Challenges

Specialized Sarcoma Care

There is evidence to suggest that referral to a specialized sarcoma treatment center may lead to improved outcomes.

A study of 375 patients with soft tissue sarcoma (STS) in Sweden found that local recurrence rates of resected tumors were lower in patients referred to a specialty center: 18% in patients referred before biopsy, 24% in patients referred after biopsy, and 45% in patients not referred (P=0.0001).¹
A study of 260 soft tissue sarcoma patients in Britain found that the rate of local recurrence was 19% for patients treated in a specialty center versus 39% for patients treated in a general hospital, even though the tumors in patients treated at the general hospital were smaller and of lower grade.²
NETSARC is a network of 26 reference multidisciplinary centers aiming to improve the quality of care for STS patients in France. Beginning in 2010, presentation to a multidisciplinary tumor board and a second pathological review were made mandatory for sarcoma patients in the network. The results of a recent analysis of the database showed that out of the 12, 528 patients aged ≥15 years with a first diagnosis of soft tissue and visceral sarcoma obtained between 2010 and 2014, 5,281 (42.2%) and 7,247 (57.8%) were presented to the multidisciplinary tumor board before and after the initiation of treatment, respectively. Regarding outcomes, the former group had generally worse prognostic characteristics. Presentation to a multidisciplinary tumor board before treatment was associated with better compliance with clinical practice guidelines (ie, biopsy before surgery, imaging, quality of initial surgery, and fewer re-operations (all P<0.001)). Local relapse-free survival and relapse-free survival were significantly better in patients presented to a multidisciplinary tumor board before initiation of treatment. The study investigators concluded that compliance to clinical practice guidelines and relapse-free survival of sarcoma patients were significantly better when the initial treatment was guided by a pre-therapeutic specialized multidisciplinary tumor board.^3,4

Prevention of Relapse

Local and metastatic relapse of soft tissue sarcoma is common and frequent monitoring is recommended for early identification and treatment of recurrent STS.

One retrospective review found that 47% of soft tissue sarcoma patients experienced a relapse, with more than 80% of the relapses occurred within the first 2 years of follow-up. In patients who relapsed, 34% developed isolated lung metastases. Over half of the patients with lung metastases were asymptomatic and the tumors were discovered on routine imaging tests. This study provides support for the use of imaging surveillance for the detection of lung metastases. Local metastases were identified by clinical examination.⁵
Late recurrences (more than 5 years after diagnosis) are more common with certain histologies, such as synovial sarcoma and alveolar soft part sarcoma.⁶

REFERENCES

Gustafson P, Dreinhöfer KE, Rydholm A: Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients. Acta Orthop Scand 1994;65:47-50.
Bhangu AA, Beard JA, Grimer RJ: Should Soft Tissue Sarcomas be Treated at a Specialist Centre? Sarcoma. 2004;8:1-6.
Blay J. Intensity of recent years in the investigation of soft tissue sarcoma. Future Oncol. 2017a;13:3-9.
Blay J, Soibinet P, Penel N; NETSARC/RREPS and French Sarcoma Group–Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol. 2017b;28:2852-2859.
Rothermundt C, Whelan JS, Dileo P, et al.: What is the role of routine follow-up for localised limb soft tissue sarcomas? A retrospective analysis of 174 patients. Br J Cancer. 2014;110:2420-2426.
Krieg AH, Hefti F, Speth BM, et al. Synovial sarcomas usually metastasize after >5 years: a multicenter retrospective analysis with minimum follow-up of 10 years for survivors. Annals Oncol. 2011;22(2):458-467.