National guidelines recommend that trauma centres have a designated consultant for managing metastatic bone disease (MBD). No such system exists in Scotland. We compared MBD cases in a trauma hospital to a national bone tumour centre to characterise differences in management and outcome.

Consecutive patients with metastatic proximal femoral lesions referred to a trauma unit and a national sarcoma centre were compared over a seven-year period (minimum follow-up one year).

From Jan 2010-Dec 2016, 195 patients were referred to the trauma unit and 68 to the tumour centre. The trauma unit tended to see older patients (mean 72 vs. 65 years, p<0001) with cancers of poorer prognosis (e.g. 31% 61/195 vs. 13% 9/68 lung primary, p<0.001).

Both units had similar operative rates but patients referred to the tumour centre were more likely to have endoprosthetic reconstruction (EPR 44% tumour vs. 3% trauma centre, p<0.001). Patients with an EPR survived longer than those with other types of fixation (81% 17/21 vs. 31% 35/112 one-year survival, p<0.001). Patients undergoing EPR were more likely to have an isolated metastasis (62% 13/21 vs. 17% 4/24, p<0.001). One patient from each centre had a revision for failed metalwork.

There was a difference in caseload referred to both units, with the tumour centre seeing younger patients with a better prognosis. Patients suitable for endoprostheses were more likely to have isolated metastatic disease and a longer survival after surgery. An MBD pathway is required to ensure such patients are identified and referred for specialist management where appropriate.

The modified Glasgow Prognostic Score (mGPS) is a validated prognostic indicator in various carcinomas as demonstrated by several meta-analyses.

The mGPS includes pre-operative CRP and albumin values to calculate a score from 0–2 that correlates with overall outcome. Scores of 2 are associated with a poorer outcome.

Our aim was to assess if the mGPS is reliable as a prognostic indicator for soft tissue sarcoma (STS) patients.

All patients with a STS diagnosed during years 2010–2014 were identified using our prospectively collected MSK oncology database. We performed a retrospective case note review examining demographics, preoperative blood results and outcomes (no recurrence, local recurrence, metastatic disease and death).

94 patients were included. 56% were female and 53% were over 50 years. 91% of tumours were high grade (Trojani 2/3) and 73% were >5cm. 45 patients had an mGPS score of 0, 16 were mGPS 1 and 33 were mGPS 2. On univariate analysis, an mGPS of 0 or 2 was statically significant with regards to outcome (p=0.012 and p=0.005 respectively).

We have demonstrated that pre-treatment mGPS is an important factor in predicting oncological outcome. A score of 0 relates to an improved prognosis whilst a score of 2 relates to an increased risk of developing metastases and death. mGPS as a prognostic indicator was not affected by either the tumour size or grade.

We believe that a pre-operative mGPS should be calculated to help predict oncological outcome and in turn influence management. Further work is being undertaken with a larger cohort.

Extracorporeal irradiation and re-implantation of a bone segment is a technique employed in bone sarcoma surgery for limb salvage in the setting of reasonable bone stock. There is neither consensus nor rationale given for the dosage of irradiation used in previous studies, with values of up to 300Gy applied. We investigated the influence of extracorporeal irradiation on the elastic and viscoelastic properties of bone. Bone specimens were extracted from mature cattle and subdivided into thirteen groups; twelve groups exposed to increasing levels of irradiation and a control group. The specimens, once irradiated, underwent mechanical testing in saline at 37°C.

Mechanical properties were calculated by experimental means which included Young's Modulus, Poisson's Ratio, Dissipation Factor, Storage Modulus, Loss Modulus and Dynamic Modulus. These were all obtained for comparison of the irradiated specimens to the control group.

We found there to be a statistically significant increase in Poisson's ratio after increasing irradiation doses up to 300Gy were applied. However, there was negligible change in all other mechanical properties of bone that were assessed. Therefore, we conclude that the overall mechanical effect of high levels of extracorporeal irradiation (300Gy) is minute, and can be administered to reduce the risk of malignancy recurrence.

Bone and soft tissue sarcoma is an uncommon. Benign swellings are, however, common. An approach to tertiary referral is required to accommodate the need for specialist interpretation of all concerning referrals, while maintaining an acceptable time to diagnosis and management.

We aim to describe a new tertiary sarcoma service, utilising modern communication technology and the “virtual clinic” model through a multidisciplinary approach.

All suspected musculoskeletal sarcoma cases are discussed, with available history and imaging, in a virtual clinic by a multidisciplinary team within a week of referral. Clinic decisions allow either immediate discharge, progress to further investigation, or clinic appointment.

Data from the first thousand patients was prospectively collected for initial management decision, and final intervention, and in 625 for waiting time. Almost one third of patients were discharged from the virtual clinic without physical appointment. 45% were sent for further investigation prior to first clinic appointment. Of 625 patients with referral data, mean waiting time was 5.1 days to virtual clinic. For malignant bone and soft tissue tumours, not requiring neoadjuvant treatment, median time to surgery from virtual clinic review was 37 and 47 days respectively.

Through a virtual clinic approach to tertiary sarcoma care, almost a third of referrals have been managed quickly without need for an unnecessary appointment. For 45% of patients the first appointment will be after all necessary investigations have been performed to facilitate rapid decision making. This enables shorter clinic waiting times and rapid transition from first referral to definitive management.