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Practice Pattern Variability in the Management of Regional Lymph Node Metastasis in Extremity and Trunk Soft Tissue Sarcoma: A Survey of the Society of Surgical Oncology and Musculoskeletal Tumor Society Membership

Annals of Surgical Oncology (2023)Cite this article

Abstract

Background

Regional lymph node metastasis in extremity and trunk soft tissue sarcoma (ETSTS) is rare with no standardized management. We sought to determine management patterns for regional lymph node metastasis in ETSTS.

Methods

A survey regarding the management of ETSTS lymph node metastasis was distributed to the membership of the Musculoskeletal Tumor Society (MSTS) and the Society of Surgical Oncology (SSO) in January 2022. The survey queried the type of training (surgical oncology, orthopedic oncology), details of their practice setting, and management decisions of hypothetical ETSTS scenarios that involved potential or confirmed lymph node metastasis.

Results

The survey was distributed to 349 MSTS members (open rate of 63%, completion rate 21%) and 3026 SSO members (open rate of 55%, completion rate 4.7%) and was completed by 214 respondents, of whom 73 (34.1%) and 141 (65.9%) were orthopedic oncology and surgical oncology fellowship-trained, respectively. The majority of respondents practiced in an academic setting (n = 171, 79.9%) and treat >10 extremity sarcoma cases annually (n = 138, 62.2%). In scenarios with confirmed nodal disease for clear cell and epithelioid sarcoma, surgical oncologists were inclined to perform lymphadenectomy, while orthopedic oncologists were inclined to offer targeted lymph node excision with adjuvant radiation (p < 0.001). There was heterogeneity of responses regarding the management of nodal disease regardless of training background.

Conclusion

Self-reported management of nodal disease in ETSTS was variable among respondent groups with differences and similarities based on training background. These data highlight the variability of practice for nodal disease management and the need for consensus-based guidelines.

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Funding

Kelly Hunt is a member of the Medical Advisory Board for Armada Health and AstraZeneca, and has received research funding, paid to her institution, from Cairn Surgical, Eli Lilly & Co., and Lumicell. Russell Witt is supported by the National Institutes of Health (T32 CA 009599) and an MD Anderson Cancer Center support grant (P30 CA016672).

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Author notes

  1. Russell G. Witt and Rachel K. Voss have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Russell G. Witt MD, MAS, Yi-Ju Chiang MSPH, Sa Nguyen MS, Christopher P. Scally MD, Keila E. Torres MD, MBA, PhD, Kelly K. Hunt MD, Barry W. Feig MD, Christina L. Roland MD, MS & Emily Z. Keung MD, AM, FACS

  2. Department of Sarcoma Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Rachel K. Voss MD, MPH

  3. Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Patrick P. Lin MD, Bryan S. Moon MD, Robert L. Satcher MD, PhD, Justin E. Bird MD & Valerae O. Lewis MD

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  1. Russell G. Witt MD, MAS
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Corresponding author

Correspondence to Emily Z. Keung MD, AM, FACS.

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Disclosures

Rachel K. Voss, Yi-Ju Chiang, Sa Nguyen, Christopher P. Scally, Patrick P. Lin, Keila E. Torres, Bryan S. Moon, Robert L. Satcher, Justin E. Bird, Barry W. Feig, Valerae O. Lewis, Christina L. Roland, and Emily Z. Keung have no disclosures to declare.

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Witt, R.G., Voss, R.K., Chiang, YJ. et al. Practice Pattern Variability in the Management of Regional Lymph Node Metastasis in Extremity and Trunk Soft Tissue Sarcoma: A Survey of the Society of Surgical Oncology and Musculoskeletal Tumor Society Membership. Ann Surg Oncol (2023). https://doi.org/10.1245/s10434-023-13142-x

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