SHOULD SOFT TISSUE SARCOMAS BE TREATED AT A SPECIALIST CENTRE?

Abstract

“Cancer should be treated by cancer specialists” is often stated, but there is little proof that outcomes are different. We have investigated whether there is evidence that patients with soft tissue sarcomas (STS) do better if treated in a specialist centre compared with district general hospitals (DGH).

We analysed the outcomes for all patients with soft tissue sarcomas in one health authority of the UK over a 3 year period, with minimum follow up of 5 years. During this time one third of patients were treated at a specialist musculoskeletal oncology centre whilst the remainder had treatment centred in a DGH. We have investigated appropriateness of treatment, adequacy of surgery, and outcomes in terms of local control and overall survival. Data was obtained from the Cancer Intelligence Unit and the specialist centre. Results were stratified for known risk factors for local control and survival (grade, depth and size for survival).

260 patients were diagnosed as having STS over the 3 year period (incidence = 17.4 per million per year). 37% of patients had the majority of treatment at the specialist centre under the care of 2 surgeons, whilst the other 63% were treated at a total of 38 different hospitals. The most significant factor affecting survival was tumour grade (relative risk 5.5). Overall survival shows that patients treated for STS have greater chance of survival at the ROH. 5 year survival for Stage III tumours was 41% at the ROH, but only 14% at DGHs. Percentage of adequate margins achieved at the DGHs and ROH were approximately equal, but there were significantly more local recurrences at the DGHs (37% DGH vs 20% ROH), suggesting the margins at the ROH are in fact better achieved.

Soft tissue sarcomas are rare. Centralisation of treatment improves survival, local control and patients care.