Post-Treatment Surveillance Protocols for Sarcomas: Comparison of International Guidelines and Clinical Adherence

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All articles of this category (opens in new window) Address for correspondence Moisés de Sousa Veloso (moisesveloso10@gmail.com) Introduction: Sarcomas are rare and heterogeneous malignant tumors that require post-treatment surveillance for early detection of recurrences and metastases, which impacts prognosis. International guidelines present varied protocols in terms of frequency, duration, and follow-up methods. However, limited clinical adherence due to factors such as cost and accessibility can compromise the effectiveness of surveillance . Objective: To compare the main international post-treatment surveillance protocols for sarcomas and evaluate the levels of clinical adherence reported in the literature. Method: A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Embase, Scopus, and Web of Science databases up to July 2025. The descriptors included: “sarcomas,” “post-treatment surveillance,” “clinical guidelines,” “follow-up protocols,” “adherence,” and “treatment.” Studies addressing follow-up protocols for soft tissue and bone sarcomas, as well as clinical adherence data, were included. Quantitative studies were analyzed to extract odds ratios (OR), 95% confidence intervals (CI), and p-values related to adherence and protocol efficacy. Methodological quality was assessed using the ROBIS tool, and risk of bias was evaluated using the Newcastle-Ottawa scale . Results: Of 254 studies identified, 18 were included. Guidelines from NCCN, ESMO, NICE, and SIGN showed significant divergences: exam frequency ranged from quarterly to annual; the use of MRI versus CT varied according to anatomical site and tumor risk. Two studies showed that adequate protocol adherence reduced the risk of late recurrence (OR 0.62; CI 0.48–0.80; p<0.001). Clinical adherence ranged from 45% to 70%, impacted by financial barriers (OR 0.55; p=0.004), lack of patient awareness (p=0.01), and logistical difficulties. Non-adherence increased the risk of worse oncologic outcomes (OR 1.75; CI 1.20–2.56; p=0.003). Methodological heterogeneity and limited standardization of adherenceand outcome metrics were observed . Conclusion: Although multiple international protocols exist, heterogeneity among them and low clinical adherence compromise post-treatment surveillance in sarcomas. There is a need for standardization, educational programs, and facilitation of access to exams to improve clinical outcomes and survival. Publication History Article published online: 26 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil Bibliographical Record Moisés de Sousa Veloso, Gustavo Daniel dos Santos Sousa Aguiar, Caroline Cavalcante Leite, Michel Patrik de Sousa Arruda, Isabelle Nunes Shimith da Silva, Lais Walesca Alencar de Castro, Ana Paula Firchhof, Vanessa Fernandes Rodhe, Isabella Bueno Pereira da Rocha, Mirelly Cândida Cavoli Lira. Post-Treatment Surveillance Protocols for Sarcomas: Comparison of International Guidelines and Clinical Adherence. Brazilian Journal of Oncology 2026; 22. DOI: 10.1055/s-0046-1825447

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