Should Soft Tissue Sarcomas Be Treated at High-volume Centers?

Gutierrez, Juan C.; Pérez, Eduardo A.; Moffat, Frederick L.; Livingstone, Alan S.; Franceschi, Dido; Koniaris, Leonidas G.

doi:10.1097/01.sla.0000250438.04393.a8

Cited by 259 publications

(210 citation statements)

References 31 publications

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“…The data collected from large cancer registries provides insight into tumor behavior and allow us to examine outcomes from current treatment strategies. [13][14][15][16][17][18] Although this represents an excellent database for comparative outcomes analysis, it is not without limitations. Using area poverty as a proxy for SES may result in misclassification of some patients whose postal code does not accurately reflect the true income level of the individual.…”

Section: Discussionmentioning

confidence: 99%

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Molina

Cheung

Pérez

et al. 2008

Cancer

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BACKGROUND.Differences in cancer survival based on race, ethnicity, and socioeconomic status (SES) are a major issue. To identify points of intervention and improve survival, the authors sought to determine the impact of race, ethnicity, and socioeconomic status for patients with cancers of the head and neck (HN).METHODS.HN cancer patients diagnosed between 1998 and 2002 were examined using a linked Florida Cancer Data System and Florida Agency for Health Care Administration data set.RESULTS.A total of 20,915 patients with HN cancers were identified, predominantly in the oral cavity and larynx. Overall, 72% of patients were male, 89.7% were white, 8.4% were African American (AA), and 10.6% were Hispanic. The median survival time (MST) was 37 months. MST varied significantly by race (white, 40 months vs AA, 21 months; P < .001), sex (men, 36 months vs women, 41 months; P = .001), and area poverty level (lowest, 27 months vs highest, 34 months; P < .0001). Only 32% of AA patients underwent surgery in comparison with 45% of white patients (P < .001). On multivariate analysis, independent predictors of poorer outcomes were race, poverty, age, sex, tumor site, stage, grade, treatment modality, and a history of smoking and alcohol consumption.CONCLUSIONS.Carcinomas of the HN have an overall high mortality with a disproportionate impact on AA patients and the poor. Dramatic disparities by race and SES are not explained completely by demographics, comorbid conditions, or undertreatment. Earlier diagnosis and greater access to surgery and adjuvant therapies in these patients would likely yield significant improvement in outcomes. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Molina

Cheung

Pérez

et al. 2008

Cancer

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196

256

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“…Patients with RSTS should receive treatment preferentially at high-volume centers 29,30 (see Table 1). In general, there are 2 ''surgery schools'': School 1 defends aggressive surgery, including reoperation and debulking in unresectable RSTS 2,23,34,35 ; whereas School 2 does not take this aggressive approach.…”

Section: Surgery Alonementioning

confidence: 99%

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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The authors undertook a systematic review to designate the role that radiotherapy (RT) might play in the treatment of retroperitoneal sarcomas. Correlating with recent literature, the objective of this review was to evaluate whether there was enough evidence for the authors to develop an institutional treatment protocol concerning the use of RT in the treatment of retroperitoneal sarcoma. Furthermore, this was a call for surgeons to talk to radiation oncologists before performing surgery. The 2 objectives of this review were: 1) to determine the benefit of RT in terms of local control and/or survival in the treatment of retroperitoneal sarcomas and 2) to discover the optimal timing of RT in the treatment sequence. A computerized literature search was performed in the PubMed database, the Cochrane Library database, and reference lists; and journals also were searched by hand to identify all retrospective and prospective reports published since 1998 relating to RT treatment of adult retroperitoneal sarcoma. Mainly, analyses were sought that were based on a 5-year local control rate (LCR), 5-year disease-free survival, and 5-year overall survival (OS). If only 2 years follow-up were available, then the authors also noted this outcome. Toxicity data were collected and analyzed separately. The synthesis of the literature was based on 9 prospectively nonrandomized studies and 10 retrospective studies that, together, reviewed a total of 1426 patients. The 5-year LCR varied from 27% to 62%, and the results from other reports fell in between those values. The 5-year OS rate ranged from 12% to 90%, and complete resection and tumor grade were the most important prognostic factors in most studies. This review resulted in 7 recommendations concerning the use of RT in the treatment of retroperitoneal sarcoma. The authors concluded that there is good evidence from multiple single-institutions studies that RT improves the LCR in patients with retroperitoneal sarcoma. Until now, there has not been a translation of this approach into survival benefit. The current results indicated that preoperative external-beam RT followed by radical surgery seems to be the preferred sequence, and adding intraoperative RT is a safe procedure for dose escalation in the upper abdomen. Cancer 2011;117:4355-

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“…Strong evidence also exists to demonstrate better outcomes for RPS managed in centralized multidisciplinary specialist centers. 7,13,14 The multidisciplinary team that makes management decisions should include a surgeon with specialized training in resection of RPS, with an understanding and recognition of the biologic behaviour, response to different treatment and clinical outcomes according to histological subtype. Sarcoma surgeons in specialist high-volume centers should have specific anatomical knowledge of the retroperitoneal space, and develop skills and experience to better select patients where a complete resection would be possible, better judgment to determine the extent of organ resection required to obtain complete resection, and develop skills to be more comfortable with performing a complex multivisceral en bloc resection.…”

Section: Complete Compartmental Resection Outcomesmentioning

confidence: 99%

Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Strauß

2014

Ann Surg Oncol

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Complete surgical resection remains the mainstay of curative treatment for retroperitoneal sarcomas (RPS) and provides the only hope for long-term survival. Unfortunately, the major mode of failure leading to poor outcome for retroperitoneal liposarcoma is intra-abdominal locoregional recurrence. The cause for the high rate of local recurrence following resection of retroperitoneal liposarcomas in contrast to limb sarcoma is customarily attributed to the specific anatomical site, containing vital neural and vascular structures, axial skeleton, and visceral organs limiting the ability to perform a wide resection. In addition, inherent tumor biology of liposarcomas has to be considered. The biological behavior of retroperitoneal liposarcomas are unpredictable. Clinically, some well-differentiated (WD) RPS behave in an indolent fashion over many years and never develop a dedifferentiated (DD) component. Other DD RPS develop de novo without a documented WD component. Some WD RPS can recur with a mainly DD component and vice versa. Although WD and DD RPS have a common genetic feature associated with genomic amplification which include amplification in 12q13-15 resulting in MDM2 and CDK4 overexpression, the specific genetic and molecular events leading to the unpredictable behavior is still not clear.

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Should Soft Tissue Sarcomas Be Treated at High-volume Centers?

Abstract: : STS patients treated at HVC have significantly better survival and functional outcomes. Patients with either large (>10 cm), high-grade or truncal/retroperitoneal tumors should be treated exclusively at a high-volume center.

Cited by 259 publications

References 31 publications

African American and poor patients have a dramatically worse prognosis for head and neck cancer

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

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