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Radiation Oncology/Sarcoma/Staging

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Sarcoma Staging

AJCC 7th Edition (2009)
Primary Tumor:

  • T1 - less than or equal to 5cm
    • T1a - superficial
    • T1b - deep
  • T2 - greater than 5cm
    • T2a - superficial
    • T2b - deep

Regional Lymph Nodes:

  • N0 - no
  • N1 - yes

Distant Metastases:

  • M0 - none
  • M1 - yes

Grade:

  • AJCC now recommends a three-tier system. The FNCLCC (French) system is the preferred grading system.
  • The grade is determined by three parameters:
    • Differentiation
    • Mitotic activity
    • Extent of necrosis


Stage Grouping:

  • IA - T1a/b N0 G1 - low grade (grade 1), small
  • IB - T2a/b N0 G1 - low grade (grade 1), large
  • IIA - T1a/b N0 G2-3 - mod/high grade (grade 2-3), small
  • IIB - T2a/b N0 G2 - mod grade (grade 2), large
  • III - T2a/b G3, or N1 - high grade (grade 3), large; or node positive
  • IV - M1 - metastatic


Changes from AJCC 6th Edition:

  • Now incorporates a three-tiered grading system. For staging, there is now a distinction between G2 and G3, at least for tumors >5 cm.
  • N1 is now Stage III instead of Stage IV
  • Stage I is divided into IA and IB. Stage II is divided into IIA and IIB.
  • Deep or superficial location of tumor no longer is a factor in overall stage

Notes:

  • This staging system does not apply to Kaposi's sarcoma, GIST (is now staged with its own classification), fibromatosis (desmoid tumor), and infantile fibrosarcoma; does not apply to sarcomas arising in the dura mater or brain, parenchymal organs, and hollow viscera.
  • Now includes dermatofibrosarcoma protuberans (which was previously excluded), angiosarcoma, and extraskeletal Ewing's sarcoma
  • Superficial - located entirely in the subcutaneous tissues without any degree of any involvement of the muscular fascia or underlying muscle


Older systems

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AJCC 6th Edition (2002)

  • T1 - less than or equal to 5cm
    • T1a - superficial
    • T1b - deep
  • T2 - greater than 5cm
    • T2a - superficial
    • T2b - deep

Stage Grouping:

  • Stage I - All low grade, N0, M0
  • Stage II - T1a/b-T2a, N0, high grade
  • Stage III - T2b, N0, high grade
  • Stage IV - N1 or M1, any grade

Note:

  • Excludes dermatofibrosarcoma protuberans. Also excludes Kaposi's, fibromatosis (desmoid tumor), sarcoma arising from dura mater, brain, parenchymal organs, and hollow viscera.


AJCC 5th Edition (1997)

  • Stage IA - low grade, small
  • Stage IB - low grade, large and superficial
  • Stage IIA - low grade, large and deep
  • Stage IIB - high grade, small and deep
  • Stage IIC - high grade, large, superficial
  • Stage III - high grade, large, deep
  • Stage IV - positive nodes or distant mets


AJCC 1st edition (1975-77)

  • T3 is bone, major nerve, or vessel involvement
  • Stage I - all grade 1
  • Stage II - all grade 2
  • Stage III - all grade 3, or T3