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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Notes

Disclosure

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

References

  1. 1.
    Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15.PubMedCrossRefGoogle Scholar
  2. 2.
    Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.PubMedGoogle Scholar
  3. 3.
    Kaushal A, Citrin D. The role of radiation therapy in the management of sarcomas. Surg Clin North Am. 2008;88:629–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Thornton K. Chemotherapeutic management of soft tissue sarcoma. Surg Clin North Am. 2008;88:647–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Wasif N, Ye X, Giuliano AE. Survey of ASCO members on management of sentinel node micrometastases in breast cancer: variation in treatment recommendations according to specialty. Ann Surg Oncol. 2009;16:2442–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Clasby R, Tilling K, Smith MA, Fletcher CD. Variable management of soft tissue sarcoma: regional audit with implications for specialist care. Br J Surg. 1997;84:1692–6.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Davis AM, O’Sullivan B, Bell RS, et al. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20:4472–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Krikelis D, Judson I. Role of chemotherapy in the management of soft tissue sarcomas. Expert Rev Anticancer Ther. 2010;10:249–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Sleijfer S, Ouali M, van Glabbeke M, et al. Prognostic and predictive factors for outcome to first-line ifosfamide-containing chemotherapy for adult patients with advanced soft tissue sarcomas: an exploratory, retrospective analysis on large series from the European Organization for Research and Treatment of Cancer–Soft Tissue and Bone Sarcoma Group (EORTC-STBSG). Eur J Cancer. 2010;46:72–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Gutierrez JC, Perez EA, Moffat FL, et al. Should soft tissue sarcomas be treated at high-volume centers? An analysis of 4205 patients. Ann Surg. 2007;245:952–8.PubMedCrossRefGoogle Scholar

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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