5df1af448fda258e8c3481eb45e98ea8 328237.pdf a5525374015ca386f6bf770e1b2626d528677aac 328237.pdf fe73d3269b1f41cd672c5ed35b5bc9702bb8ca1ef822f256b060fbffc19b8319 328237.pdf Title: Diagnosis and Therapy of Soft Tissue Sarcomas: Spanish Group for Research in Sarcomas (GEIS) Guidelines Subject: Soft tissue sarcomas (STSs) are a rare and highly heterogeneous group of tumours originating from mesenchymal cells, characterized by significant clinical and biological diversity. Due to this complexity, STSs present considerable challenges in both diagnosis and treatment, requiring an expert, multidisciplinary, and coordinated approach. To address these challenges, a multidisciplinary team of experts from the Spanish Group for Research in Sarcomas (GEIS) has developed a comprehensive, evidence-based consensus guideline that incorporates the latest advancements in biology, imaging techniques, and treatment options. The primary objective of this guideline is to provide clear and practical, up-to-date recommendations addressing the key questions that arise in the management of STSs. This approach aims to support therapeutic decision-making, enhance overall patient management, and ultimately improve clinical outcomes for patients affected by STSs. Key recommendations include the use of MRI as the preferred imaging modality prior to biopsy and ensuring that all patients are referred to specialised sarcoma centres with a multidisciplinary team for diagnosis and treatment. Keywords: soft tissue sarcoma; clinical guidelines; sarcoma multidisciplinary therapy Author: Maria Angeles Vaz-Salgado, Claudia Valverde-Morales, Rosa Alvarez, Jose Manuel Asencio, Erica Collado, Enrique de Alava, Roberto Diaz Beveridge, M. Carmen Gómez-Mateo, Isidro Gracia Alegria, Gloria Marquina, Javier Martin Broto, Javier Martínez-Trufero, José Antonio Narváez, Andres Redondo, Ana Sebio, Ramona Verges, Joan Maria Viñals and Xavier García del Muro Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Sat Oct 11 09:23:12 2025 CEST ModDate: Sat Oct 11 09:28:15 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 29 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 424468 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ZCFXLP+VnURWPalladioL Type 1 Custom yes yes yes 203 0 EHHGTS+URWPalladioL-Bold Type 1 Custom yes yes yes 204 0 DVAXIL+URWPalladioL-Roma Type 1 Custom yes yes yes 205 0 ERGZUW+URWPalladioL-Ital Type 1 Custom yes yes yes 206 0 BMCMOQ+CMSY10 Type 1 Builtin yes yes yes 263 0 WPQCLC+wasy10 Type 1 Builtin yes yes yes 333 0 MKDWFJ+EURM10 Type 1 Builtin yes yes yes 918 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-05-13 04:13:59 CEST RepresentationInformation: 328237.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-05-12 12:59:42 CEST Size: 424468 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 1005 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Methodology Item: Title: Recommendations Children: Item: Title: Section 1: Diagnostic Approach Children: Item: Title: Question: What Are the Key Warning Signs to Rule out Sarcomas, and How Should We Proceed? Item: Title: Question: What Imaging Studies Should Be Performed When an STS Is Suspected? Item: Title: Question: What Essential Data Should Be Included in the MRI Report? Item: Title: Question: Which Modality of Biopsy Should Be Performed? Item: Title: Question: What Essential Information Should the Pathological Report Include for Diagnostic Biopsies and Surgical Resection Specimens? Item: Title: Question: When Should Molecular Studies and NGS/High-Throughput Molecular Technologies Be Performed? Item: Title: Question: What Is the Recommended Approach for Staging STSs? Item: Title: Section 2: Treatment of Localized Disease Children: Item: Title: Question: What Is the Appropriate Surgical Procedure for a Patient with a Localized STS? Item: Title: Question: In Which Cases Is Limb Amputation Indicated? Item: Title: Question: What