Nonrhabdomyosarcoma Soft Tissue Sarcomas Follow-up

Updated: Mar 27, 2015
  • Author: Justine K Walker, MD; Chief Editor: Robert J Arceci, MD, PhD  more...
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Follow-up

Further Outpatient Care

Frequent outpatient visits are required to monitor the effects and adverse effects of therapy. CBC counts should be assessed once or twice a week while patients are receiving granulocyte-colony stimulating factor (G-CSF) therapy. Periodically monitoring the toxic effects of chemotherapy on liver and renal function is required with serum chemistry levels. Supportive treatment with blood products, including packed RBCs and platelets, may be necessary if patients are given chemotherapy

Long-term follow-up is required after therapy is completed to monitor the following:

  • Disease recurrence
  • Development of a secondary malignancy, particularly if the patient received radiation therapy and/or chemotherapy with etoposide
  • Growth and development
  • Cardiac function in children who received anthracycline chemotherapy (Perform annual ECG and echocardiography.)
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Further Inpatient Care

Inpatient care of patients with nonrhabdomyosarcoma soft tissue sarcomas (NRSTS) involves admissions for chemotherapy and for supportive care related to therapy.

Patients must be hospitalized to manage episodes of fever and neutropenia and to start broad-spectrum antibiotic coverage while culture results or recovery from illness are awaited.

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Complications

The long-term effects of NRSTS treatment in children are many.

Surgical treatments may cause marked permanent functional deficits, depending on the location and extent of surgery.

The use of chemotherapy has been associated with numerous late effects. Doxorubicin can cause life-threatening cardiomyopathy. Ifosfamide can cause permanent renal impairment, hemorrhagic cystitis, infertility, gonadal failure, and an increased risk of secondary malignancies. Radiation therapy can also have lifelong debilitating effects. The effects of radiation depend on the location irradiated and the amount of radiation given to the site. Common effects can include growth plate arrest, pulmonary fibrosis, development of muscle fibrosis and contractures, and development of a secondary cancer in the radiation field.

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Prognosis

Prognostic factors for children with NRSTS include the presence of metastatic disease, ability to achieve local control, tumor size and invasiveness, and tumor histologic grade.

According to IRS groups, survival rates are as follows:

  • Group I - 82%
  • Group II - 67%
  • Group III - 12%
  • Group IV - 5

Tumor, node, and metastases (TNM) stage 4 ( the presence of metastasis) correlates with an extremely poor prognosis of (< 20%).

Many factors contribute to survival, but the degree of resectability at the time of diagnosis is the most important factor identified to date.

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