UK Guidelines for the Management of Bone Sarcomas

Grimer, R. J.; Athanasou, Nick; Gerrand, Craig; Judson, Ian; Lewis, Ian; Morland, Bruce; Peake, D.; Seddon, Beatrice; Whelan, Jeremy

doi:10.1155/2010/317462

Cited by 58 publications

(105 citation statements)

References 95 publications

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“…This retrospective study queried a longitudinally maintained (10), angiosarcoma (seven), and others (12). Three hundred twenty-three patients received chemotherapy and 35 were treated with radiotherapy (18 CSA, eight OSA, six Ewing's, and one each of fibrosarcoma, undifferentiated pleomorphic sarcoma, and other) [10].…”

Section: Methodsmentioning

confidence: 99%

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Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed. Questions/purposes The purposes of this study were to (1) describe the frequency and timing of local recurrence by histologic grade over time; (2) describe the frequency and timing of metastasis by histologic grade and diagnosis over time; and (3) use these data to either justify current surveillance schedules and/or propose modifications that may improve the rate of new pulmonary metastatic events detected per examination. Methods A retrospective review was performed of all patients who underwent resection of a primary, nonmetastatic bone sarcoma (excluding chordoma) at a single tertiary oncology center from 1989 to 2010. Of the 680 patients identified, 15 were excluded for loss of followup in the first 2 years, leaving 665 eligible for study. Of these, 437 patients were alive with no evidence of disease at the conclusion of the study (mean followup, 136 months; range, 25-321 months). Cox regression analysis was performed to evaluate and control for patient age, tumor size, tumor location, and surgical margins. With patients stratified by sarcoma grade, Kaplan-Meier survival curves were constructed for the endpoints of local recurrence and metastasis, and log-rank tests were used to compare the rates of these events between grades and diagnoses. The number of new pulmonary metastatic events per patientyear was calculated for each sarcoma grade over the time intervals used in current surveillance protocols (0-2, 2-5, 5-10, and [ 10 years) to facilitate development of a surveillance schedule that would maximize events detected per imaging study performed. In addition, to determine the effect of disease type, subset analysis was performed for osteosarcoma (OSA) and chondrosarcoma because these were the only diagnoses with sufficient numbers to support individual statistical analysis. Results With the numbers available for study, the overall local recurrence-free survival did not differ between sarcoma grades at any time points (p = 0.864). Metastasis-free survival curves differed between sarcoma grades (p \ 0.001), and the pattern of Grade 2 OSA metastasis was more consistent with other Grade 3 sarcomas, so it was

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Section: Methodsmentioning

confidence: 99%

“…However, the authors also acknowledge that ''strict rules cannot be provided in the absence of any formal validation,'' and the British Sarcoma Group echoes that ''there is an urgent need for research'' [12]. The National Cancer Institute recommends some form of chest imaging as followup but specifies neither modality nor timing.…”

Section: Introductionmentioning

confidence: 99%

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Treatment decisions were made by a multidisciplinary team according to United Kingdom guidelines. 11 All patients in our series had surgical resection designed to achieve clear margins, followed by radiotherapy for histological high grade, large or deep tumours.…”

Section: Methodsmentioning

confidence: 99%

Outcome of soft-tissue sarcoma patients who were alive and event-free more than five years after initial treatment

Nakamura

Grimer

Carter

et al. 2013

The Bone & Joint Journal

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We evaluated the risk of late relapse and further outcome in patients with soft-tissue sarcomas who were alive and event-free more than five years after initial treatment. From our database we identified 1912 patients with these pathologies treated between 1980 and 2006. Of these 1912 patients, 603 were alive and event-free more than five years after initial treatment and we retrospectively reviewed them. The mean age of this group was 48 years (4 to 94) and 340 were men. The mean follow-up was 106 months (60 to 336). Of the original cohort, 582 (97%) were alive at final follow-up. The disease-specific survival was 96.4% (95% confidence interval (CI) 94.4 to 98.3) at ten years and 92.9% (95% CI 89 to 96.8) at 15 years. The rate of late relapse was 6.3% (38 of 603). The ten- and 15-year event-free rates were 93.2% (95% CI 90.8 to 95.7) and 86.1% (95% CI 80.2 to 92.1), respectively. Multivariate analysis showed that tumour size and tumour grade remained independent predictors of events. In spite of further treatment, 19 of the 38 patients died of sarcoma. The three- and five-year survival rates after the late relapse were 56.2% (95% CI 39.5 to 73.3) and 43.2% (95% CI 24.7 to 61.7), respectively, with a median survival time of 46 months. Patients with soft-tissue sarcoma, especially if large, require long-term follow-up, especially as they have moderate potential to have their disease controlled.

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“…It is essential that the approach to biopsy is carefully considered because all of the tissues contaminated by the biopsy and its tract must later be removed during definitive therapy. 49 …”

Section: Initial Diagnostic Work-upmentioning

confidence: 99%