Controversies in the management of patients with soft tissue sarcoma: Recommendations of the Conference on State of Science in Sarcoma 2022

Rothermundt, Christian; Andreou, Dimosthenis; Blay, Jean‐Yves; Brodowicz, Thomas; Desar, Ingrid M.E.; Dileo, Palma; Gelderblom, Hans; Haas, Rick L.; Jakob, Jens; Jones, Robin L.; Judson, Ian; Kunz, Wolfgang G.; Liegl-Atzwanger, Berndadette; Lindner, Lars H.; Messiou, Christina; Miah, Aisha; Reichardt, Peter; Szkandera, Joanna; Graaf, Winette T.A. van der; Houdt, Winan J. van; Wardelmann, Eva; Höfer, Silvia

doi:10.1016/j.ejca.2022.11.008

Cited by 14 publications

(7 citation statements)

References 46 publications

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“…Over the past decades, standard of care recommendations by ESMO, NCCN, or national scientific groups were developed via task forces or consensus conferences with sometimes more than 50 experts discussing in a multiday, person-to-person meeting [17][18][19][20]. Recently, virtual formats had to be adapted due to COVID restrictions [21,22]. Despite all efforts to integrate scientific data preferably from well-accepted publications during the discussion of a new or to-be-refurbished guideline, these formats open space for personal attitudes or country-specific views.…”

Section: Discussionmentioning

confidence: 99%

Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline “Adult Soft Tissue Sarcomas”

Jakob

Andreou

Bedke

et al. 2023

Langenbecks Arch Surg

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Purpose The evidence-based (S3) guideline “Adult Soft Tissue Sarcomas” (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies. Methods A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step. Results The statement “Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection” was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee. Conclusion The evidence-based guideline “Adult Soft Tissue Sarcomas” is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients.

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Section: Discussionmentioning

confidence: 99%

Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline “Adult Soft Tissue Sarcomas”

Jakob

Andreou

Bedke

et al. 2023

Langenbecks Arch Surg

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“…The opinion of experts from various reference centres is also unanimous on this issue, stating that re-excision is mandatory and additional perioperative radiation therapy or chemotherapy should be used. If radical resection is impossible, sparing resection with additional perioperative procedures is recommended to reduce the risk of recurrence and dissemination [ 8 •]. Similar guidelines have been used for PPR, but when radical resection is not possible, additional therapy is recommended, and for patients with stage IA, close observation is an option [ 48 ].…”

Section: Management Of R2 Resectionmentioning

confidence: 99%

“…However, the surgical approach can be challenging for several reasons. Firstly, the disease may have extended and infiltrated crucial structures such as vessels, nerves, and organs, making radical resection questionable [ 8 •]. Second, inadequate estimation of the disease may result in a "whoops operation", where surgery is performed assuming the mass is benign, but postoperative pathological examination reveals a diagnosis of sarcoma [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

What is the Optimal Treatment Strategy after Sarcoma R2 Surgery?

Chmiel,

Rutkowski,

Spałek

et al. 2024

Curr. Treat. Options in Oncol.

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Opinion statementSoft tissue sarcomas (STS) are rare tumours of mesenchymal origin, most commonly occurring in the extremity but also in the retroperitoneum. The curative treatment for STS is radical surgery with wide margins, in some cases in combination with perioperative radiotherapy and chemotherapy. Nonradical resection (R2) of STS has been an emerging issue in recent decades, as optimal subsequent management remains debatable. Similarly, there is still no consensus on optimal surgical margins. Combining multiple treatment modalities in adjuvant therapy can achieve local and distant control in patients following surgery with positive margins. Patients who have undergone nonradical resection therefore require additional surgical interventions, and adjuvant radiotherapy resulting in a better prognosis but a higher number of complications. Following non-radical treatment, patients with limb and trunk wall sarcomas and retroperitoneal sarcomas should also undergo increased oncological surveillance. Given the potential issues that may emerge in such clinical situations, it is crucial to up-date the current guidelines to enhance the long-term prognosis of these patients.

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“…For patients with a high-grade sarcoma in the extremity or trunk, the wide local excision is followed by radiotherapy (RT) 4. The role of (neo)adjuvant chemotherapy to enhance local control remains a matter of debate,5 6 as the benefit of (neo)adjuvant chemotherapy for patients with high-risk resectable STS relies on indirect evidence only 6 7. Gaining local control for RPS includes complex, multivisceral resectional surgery, which is critical for cure 1 3 8–10.…”

Section: Introductionmentioning

confidence: 99%

“…The intensity of postoperative surveillance imaging is highly varied across centres throughout the world,1 9 13 18 reflecting a lack of evidence to guide decision-making. Current recommended follow-up protocols1 9 21–24 extrapolate from evidence in sarcoma of the limb25 26 and expert opinion 1 7 9 10…”

Section: Introductionmentioning

confidence: 99%

Experiences of patients and their relatives of postoperative radiological surveillance and surveillance intensity following primary resection of a soft tissue sarcoma and its impact on their quality of life: a systematic review protocol

et al. 2023

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IntroductionPostoperative radiological surveillance following primary resection of a soft tissue sarcoma (sarcoma of the retroperitoneum, abdomen, pelvis, trunk or extremities) is standard of care in all international high-volume sarcoma centres in the world. The intensity of postoperative surveillance imaging is highly varied and knowledge of the impact of surveillance and surveillance intensity on patients’ quality of life is limited. The aim of this systematic review is to summarise the experiences of patients and their relatives/caregivers of postoperative radiological surveillance following resection of a primary soft tissue sarcoma and its impact on their quality of life.Methods and analysisWe will systematically search MEDLINE, EMBASE, PsycINFO, CINAHL Plus and Epistemonikos. Hand searching of reference lists of included studies will be conducted. Further searches will be performed via Google Scholar, to reveal further studies within unpublished ‘grey’ literature. Two reviewers will independently screen the titles and abstracts following the eligibility criteria. After retrieval of the full text of the selected studies, the methodological quality will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and the Center for Evidence-Based Management checklist for Critical Appraisal of a Cross-Sectional Study. Data on the study population, relevant themes and conclusions will be extracted from the selected papers, and a narrative synthesis will be conducted.Ethics and disseminationThe systematic review does not require ethics approval. The findings of the proposed work will be published in a peer-reviewed journal and disseminated widely to patients, clinicians and allied health professionals through the Sarcoma UK website, the Sarcoma Patient Advocacy Global Network and the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group. In addition, the outcomes of this research will be presented at national and international conferences.PROSPERO registration numberCRD42022375118.

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Controversies in the management of patients with soft tissue sarcoma: Recommendations of the Conference on State of Science in Sarcoma 2022

Cited by 14 publications

References 46 publications

Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline “Adult Soft Tissue Sarcomas”

Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline “Adult Soft Tissue Sarcomas”

What is the Optimal Treatment Strategy after Sarcoma R2 Surgery?

Experiences of patients and their relatives of postoperative radiological surveillance and surveillance intensity following primary resection of a soft tissue sarcoma and its impact on their quality of life: a systematic review protocol

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