Influence of specialty and clinical experience on treatment sequencing in the multimodal management of soft tissue extremity sarcoma

Nabil Wasif, Robert M. Tamurian, Scott Christensen, Ly Do, Steve R. Martinez, Steven L. Chen, Robert J. Canter

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: Although multimodal management of extremity soft tissue sarcoma (STS) is the standard of care, considerable variation exists in the sequencing of radiotherapy (RT) or chemotherapy (CT). Our goal was to identify factors responsible for this variation. Methods: Members of specialty societies with an interest in STS were emailed a questionnaire about multimodal treatment of STS. Survey responses were scored on a 5-point Likert scale (1 = always preoperative and 5 = always postoperative) and analyzed by specialty, years in practice, and percentage of practice consisting of STS. Results: The questionnaire was completed by 320 (65%) of 490 physicians, including medical oncologists (18%), radiation oncologists (8%), orthopedic oncologists (22%), surgical oncologists (45%), and others (7%). Respondents were evenly split on the use of neoadjuvant RT (mean 3.03 ± 0.06) and showed a slight preference for neoadjuvant CT (2.89 ± 0.06). Radiation oncologists (2.52 ± 0.18), physicians with a >75% STS practice (2.58 ± 0.17), and those in practice <5 years (2.79 ± 0.12) preferred neoadjuvant RT. Neoadjuvant CT was preferred by orthopedic oncologists (2.62 ± 0.12) and physicians with >75% STS practice (2.51 ± 0.16). Factors influencing the choice for neoadjuvant RT were well-defined treatment volume, increased acute morbidity, and decreased late morbidity, while for CT, they were in-situ disease monitoring and early treatment of micrometastases. Conclusions: Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care.

Original languageEnglish (US)
Pages (from-to)504-510
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Sarcoma
Extremities
Radiotherapy
Therapeutics
Drug Therapy
Morbidity
Physicians
Combined Modality Therapy
Neoplasm Micrometastasis
Standard of Care
Orthopedics
Surveys and Questionnaires
Oncologists

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Influence of specialty and clinical experience on treatment sequencing in the multimodal management of soft tissue extremity sarcoma. / Wasif, Nabil; Tamurian, Robert M.; Christensen, Scott; Do, Ly; Martinez, Steve R.; Chen, Steven L.; Canter, Robert J.

In: Annals of Surgical Oncology, Vol. 19, No. 2, 02.2012, p. 504-510.

Research output: Contribution to journalArticle

Wasif, Nabil ; Tamurian, Robert M. ; Christensen, Scott ; Do, Ly ; Martinez, Steve R. ; Chen, Steven L. ; Canter, Robert J. / Influence of specialty and clinical experience on treatment sequencing in the multimodal management of soft tissue extremity sarcoma. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 2. pp. 504-510.
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abstract = "Purpose: Although multimodal management of extremity soft tissue sarcoma (STS) is the standard of care, considerable variation exists in the sequencing of radiotherapy (RT) or chemotherapy (CT). Our goal was to identify factors responsible for this variation. Methods: Members of specialty societies with an interest in STS were emailed a questionnaire about multimodal treatment of STS. Survey responses were scored on a 5-point Likert scale (1 = always preoperative and 5 = always postoperative) and analyzed by specialty, years in practice, and percentage of practice consisting of STS. Results: The questionnaire was completed by 320 (65{\%}) of 490 physicians, including medical oncologists (18{\%}), radiation oncologists (8{\%}), orthopedic oncologists (22{\%}), surgical oncologists (45{\%}), and others (7{\%}). Respondents were evenly split on the use of neoadjuvant RT (mean 3.03 ± 0.06) and showed a slight preference for neoadjuvant CT (2.89 ± 0.06). Radiation oncologists (2.52 ± 0.18), physicians with a >75{\%} STS practice (2.58 ± 0.17), and those in practice <5 years (2.79 ± 0.12) preferred neoadjuvant RT. Neoadjuvant CT was preferred by orthopedic oncologists (2.62 ± 0.12) and physicians with >75{\%} STS practice (2.51 ± 0.16). Factors influencing the choice for neoadjuvant RT were well-defined treatment volume, increased acute morbidity, and decreased late morbidity, while for CT, they were in-situ disease monitoring and early treatment of micrometastases. Conclusions: Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care.",
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AB - Purpose: Although multimodal management of extremity soft tissue sarcoma (STS) is the standard of care, considerable variation exists in the sequencing of radiotherapy (RT) or chemotherapy (CT). Our goal was to identify factors responsible for this variation. Methods: Members of specialty societies with an interest in STS were emailed a questionnaire about multimodal treatment of STS. Survey responses were scored on a 5-point Likert scale (1 = always preoperative and 5 = always postoperative) and analyzed by specialty, years in practice, and percentage of practice consisting of STS. Results: The questionnaire was completed by 320 (65%) of 490 physicians, including medical oncologists (18%), radiation oncologists (8%), orthopedic oncologists (22%), surgical oncologists (45%), and others (7%). Respondents were evenly split on the use of neoadjuvant RT (mean 3.03 ± 0.06) and showed a slight preference for neoadjuvant CT (2.89 ± 0.06). Radiation oncologists (2.52 ± 0.18), physicians with a >75% STS practice (2.58 ± 0.17), and those in practice <5 years (2.79 ± 0.12) preferred neoadjuvant RT. Neoadjuvant CT was preferred by orthopedic oncologists (2.62 ± 0.12) and physicians with >75% STS practice (2.51 ± 0.16). Factors influencing the choice for neoadjuvant RT were well-defined treatment volume, increased acute morbidity, and decreased late morbidity, while for CT, they were in-situ disease monitoring and early treatment of micrometastases. Conclusions: Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care.

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