e., around the shoulder), and risk of radiation injury to nerves that are in direct contact with the BT catheters.

A group of practitioners with expertise and experience in sarcoma BT were appointed by the American Brachytherapy Society (ABS) Board of Directors to provide a consensus statement for the use of BT in STS. The previously published ABS guidelines were updated with a literature search, and the experts view on the state of the art was formulated. The evidence supporting BT as a component of the multidisciplinary management of sarcoma is described. Recommendations are made on radiation techniques and doses, and the expected tumor Selleck ZD6474 control and complication rates are provided. This consensus statement was submitted to the ABS Board of Directors for approval before publication. Ideally, patients should be evaluated by a multidisciplinary sarcoma team, which Saracatinib clinical trial includes surgical, radiation and medical oncologists, radiologists, and pathologists with knowledge and experience in the management of sarcomas. Preoperative staging evaluations include careful examination of the affected body site for extent of disease and the functional status of the affected body structure followed by imaging of the tumor with MRI for pelvic, extremity, and truncal lesions and CT for abdominal and retroperitoneal lesions to determine FER the

radiologic extent of disease. Preoperative imaging delineates the gross disease and associated tissue edema, and it may reveal invasion into surrounding structures.

Identification of the relationship of the lesion to adjacent critical structures, such as bone, nerves, and blood vessels, can be used to plan the extent and nature of the surgery. It is equally important to consider whether skin, soft tissue, bone, or vascular grafting will be required to repair the surgical defect. Chest CT should be obtained to rule out lung metastasis, which is the most common site of distant spread; patients with low-grade T1 lesions can be adequately staged with a chest X-ray. CT of the abdomen and pelvis may be valuable for patients with extremity or truncal liposarcoma, epithelioid sarcoma, angiosarcoma, or leiomyosarcoma, which have a higher rate of extrapulmonary spread (11). PET/CT may be useful for histologies with a predilection for nodal metastases, including clear cell sarcoma, angiosarcoma, rhabdomyosarcoma, epithelioid sarcoma, and synovial sarcoma. MRI of the spine for patients with myxoid liposarcoma can also be considered (12). Detection of lung metastasis should prompt consideration of chemotherapy and possibly surgical resection depending on the number, location, size, and rapidity of progression [13], [14] and [15]. Metastectomy for non-pulmonary metastasis has also been reported [16], [17] and [18].