1. Ongoing collaborative projects Prospective for collaborative projects Kirsten Sundby Hall Oslo CTOS 4. Nov - 06

2. Orthopedic Surgery Viseral and Retroperitoneal Surgery RadiotherapyChemotherapy Skeletal metastasis Morphology (Pathology and Cytology) Tumorbiology Diagnostic Radiology and Nuclear medicine Scandinavian Sarcoma Group (SSG) Organization – Subcommittees www.ssg-org.net 2 Chairmen2 Vice chairmen1 Secretary1 Vice secretary 1 Publication ombudsman Meeting once a year Working committee groups meeting once a year Central Register Secretariat Oncological Center LundSweden

3. SSG Registry 1986–2005: 8 126 patients All sarcoma centers in Sweden (6) and Norway (3) register patients, Finland (1) Population based for Norway and Sweden. Referral pattern, treatment, prognosis www.ssg-org.net

5. Current thesis projects based on SSG registry Leiomyosarcoma C. Svarvar, Helsinki Liposarcoma K. Engström, Gothenburg Chondrosarcoma B. Widhe, Stockholm Osteosarcoma C. Müller, Oslo Quality of life L. H. Aksnes, Oslo Skeletal metastases B. H. Hansen, Århus Radiation therapy and local recurrence in STS N. L. Jebsen, Bergen www.ssg-org.net

6. 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

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

8. Osteosarcoma SSG IICombination therapy in OS1982 – 1990 SSG VIIITherapy of OS1990 – 1998 ISG/SSG I An Italian-Scandinavian treatment and 1997 – 2000 research protocol for high-grade osteosarcoma of the extremities ISG/SSG IITreatment of metastatic and pelvic 1998 – 2003 osteosarcoma SSG XIVA Scandinavian treatment research2000 – 2004 protocol for extemity localized high- grade osteosarcoma Euroboss I A European treatment protocol for bone2003 sarcoma in patients older than 40 years Euramos IAn American/European treatment protocol2004 for OS in patients <40 years www.ssg-org.net

9. Pan-European/American Cooperation EURAMOS SSG COG EOI COSS

10. EURAMOS Treatment outline Good response Poor response A M P A M P + IE RandRand A M P IF-maintenance www.ssg-org.net / www.euramos.org

11. Current status of SSG contribution to EURAMOS I Total of registered patients 18 Total of randomized patients13 30/9 2006

12. Ewing´s sarcoma SSG IVCombined modality therapy in EWS1984 – 90 SSG IXTherapy of EWS1990 – 99 ISG/SSG IIIISG/SSG treatment protocol for 1999 non-metastatic EWS ISG/SSG IVISG/SSG treatment protocol for 1999 high-risk EWS www.ssg-org.net

13. RANDOMIZERANDOMIZE ImatinibFollow-up 12 months 48 months ImatinibFollow-up 36 months 24 months SSG/AIO (SSG XVIII) Adjuvant study for high-risk GIST Primary objective: To investigate the recurrence-free survival in GIST patients with a high (>50%) risk of disease recurrence within the first 5 years following the diagnosis and treated with adjuvant imatinib mesylate either for 12 or 36 months. Arm 1 Arm 2 www.ssg-org.net

14. SSG XVIII SSG/AIO – adjuvant study for high risk GIST Participating hospitals SSG CountryHospitalResponsible physician FinlandHelsinkiHeikki Joensuu PikonlinnaTuula Lehtinen OuluRaija Kallio TurkuPaula Lindholm NorwayBergenOdd Monge OsloKirsten Sundby Hall TromsøEivind Smeland TrondheimRagnhild Klepp SwedenGothenburgHåkan Ahlman LinköpingNajme Wall LundMikael Eriksson StockholmJonas Bergh UppsalaIngela Turesson AOI CountryHospitalResponsible physician GermanyBerlinPeter Reichardt DüsseldorfHans Joachim Schütte EssenPeter Eberling FrankfurtElke Jaeger GöttingenGiuliano Ramadori MannheimPeter Hohenberger MünchenThomas Licht TübingenJoerg Thomas Hartmann Number of randomized patients sept 30 2006: 222 www.ssg-org.net

15. SSGXX-a new adjuvant STS protocol 2007 “A Scandinavian Sarcoma Group (SSG) treatment protocol for adult patients with non-metastatic high-risk STS of the extremities and trunk wall”

16. * 2 or 3 risk (SIN) factors Size>8cm Presence of necrosis Presence of vascular invasion (Opened 1998-closed 31.12.05)

17. Introduction of a novel risk factor assessment Peripheral tumor growth pattern Infiltrative growth of a STS is a strong factor for both local recurrence and metastases

18. Vascular invasion Yes No Eligible in Group A 2 or 3 risk-factors - Size >8 cm - Infiltrative growth - Necrosis Yes No Not included in study Decision algoritm for adjuvant treatment in group A

19. Group A SSG XX Adjuvant therapy arm For high-risk STS in extremities and trunk wall with primary surgery Surgery Wide margin for subcutaneous tumors or radically amputated patients CT1 CT2 CT3 CT4 CT5 CT6 Max 12 weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 weeks Surgery Marginal, for all tumors, wide margin for deep tumors RT 36 Gy CT1 CT2 CT3 (1.8 x 2/d x 10d) CT4 CT5 CT6 Max 12 weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 weeks Surgery Intralesional margin, regardless of tumor depth RT 45Gy CT1 CT2 CT3 (1.8 x 2/d x 12.5d) CT4 CT5 CT6 Max 12 weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 weeks CT regimen Doxorubicin: 60mg/m 2 as 4 hours infusion Ifosfamide: 2g/m 2 as a 2 hours infusion (with Mesna) on 3 consecutive days G-CSF routinely

20. Group B SSG XX Preoperative therapy For high-risk STS in extremities and trunk wall when primary resection carries an obvious risk of an intralesional margin RT MR Surgery CT1 CT2 (1.8 x 2/d x 10d) CT3 CT4 CT5 CT6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 CT regimen Doxorubicin: 60 mg/m 2 as 4 hours infusion Ifosfamide: 2g/m 2 as a 2 hours infusion (with Mesna) on 3 consecutive days G-CSF routinely Surgery: 2.5 weeks after start of the third cycle. weeks

21. SSG policy - to continuously work for more international collaboration on treatment protocols and research www.ssg-org.net

22. End