Surveillance Strategies for Sarcoma: Results of a Survey of Members of the Musculoskeletal Tumor Society

Abstract

Background. Surveillance is crucial to oncology, yet there is scant evidence to guide strategies. Purpose. This survey identified sarcoma surveillance strategies for Musculoskeletal Tumor Society (MSTS) members and rationales behind them. Understanding current practice should facilitate studies to generate evidence-based surveillance protocols. Methods. Permission was granted by the Research and Executive Committee of the MSTS to survey members on surveillance strategies. First, the questionnaire requested demographic and clinical practice information. Second, the survey focused on clinicians' specific surveillance soft tissue and bone sarcoma protocols. Results. 20 percent of MSTS members completed the survey. The primary rationale for protocols was training continuation, followed by published guidelines, and finally personal interpretation of the literature. 95% of the respondents believe that additional studies regarding appropriate surveillance protocols are needed. 87% reported patient concerns regarding radiation exposure from surveillance imaging. For soft tissue and bone sarcoma local recurrence, responders identified surgical margin, histologic grade, and tumor size as the most important factors. For metastases, important risk factors identified included histologic grade, tumor size, and histologic type. Protocols demonstrated wide variation. Conclusion. This survey demonstrates that surveillance strategies utilized by MSTS members are not evidence-based, providing rationale for multi-institutional studies. It also confirms the public health issue of excessive radiation exposure.

Advances in the management of osteosarcoma

“…Surveillance usually includes chest X-rays or chest CTs in addition to history, physical, and imaging of the former primary tumor site. The wide variability of surveillance protocols actually employed is exemplified by a Musculoskeletal Tumor Society (MSTS) survey, where the number of first-year surveillance visits ranged from three to six, chest X-rays from zero to three, chest CT scans from one to four, and X-rays of the former primary site from three to six 69 . Imaging guidelines developed by the Children’s Oncology Group (COG) suggest a schedule which heavily relies on repeated CT scanning of the lungs 20 .…”

Surveillance AFter Extremity Tumor surgerY (SAFETY): A Protocol for an International Randomized Controlled Trial

“…However, surveillance strategies have not been well researched and current guidelines are based on expert opinions and not based on high quality studies 17,18 . Given the limitations of the evidence, it has not been possible for sarcoma surgeons to draw firm conclusions and, therefore, current clinical practice is highly varied, particularly with respect to oncologic follow-up of sarcoma patients following multimodal treatment [19][20][21] . In fact, several published surveys in the field highlight the clinical equipoise among orthopaedic oncologists regarding surveillance frequency, with the number of clinic visits ranging from two to 12 in the first year [19][20][21] .…”

“…Given the limitations of the evidence, it has not been possible for sarcoma surgeons to draw firm conclusions and, therefore, current clinical practice is highly varied, particularly with respect to oncologic follow-up of sarcoma patients following multimodal treatment [19][20][21] . In fact, several published surveys in the field highlight the clinical equipoise among orthopaedic oncologists regarding surveillance frequency, with the number of clinic visits ranging from two to 12 in the first year [19][20][21] . Similarly, these surveys also demonstrate the wide variations of imaging modality practices, with the number of CXRs obtained ranging from zero to 13 and the number of CT scans ranging from one to eight in the first year of surveillance [19][20][21] .…”

Behandlung retroperitonealer Sarkome in Deutschland

“…Die o. g. 20 %) und entsprach derjenigen, die nordamerikanische Kollegen bei einer Umfrage von Mitgliedern der MSTS (Musculosceletal Tumor Society) über die Nachsorge von Sarkomen erreichten [11,12]. Die Rücklaufquote kann daher als absolut angemessen eingestuft werden.…”