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Staging of soft tissue sarcoma, Ewing sarcoma, and osteosarcoma involves MRI of the primary tumor, computed tomography of the chest, and, in the case of Ewing Sarcoma and rhabdomyosarcoma, evaluation of the bone marrow. FDG PET imaging, when available, is replacing technetium bone scanning for evaluation of metastatic disease in sarcomas and is being investigated to determine response to treatment and prognosis. Staging and risk assignment for rhabdomyosarcoma (RMS) have undergone significant evolution since the original description of the clinical group assignment and modified TNM system. The next generation of RMS studies in the Children’s Oncology Group will use fusion status instead of histologic determination for treatment assignment. For selected low-risk patients, some staging studies can be omitted. There remain some differences in risk and treatment assignment between the European Pediatric Soft Tissue Sarcoma Group and the Children’s Oncology Group. |
