Radiation Oncology/Sarcoma/Staging

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

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