At presentation and prior to local control | |
Site | Testing |
Primary and bone metastases | AP and lateral radiographs |
Primary tumor | MRI with gadolinium (presurgery exam should be performed within four weeks of local control procedure) |
Bone metastases | MRI with gadolinium or CT scan with contrast (recommended for possible bone metastases if diagnosis uncertain) |
Chest | CT |
AP and lateral radiographs (recommended at presentation only) | |
Whole body | Technetium bone scintigraphy and/or FDG-PET (recommended at presentation, particularly if primary bone tumor negative on bone scintigraphy) |
Baseline after local treatment | |
Site | Testing and timing |
Primary and bone metastases | AP and lateral radiographs within two weeks of surgery |
Primary tumor | MRI with gadolinium or CT scan with IV contrast (in patients without significant metallic artifact at primary tumor site) three to four months after local control |
Bone metastases | MRI with gadolinium or CT scan with contrast (recommended for possible bone metastases if diagnosis uncertain) |
Surveillance on chemotherapy | |
Site | Testing and timing |
Primary and bone metastases | AP and lateral radiographs after 10 cycles (approximately halfway through postoperative chemotherapy) |
MRI with gadolinium or CT scan with IV contrast recommended if symptoms or abnormal imaging (and surgical intervention or radiation therapy contemplated) | |
Chest | CT after 10 cycles (approximately halfway through postoperative chemotherapy) |
Whole body | Technetium bone scintigraphy (if disease positive on prior bone scintigraphy) or FDG-PET (if disease positive on prior FDG-PET and bone scan-negative) recommended
|
Surveillance postchemotherapy | |
Site | Testing and timing |
Primary and bone metastases | AP and lateral radiographs every three months x 8, then every six months x 6, then every 12 months x 5 |
MRI with gadolinium or CT scan with IV contrast recommended if symptoms or abnormal imaging (and surgical or other intervention contemplated) | |
Chest | AP and lateral radiographs every three months x 8, then every six months x 6, then every 12 months x 5 |
CT recommended if abnormal radiographs | |
Whole body | Technetium bone scintigraphy (if positive on prior scans) or FDG-PET (if positive on prior scans and bone scan-negative) if symptoms or abnormal imaging AND surgical or other intervention contemplated |
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