Reconstructive Procedures Are Used in Sarcoma Surgery and in Which Cases? Item: Title: Question: In Which Cases Should Perioperative Radiotherapy (RT) Be Administered, and What Is the Preferred Timing (Preoperative or Postoperative) and Dosage? Item: Title: Question: When Should Neoadjuvant Chemotherapy Be Administered? What Is the Recommended Regimen, and How Can It Be Combined with RT? Item: Title: Question: When Should Adjuvant Chemotherapy Be Administered? What Is the Recommended Schedule? How Should Postoperative Chemotherapy and Radiation Be Combined? Item: Title: Question: How Do We Treat an Isolated Local Relapse? Item: Title: Question: How Should Patients with STSs Be Followed After Their Primary Tumour Treatment? Item: Title: Section 3: Management of Metastatic Disease Children: Item: Title: Question: When Should Surgery Be Considered for Metastatic Patients? Should It Be Combined with Systemic Treatment? Item: Title: Question: What Is the Role of Stereotactic Body Radiotherapy (SBRT) in Metastatic STSs? Item: Title: Question: What Is the Role of Ablative Focal Treatments Like Cryotherapy and Radiofrequency in Advanced/Metastatic Disease? Item: Title: Question: What Is the Best First-Line Option for Metastatic Patients Who Are Not Candidates to Surgery? Item: Title: Question: What Are the Alternative First-Line Therapies for Patients Who Are Not Eligible for Anthracyclines? Item: Title: Question: What Systemic Treatment Options Are Available for Advanced STS Patients in the Second and Subsequent Lines? In Which Cases and at What Point Should Each Option Be Administered? Item: Title: Question: Is There Any Role for Immunotherapy in STSs? Item: Title: Section 4: Therapeutic Considerations for Specific Subtypes of STSs Children: Item: Title: Question: What Are the Diagnostic and Therapeutic Peculiarities of Retroperitoneal Sarcomas (RPSs)? Item: Title: Question: What Is the Recommended Treatment for Desmoid Tumours? Item: Title: Question: Which Peculiarities Does the Treatment of Gynaecological Sarcomas Have? Item: Title: Question: What Sarcoma Pathological/Molecular Histotypes Require a Specific Approach? Item: Title: Conclusions Item: Title: References Info: Title: Diagnosis and Therapy of Soft Tissue Sarcomas: Spanish Group for Research in Sarcomas (GEIS) Guidelines Author: Maria Angeles Vaz-Salgado, Claudia Valverde-Morales, Rosa Alvarez, Jose Manuel Asencio, Erica Collado, Enrique de Alava, Roberto Diaz Beveridge, M. Carmen Gómez-Mateo, Isidro Gracia Alegria, Gloria Marquina, Javier Martin Broto, Javier Martínez-Trufero, José Antonio Narváez, Andres Redondo, Ana Sebio, Ramona Verges, Joan Maria Viñals and Xavier García del Muro Subject: Soft tissue sarcomas (STSs) are a rare and highly heterogeneous group of tumours originating from mesenchymal cells, characterized by significant clinical and biological diversity. Due to this complexity, STSs present considerable challenges in both diagnosis and treatment, requiring an expert, multidisciplinary, and coordinated approach. To address these challenges, a multidisciplinary team of experts from the Spanish Group for Research in Sarcomas (GEIS) has developed a comprehensive, evidence-based consensus guideline that incorporates the latest advancements in biology, imaging techniques, and treatment options. The primary objective of this guideline is to provide clear and practical, up-to-date recommendations addressing the key questions that arise in the management of STSs. This approach aims to support therapeutic decision-making, enhance overall patient management, and ultimately improve clinical outcomes for patients affected by STSs. Key recommendations include the use of MRI as the preferred imaging modality prior to biopsy and ensuring that all patients are referred to specialised sarcoma centres with a multidisciplinary team for diagnosis and treatment. 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