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