Bone sarcoma: Success through interdisciplinary collaboration

Hecker‐Nolting, Stefanie; Ferreira, Ana F.; Bielack, Stefan

doi:10.1302/1863-2548.15.210122

Cited by 6 publications

(2 citation statements)

References 52 publications

(86 reference statements)

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“…Given the primary occurrence of bone sarcomas in the extremities, alongside their potential to originate Reports 2024, 7, 35 2 of 15 from any bone or soft tissue, a multidisciplinary approach is crucial [3]. It is widely recognized that patients benefit significantly from treatment at specialized sarcoma networks, where comprehensive care and expertise are available to address the unique challenges posed by these tumors [4].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of the Bone Tumor Surgery Complexity Score

Frei,

Schelling,

Heesen

et al. 2024

Reports

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Bone tumors often manifest with non-specific symptoms such as pain and swelling, often posing diagnostic challenges. Optimal treatment requires centralized care in specialized centers, emphasizing the need for complete tumor removal and interdisciplinary collaboration. We developed the Bone Tumor Surgery Complexity Score (BT-SCS) based on a retrospective study of 501 patients. The BT-SCS, structured around patient demographics, tumor biology, and surgical parameters, categorizes surgical cases into four groups to comprehensively assess complexity. Application of the BT-SCS resulted in scores ranging from 3 to 33, with an average score of 14 ± 7.2. Patients with malignant tumors had higher scores (19.6 ± 5.2) compared to those with benign (10.0 ± 3.8) or intermediate malignant tumors (14.6 ± 7.1). Patients with pelvic tumors registered the highest scores (16.0), followed by extremities/trunk (14.3) and spinal tumors (13.6). The BT-SCS was validated against the Case Mix Index (CMI), using an independent cohort of bone and soft tissue cases. This validation process, utilizing Loess smoothing, illustrated the BT-SCS’s granular differentiation of surgical complexity, particularly in the lower-to-mid-range of case severities. The BT-SCS represents a significant shift from volume-based to complexity-based assessments in surgical care, aligning with evolving healthcare paradigms. It serves as a tool for strategic patient allocation to treatment centers, aiming to improve outcomes and benchmarking in sarcoma care. The score’s development and application in clinical practice align with the focus on patient-centered and value-based healthcare. Future enhancements, including machine learning integration and outcome data, will refine its categorization process, enhancing clinical utility.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of the Bone Tumor Surgery Complexity Score

Frei,

Schelling,

Heesen

et al. 2024

Reports

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“…Metastatic disease is a common cause of death in patients with bone sarcoma [ 1 ]. Synchronous metastases are present in 15–20% of osteosarcomas [ 2 , 3 , 4 ] and up to 25% of Ewing sarcomas [ 5 , 6 , 7 ], while 20–50% of osteosarcoma and Ewing sarcoma patients will develop secondary metastases, most commonly affecting the lungs [ 8 , 9 , 10 ]. Apart from chemotherapy (CTX) and radiotherapy (RTX), resection of metastases in general, and lung metastases in particular, has become an important therapeutic option in bone sarcoma patients [ 11 , 12 ], in addition to other local treatment options [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Pulmonary Metastasectomy in Bone Sarcoma Patients: A Retrospective, Single-Centre Study

Smolle

Kogler

Andreou

et al. 2023

Cancers

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This retrospective study aimed at analyzing the impact of metastasectomy on post-metastasis survival (PMS) in bone sarcoma patients with lung metastases. Altogether, 47 bone sarcoma patients (24 males, median age at diagnosis of lung metastases: 21.8 (IQR: 15.6–47.3) years) with primary (n = 8) or secondary (n = 39) lung metastases treated at a single university hospital were retrospectively included. Based on a propensity score, inverse probability of treatment weight (IPTW) was calculated to account for selection bias whether patients had undergone metastasectomy or not. The most common underlying histology was osteosarcoma (n = 37; 78.7%). Metastasectomy was performed in 39 patients (83.0%). Younger patients (p = 0.025) with singular (p = 0.043) and unilateral lesions (p = 0.024), as well as those with an interval ≥ 9 months from primary diagnosis to development of lung metastases (p = 0.024) were more likely to undergo metastasectomy. Weighted 1- and 3-year PMS after metastasectomy was 80.8% and 58.3%, compared to 88.5% and 9.1% for patients who did not undergo metastasectomy. Naive Cox-regression analysis demonstrated a significantly prolonged PMS for patients with metastasectomy (HR: 0.142; 95%CI: 0.045–0.450; p = 0.001), which was confirmed after IPTW-weighting (HR: 0.279; 95%CI: 0.118–0.662; p = 0.004), irrespective of age, time to metastasis, and the number of lesions. In conclusion, metastasectomy should be considered in bone sarcoma patients with lung metastases, after carefully considering the individual risks, to possibly improve PMS.

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