10 YEAR MUSCULOSKELETAL REVIEW OF SARCOMAS THE OTTAWA REGIONAL CANCER CENTRE EXPERIENCE:

Healey D., Moreau G., Lalonde K.A. (MD Ottawa General Hospital, ON, Canada K1H 8L6).

We carried out an extensive review of all sarcomas that were referred to The Ottawa Regional Cancer Centre from Jan/87 to Dec/96. There were a total of 278 patients identified; of these, 33 charts were unavailable for review and thus were excluded. The remainder of the charts were perused for: demographics, type of sarcoma, location, pathology surgical margins, treatment, metastasis and survival up to the cut off time of May/98. Upon completion of this process a further 66 patients or 23.7% were eliminated for non-musculoskeletal sarcomas. These consisted mainly of abdominal or thoracic leiomyosarcomas and liposarcomas. The remaining 179 patients were studied to provide information concerning prognostic factors, efficacy of treatment and sites of metastasis.

Once this was obtained, we scrutinized the results to make treatment and follow-up modifications specific for this treatment centre. After the internal audit is complete, this statistical information can then be compared with literature values and other treatment centers to critique our outcomes and potentially modify treatment.

Malignant Fibrous Histiocytoma is the most common musculoskeletal sarcoma in this region at 28.5%. Particular interest was noted that only 16.l% of all metastatic tumors involved the lung, 20.8% had a local recurrence and 8.1% had a distant non-pulmonary focus. It was also noteworthy that l0% of patients presented with metastasis and 54.4% of all treated sarcomas did not have any form of recurrence or metastasis during the study period. All of the calculations and demographics were carried out on each specific type of sarcoma and are reported as such. The Kaplan-Meier survival curves for all patients had a 5-year survival between 39% and 54%. The greatest concern encountered was that for all surgical specimens analyzed, (14.8-36.4)% of the sarcomas had involved margins at the primary surgery. The large number of positive margins especially with the soft tissue sarcomas may reflect the low level of suspicion that many of the treating surgeons had pre-operatively. This partially accounts for the high level of local recurrences in some sarcoma groups, however, MFH had a much higher rate of local recurrence even with clear surgical margins.

A specialized team approach to treating sarcomas is necessary to improve patient outcome and survival. Prior to implementation the primary care physician and surgeon must have a high level of suspicion regarding a lesion and complete a proper preoperative assessment. Once this is complete, a proper treatment protocol, including a biopsy should commence.