2002 CTOS Annual Meeting Posters — Pathology

SOFT TISSUE SARCOMA (STS) MANAGEMENT. REGIONAL AUDIT WITH IMPLICATION OF REGIONAL CANCER NETWORK ORGANISATION.
[Abstract ID: 11]

Category: Pathology

Authors: isabelle ray-coquard¹, thierry philip¹, philippe thiesse¹, dominique ranchère-vince¹, pierre meeus¹, jean-yves bobin³, marie-pierre sunyach¹, perrine marec-berard¹, pierre biron¹, jean-yves blay²

Author Institutions: ¹Centre Leon Berard, lyon, France; ²Hopital Edouard Herriot, Lyon, France; ³hopital jules courmont, pierre benite, France

Presenter: isabelle ray-coquard
ray@lyon.fnclcc.fr

Correspondent: isabelle ray-coquard
ray@lyon.fnclcc.fr
lyon France 69008
Ph: 33 4 78 78 26 44
Fax: 33 4 78 78 27 16

Objectives: STS are rare. Lack of experience outside specialist centers poses difficulties for clinicians, leading to wide variation in treatment. Development of cancer network organization was performed in the Rhône-Alpes region. A study on sts management was realized to 1) investigate sarcoma management before cancer network, 2) assess the non-conformity of medical practice with "evidence based medicine" (EBM). Evidence based medicine were reported under form of Clinical Practice Guidelines (CPGs) which were derived from an extensive literature review and opinion of experts and have been published in 1998 (bull cancer 1998, 12).

Methods: A retrospective study, using institutional medical records of patients with sts was conducted in two institutions (comprehensive cancer center and university hospital). From 1999 to 2001, all new patients with sts (stade TxNxM0) were selected (200 and 300 patients respectively) because of their large recruitment, 50 of the newly patients were randomly selected. Medical decisions were analyzed to assess their conformity with the CPGs.

Results: 100 medical records were evaluated for both institutions. Median age 56y (18-90), tumor size 9cm (1-26), major location: extremities and trunk, frequent histology: leiomyosarcoma and liposarcoma. Concerning medical practices: Only 7% (7/100) of cases were discussed in a formal multidisciplinary staff before biopsy. Biopsy preceded surgical procedure for 41% of pts. The first surgical resection was R0, R1, R2 in 23%, 27%, 43% respectively. Conformity rate to CPGs were 47%, 71%, 87%, 68% for surgery, radiation therapy, chemotherapy, and follow-up respectively. Multivariate analysis shows only multidisciplinary discussion before surgery and management within a cancer network as independent prognostic factor for conformity with CPGs.

Conclusions: Conformity rates with EBM were as those published elsewhere. The development and implementation of CPGs and management in formal multidisciplinary staff seem to be essential for sts management. Cancer network would be a good organization to promote both the uses of local services and specialized oncology care.