Abstract
Introduction
Current practice in the UK is to perform clinical follow up and CXR on patients with sarcomas with the use of cross-sectional imaging reserved for high clinical suspicion of recurrence. We aimed to assess the effectiveness of this policy by investigating patients who developed local recurrence (LR) after previous treatment of a bone or soft tissue sarcoma (STS). Additionally, we aimed to determine whether size and extent of LR at diagnosis of recurrence affected subsequent management.
Method
We reviewed clinical records and imaging of all patients in the previous 5 years (01/01/2005–01/07/2010) with diagnosed LR to investigate: how it was diagnosed, site and size of recurrence and management. A value judgement was made as to whether earlier diagnosis may have altered treatment and/or outcome.
Results
A total of 161 patients were identified; 87 patients with STS and 74 with bone sarcoma. Median time from diagnosis to LR was 27 months for both bone sarcoma and STS, but was shorter for high grade tumours. 115 cases (71%) were identified by the patient, 30 by routine imaging (19%), 15 by a doctor, and 1 by district nurse. Average size at time of LR was 7cm for STS and 8cm for bone sarcomas. 79 of the patients (49%) could have had their LR diagnosed earlier with routine imaging. Of these, 53 would have received the same treatment, but 26 would have had different treatment. Of those, 23 would probably have had a smaller operation and 3 could have avoided amputation.
Discussion
Earlier diagnosis could have led to simpler surgery in 1/3 of those patients with potential to have their LR diagnosed earlier. This raises the question as to whether a more aggressive policy of follow up with regular imaging (either MRI or ultrasound) could detect LR earlier leading to improved outcomes.
