Radiation Oncology/Bone/Staging

Bone sarcoma staging

AJCC 7th Edition

 * Although the AJCC staging is not commonly used in practice, it is technically used for osteosarcoma, chondrosarcoma, Ewing's sarcoma, angiosarcoma, fibrosarcoma, MFH, chordoma, adamantinoma, and other sarcomas. *Excludes lymphoma of bone and multiple myeloma

Primary Tumor:
 * T1 - 8 cm or less in greatest dimension
 * T2 - >8 cm
 * T3 - discontinuous tumors in the primary bone site

Regional Lymph Nodes:
 * N0 - no
 * N1 - yes

Distant Metastases:
 * M0 - no
 * M1a - lung
 * M1b - other distant sites

Stage Grouping:
 * IA - T1 N0, Low grade
 * IB - T2 N0, Low grade; or T3 N0, Low grade
 * IIA - T1 N0, High grade
 * IIB - T2 N0, High grade
 * III - T3 N0, High grade
 * IVA - M1a
 * IVB - N1, M1b

Note: Ewing's sarcoma is classified as grade 4.

Change from AJCC 6th Edition:
 * T3 N0 Low Grade moved to IB (was Stage III for low or high grade)

AJCC Older Editions
AJCC 6th Edition (2002)
 * No changes in TNM compared to 7th edition
 * Difference in stage grouping:

Stage Grouping:
 * IA - T1 N0, Low grade
 * IB - T2 N0, Low grade
 * IIA - T1 N0, High grade
 * IIB - T2 N0, High grade
 * III - T3 N0
 * IVA - M1a
 * IVB - N1, M1b

Musculoskeletal Tumor Society (MSTS) Staging

 * IA - low grade, intracompartmental
 * IB - low grade, extracompartmental
 * IIA - high grade, intracompartmental
 * IIB - high grade, extracompartmental
 * III - regional or distant metastases