Ongoing collaborative projects Prospective for collaborative projects Kirsten Sundby Hall

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

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

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

4. www.ssg-org.net

5. Current thesis projects based on SSG registry LeiomyosarcomaC. Svarvar, Helsinki LiposarcomaK. Engström, Gothenburg ChondrosarcomaB. Widhe, Stockholm OsteosarcomaC. Müller, Oslo Quality of lifeL. H. Aksnes, Oslo Skeletal metastasesB. H. Hansen, Århus Radiation therapy and local recurrence in STSN. 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 II Combination therapy in OS 1982 – 1990 SSG VIII Therapy of OS 1990 – 1998 ISG/SSG I An Italian-Scandinavian treatment and 1997 – 2000 research protocol for high-grade osteosarcoma of the extremities ISG/SSG II Treatment of metastatic and pelvic 1998 – 2003 osteosarcoma SSG XIV A Scandinavian treatment research 2000 – 2004 protocol for extemity localized high- grade osteosarcoma Euroboss I A European treatment protocol for bone 2003 sarcoma in patients older than 40 years Euramos I An American/European treatment protocol 2004 for OS in patients <40 years www.ssg-org.net

9. Pan-European/American CooperationEURAMOS SSG COG EOI COSS

10. EURAMOSTreatment outline A M P IF-maintenance Good response Poor response A M P Ra n d A M P A M P A M P + IE www.ssg-org.net / www.euramos.org

11. Current status of SSG contribution to EURAMOS I Total of registered patients 18 Total of randomized patients 13 30/9 2006

12. Ewing´s sarcoma SSG IV Combined modality therapy in EWS 1984 – 90 SSG IX Therapy of EWS 1990 – 99 ISG/SSG III ISG/SSG treatment protocol for 1999 non-metastatic EWS ISG/SSG IV ISG/SSG treatment protocol for 1999 high-risk EWS www.ssg-org.net

13. SSG/AIO (SSG XVIII) Adjuvant study for high-risk GIST R A N D O M I Z E Arm 1 Imatinib Follow-up 12 months 48 months Imatinib Follow-up 36 months 24 months Arm 2 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. www.ssg-org.net

14. SSG XVIII SSG/AIO – adjuvant study for high risk GISTParticipating hospitals SSG Country Hospital Responsible physician Finland Helsinki Heikki Joensuu Pikonlinna Tuula Lehtinen Oulu Raija Kallio Turku Paula Lindholm Norway Bergen Odd Monge Oslo Kirsten Sundby Hall Tromsø Eivind Smeland Trondheim Ragnhild Klepp Sweden Gothenburg Håkan Ahlman Linköping Najme Wall Lund Mikael Eriksson Stockholm Jonas Bergh Uppsala Ingela Turesson AOI Country Hospital Responsible physician Germany Berlin Peter Reichardt Düsseldorf Hans Joachim Schütte Essen Peter Eberling Frankfurt Elke Jaeger Göttingen Giuliano Ramadori Mannheim Peter Hohenberger München Thomas Licht Tübingen Joerg Thomas Hartmann Number of randomizedpatients 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. (Opened 1998-closed 31.12.05) • * 2 or 3 risk (SIN) factors • Size>8cm • Presence of necrosis • Presence of vascular invasion

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

19. Group ASSG 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/m2 as 4 hours infusion Ifosfamide: 2g/m2 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 carriesan 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/m2 as 4 hours infusion Ifosfamide: 2g/m2 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