Soft tissue sarcoma clinical practice guidelines in oncology.
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ABSTRACT:
SUBMITTER: Demetri GD
PROVIDER: S-EPMC5788173 | biostudies-literature | 2005 Mar
REPOSITORIES: biostudies-literature
Publications
Soft tissue sarcoma clinical practice guidelines in oncology.
Demetri George D GD Baker Laurence H LH Beech Derrick D Benjamin Robert R Casper Ephraim S ES Conrad Ernest U EU DeLaney Thomas F TF Ettinger David S DS Heslin Martin J MJ Hutchinson Ray J RJ Kiel Krystyna K Kraybill William G WG Letson G Douglas GD Neff James J O'Donnell Richard J RJ Paz I Benjamin IB Pollock Raphael E RE Randall R Lor RL Schupak Karen D KD Tyler Douglas S DS von Mehren Margaret M Wayne Jeffrey J
Journal of the National Comprehensive Cancer Network : JNCCN 20050301 2
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Project description:IntroductionOptimal management of soft tissue sarcoma (STS) remains a challenge. A nationwide survey assessed the quality of STS care in the Netherlands, thereby aiming to identify potentialities for improvement through more centralized disease management.MethodsFrom the Netherlands Cancer Registry (NCR), data were obtained on 3317 adult STS patients (excluding gastrointestinal stromal tumor, GIST) diagnosed in 2006-2011. Logistic regression models were employed to compare outcomes on selected clinical indicators reflecting prevailing STS guidelines between high-volume (≥10 resections annually) and low-volume (<10 resections) hospitals, between academic and general hospitals, and between sarcoma research centers and other hospitals, adjusted for case mix. Analyses were performed on imputed datasets (m = 50), generated through multiple imputations by chained equations.ResultsOverall, 89% of patients underwent surgical resection. Resection status remained unknown in 24% (excluding those with metastasized disease), and grade was not documented for one-third of tumors. Microscopic residual disease was detected in 20% with an increased risk for older patients, larger and deeply located tumors, and those located in the (retro)peritoneum or upper extremity. Almost half of patients with an R1 resection received adjuvant radiotherapy. Following adjustment for case mix factors, patients treated in high-volume hospitals less often had macroscopic residual disease (R2 resection; adjusted odds ratio: 0.54). A strongly skewed distribution of surgical volumes was observed.ConclusionsThese survey results indicate a potential for improving Dutch STS care. More centralized sarcoma management should improve definitive pathology reporting on tumor characteristics, adherence to treatment guidelines and overall disease outcome.
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