Posters— Surgical Treatment of Sarcomas

HOW COULD THE TREATMENT OF SOFT TISSUE SARCOMA BE IMPROVED ON A REGIONAL BASIS?

Glencross J², Silcocks P³, Robinson MH¹. ( ¹ YCR Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK S10 2SJ), 2 Leicestershire Health Authority, 3 Trent Cancer Registry, Weston Park Hospital)

Background: Bone and soft tissue sarcomas are a rare and heterogeneous group of tumours, rarely seen by most clinicians during their careers. Early recognition, appropriate and timely investigations, and treatment are shown to markedly affect outcomes. In Trent Region in the UK, a soft tissue sarcoma interest group had developed outline consensus based guidelines for investigation and management. The Trent Cancer Registry was asked to undertake a retrospective baseline audit of the care of such patients in Trent.

Results: Soft tissue sarcomas registered with Trent Cancer Registry in 1995-1997 and meeting ICD-O criteria for site and morphology were selected. Data were collected from clinical records against a set of criteria outlined in the protocol in all registering hospitals. Data included: recording of clinical details, specialities involved in management, diagnostic and staging investigations, completeness of surgery, histological reporting, use of adjuvant therapy and outcome (death or known recurrence)

From 257 registrations, 204 cases were included. 10% of notes were unobtainable; 50% were initially referred to general surgeons, although definitive surgery was performed by surgeons (40%) and orthopaedic surgeons (33%); 74% saw an oncologist; 55% had a diagnostic CT or MRI scan. Only 52% had adequate staging investigations; 63% had a biopsy; but 13% were “shelled out” at biopsy. 35% had wide or adequate excision; in 48% primary surgery was incomplete or marginal. Outcome was poorer in these patients. Histological reporting was variable. No consistent grading system was used; details on tumour margins were available for 66% of cases; tumour size stated in 73% of cases; 52% received adjuvant therapy; 10% being considered for EORTC trial entry. Follow up was generally by a specialist oncology team, although 10% had no recorded follow up.

A comparison of patients referred to a sarcoma “expert” prior to surgical exploration with those not referred was undertaken. From the patients having surgery the following pre-operative investigations were made: CT or MRI before definitive surgery — expert 23/25 (92%), non-expert 51/135 (37%); CT scan to include metastases — expert 18/25 (72%), non-expert 72/179 (40.2%); Biopsy taken — expert 24/25 (96%), non-expert 98/179 (55.9%); No record of tumour size in notes — expert 7/25 (28%), non-expert 37/179 (20.7%).

Conclusions: The audit demonstrates that optimal care as defined by the soft tissue sarcoma group in Trent was not provided over this period within the region. All clinicians should follow management guidelines and proposals to set up specialist referral centres should be considered.