The Influence of Personalised Sarcoma Care (PERSARC) Prediction Modelling on Clinical Decision Making in a Multidisciplinary Setting

Abstract

Background. With soft-tissue sarcoma of the extremity (ESTS) representing a heterogenous group of tumors, management decisions are often made in multidisciplinary team (MDT) meetings. To optimize outcome, nomograms are more commonly used to guide individualized treatment decision making. Purpose. To evaluate the influence of Personalised Sarcoma Care (PERSARC) on treatment decisions for patients with high-grade ESTS and the ability of the MDT to accurately predict overall survival (OS) and local recurrence (LR) rates. Methods. Two consecutive meetings were organised. During the first meeting, 36 cases were presented to the MDT. OS and LR rates without the use of PERSARC were estimated by consensus and preferred treatment was recorded for each case. During the second meeting, OS/LR rates calculated with PERSARC were presented to the MDT. Differences between estimated OS/LR rates and PERSARC OS/LR rates were calculated. Variations in preferred treatment protocols were noted. Results. The MDT underestimated OS when compared to PERSARC in 48.4% of cases. LR rates were overestimated in 41.9% of cases. With the use of PERSARC, the proposed treatment changed for 24 cases. Conclusion. PERSARC aids the MDT to optimize individualized predicted OS and LR rates, hereby guiding patient-centered care and shared decision making.

Prediction tools for the personalized management of soft-tissue sarcomas of the extremity

“…7,8,38 Prediction tools in the form of a nomogram or a computeror smartphone-based calculator are commonly used to estimate oncological events such as the risk of recurrence and death. 12,39 These tools generate individual probabilities of an event based on a combination of factors accounting for the fact that patients have many characteristics that may vary simultaneously. This results in the identification of a more accurate individual prognosis, which is easier to explain compared with conventional staging systems in cancer.…”

An algorithmic approach to the management of peripheral nerve tumours

“…Though downstaging is uncommon in soft tissue sarcomas, biopsy for diagnosis may help to downstage a tumour considered primarily inoperable with neoadjuvant chemotherapy or radiotherapy making surgery possible (Prudner et al., 2020). Calculators such as PERSARC (Personalized Sarcoma Care) aids in the management of primary high grade extremity soft tissue sarcomas and MPNST specific calculators are being developed (Hagenmaier et al., 2021).…”

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

“…57 Notably, the influence of PERSARC extends to treatment decisions in multidisciplinary teams, also enhancing local recurrence predictions. 58 Lastly, via external validation at a single tertiary center, this model led to discrimination between high-and low-risk patients in predicting survival at a specific time point during follow-up. 59…”