 15%

8. Smeland, Stuttgart 2005

9. Increased use of radiotherapy % AllScDeep 1986-99 211124 2000-03 332444

10. Guidelines for referral of bone lesions to tumor center Lesions that can simulate bone tumors osteosarcoma GCT GCT with ABC

11. Referral before biopsy (bone lesions) % All bone 1986-9281 1993-0388

12. Biopsy method (bone lesions) % NoneCytology True- cut Open 1986-92 11142055 1993-03 5362435 More than 1 type of biopsy: from 8% to 13%

13. Guidelines for treatment of metastatic soft-tissue sarcomas in adult patients Proposals for treatment With a curative intent With a palliative intent Chemotherapy-Surgery-Radiotherapy

14. Guidelines for treatment of abdominal sarcomas Preoperative diagnosis and planning Surgery Chemotherapy, radiotherapy Follow-up Centralized management !

15. Concluding statement Guidelines for clinical practice should be continuously evaluated and revised according to register data subject to increasing international collaboration