How do you sequence treatment for a patient following R2 resection of a large extremity leiomyosarcoma who has small lung nodules concerning for metastatic disease, but not yet biopsy proven?

In general R2 resection is not good news. I would first clarify with the surgeon, the barriers to a re-resection. If re-resection is feasible, then perhaps that should be attempted first.

This patient is at high risk for local relapse, which ultimately leads to a poor quality of life. If the lung no...