Management of Soft Tissue Sarcomas in Extremities: Variation in Treatment Recommendations and Surveillance According to Specialty and Continent

• Published in: Annals of surgical oncology Vol. 28; no. 12; pp. 7923 - 7936
• Main Authors: Acem, Ibtissam, Smit, Merel M., Verhoef, Cornelis, van Houdt, Winan J., Haas, Rick L., van der Hage, Jos A., Grünhagen, Dirk J., van de Sande, Michiel A. J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2021; Springer Nature B.V
• Subjects: Adult; Chemotherapy; Chest; Computed tomography; Decision making; Extremities; Humans; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Oncology; Patients; Radiation Oncology; Radiation therapy; Sarcoma; Sarcoma - diagnostic imaging; Sarcoma - therapy; Soft Tissue Neoplasms - diagnostic imaging; Soft Tissue Neoplasms - therapy; Soft tissue sarcoma; Surgery; Surgical Oncology; Surveillance; Asia; North America; Europe
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-09946-4

Background This study aimed to provide an insight into clinical decision-making and surveillance strategy of sarcoma specialists for patients with primary soft tissue sarcoma of the extremities (eSTS). The secondary aim was to quantify the role of patient- and tumor-specific factors in the perioperative management. Methods Members of sarcoma societies were sent a Web-based 21-item survey about eSTS management. The survey concerned only primary resectable high-grade eSTS in adults. Results The study enrolled 396 respondents. The majority of the surgical specialists thought the evidence for perioperative chemotherapy (CTX) for high-grade eSTS was insufficient. Radiotherapy (RTX) was less frequently offered in Asia than in North America and Europe. The specialties and continents also differed regarding the importance of patient and tumor characteristics influencing RTX and CTX recommendation. For surveillance after initial treatment outpatient visits, chest computed tomography (CT) scans, and magnetic resonance images of the extremity were the methods primarily used. The specialists in North America preferred chest CT scan over chest x-ray, whereas those in Asia and Europe had no clear preference. Discussion Specialty and continent are important factors contributing to the variation in clinical practice, treatment recommendations, and surveillance of patients with primary resectable high-grade eSTS.