Annals of Surgical Oncology

, Volume 19, Issue 2, pp 504–510 | Cite as

Influence of Specialty and Clinical Experience on Treatment Sequencing in the Multimodal Management of Soft Tissue Extremity Sarcoma

  • Nabil Wasif
  • Robert M. Tamurian
  • Scott Christensen
  • Ly Do
  • Steve R. Martinez
  • Steven L. Chen
  • Robert J. Canter
Bone and Soft Tissue Sarcomas



Although multimodal management of extremity soft tissue sarcoma (STS) is the standard of care, considerable variation exists in the sequencing of radiotherapy (RT) or chemotherapy (CT). Our goal was to identify factors responsible for this variation.


Members of specialty societies with an interest in STS were emailed a questionnaire about multimodal treatment of STS. Survey responses were scored on a 5-point Likert scale (1 = always preoperative and 5 = always postoperative) and analyzed by specialty, years in practice, and percentage of practice consisting of STS.


The questionnaire was completed by 320 (65%) of 490 physicians, including medical oncologists (18%), radiation oncologists (8%), orthopedic oncologists (22%), surgical oncologists (45%), and others (7%). Respondents were evenly split on the use of neoadjuvant RT (mean 3.03 ± 0.06) and showed a slight preference for neoadjuvant CT (2.89 ± 0.06). Radiation oncologists (2.52 ± 0.18), physicians with a >75% STS practice (2.58 ± 0.17), and those in practice <5 years (2.79 ± 0.12) preferred neoadjuvant RT. Neoadjuvant CT was preferred by orthopedic oncologists (2.62 ± 0.12) and physicians with >75% STS practice (2.51 ± 0.16). Factors influencing the choice for neoadjuvant RT were well-defined treatment volume, increased acute morbidity, and decreased late morbidity, while for CT, they were in-situ disease monitoring and early treatment of micrometastases.


Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care.



No financial disclosures or conflicts of interest for any of the authors.


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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Nabil Wasif
    • 1
  • Robert M. Tamurian
    • 2
  • Scott Christensen
    • 3
  • Ly Do
    • 4
  • Steve R. Martinez
    • 5
  • Steven L. Chen
    • 5
  • Robert J. Canter
    • 5
  1. 1.Department of SurgeryMayo Clinic ArizonaPhoenixUSA
  2. 2.Department of Orthopedic SurgeryUniversity of California at Davis Health SystemDavisUSA
  3. 3.Department of Hematology and OncologyUniversity of California at Davis Health SystemDavisUSA
  4. 4.Department of Radiation OncologyUniversity of California at Davis Health SystemDavisUSA
  5. 5.Department of SurgeryUniversity of California at Davis Health SystemDavisUSA

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