Centralised treatment of soft tissue sarcomas in adults

Abstract

The clinical research developed in specialised centres and oncologic cooperative groups has permitted various scientific societies to collect recommendations used in the treatment of soft tissue sarcomas (STS) and incorporate them into clinical practice guidelines (CPG). Some studies have been conducted in diverse healthcare ambits to assess the influence of CPG. This revision of the medical literature analyses the impact that healthcare management -centralised or otherwise- and clinical practice in conformity with CPG have on the clinical outcome variables of STS. Eight CPG have been identified, as well as 12 conformity studies or audits. These conformity studies and audits demonstrate that the grade of adaptation of medical interventions with CPG, medical healthcare in reference centres and procedures of referrals to these centres, as well as the process of organising healthcare teams into Sarcoma Committees, have a significant influence on clinical outcome. We can conclude that excellent healthcare of STS implies the adaptation of healthcare practice to CPG, the existence of Reference Centres guided by Sarcoma Committees, and the observance of strict referral procedures within the Healthcare Area.

Multidisciplinary management of adolescents and young adults (AYA) sarcoma: A successful effort of an adult high‐volume cancer center

“…Obviously, the significant positive role of a Referral Center led by a high level of multidisciplinary expertise has been proved to have a cost-effectiveness impact on the management of rare cancers and could potentially impact the value of the diagnostic delay on survival. [19][20][21][22] We reported a significantly worse 5-year OS in the youngest cohort (≤25 years old), which represents almost 30% of patients in our sample and harbors the highest incidence of SRCT, mostly extraskeletal Ewing's sarcomas and desmoplastic small round cell tumor. The prevalence of these histologies could explain the poorer OS, given that these tumors are typically diagnosed in pediatric patients, but in AYA patients are characterized by a worse clinical outcome, compared with pediatric patients.…”

“…Obviously, the significant positive role of a Referral Center led by a high level of multidisciplinary expertise has been proved to have a cost‐effectiveness impact on the management of rare cancers and could potentially impact the value of the diagnostic delay on survival. 19 , 20 , 21 , 22 …”

Multidisciplinary management of soft tissue sarcomas

“…Recently, a population-based study reported in patients undergoing limb-sparing surgery for STS of the extremities concluded that radiotherapy was associated with improved survival in patients with highgrade tumour [44]. Adjuvant radiotherapy is employed together with surgery in the case of STS showing a poor prognosis (T2, G2-3) after surgery with close (<10 mm) or microscopically affected margins and after surgery of locally relapsed previously untreated STS [5, 6, 45,46].…”