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