From: "Dr. D. Kossove" <doctordee@telkomsa.net>
Subject: !treatment at specialty centers
Date: Thursday, January 22, 2004 3:14 PM

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View..ShowSection&rid=cmed.section.32473


Treatment at Specialty Centers

Evolution in soft-tissue sarcoma management has occurred in part through the development of multi-disciplinary groups that combine subspecialty expertise in diagnostic imaging, pathology, and surgical, radiation, and medical oncology. Coupled with a better understanding of tumor growth characteristics and availability of new imaging capability with CT and MRI, there is no reason why patients should not benefit from available expertise in this rare disease. Gustafson et al. compared patients referred to a specialty center before surgery (195 cases), following surgery (102 cases), and those not referred for specialty consultation (78 cases). This work examined a Swedish population-based series of primary soft-tissue sarcoma of extremity (329 cases) or trunk (46 cases). 294 The combined number of primary tumor operations was 1.4 times higher in patients not referred and 1.7 times higher in patients referred after surgery compared to patients referred to a specialty center prior to any surgery. Moreover, the local recurrence was 2.4 times higher in the group not referred and 1.3 times higher in the group only referred to the specialty center following an initial surgery. Clasby and colleagues reporting from a single large health region in the United Kingdom, also noted inappropriate surgery, including unnecessary amputation. In addition, much of the surgery was performed by trainees, and in two-thirds of cases the resection margins were unsatisfactory. 295 In another U.K. study, disappointing results were obtained in a region during a period of time devoid of a dedicated sarcoma unit, which prompted recommendation to introduce multi-disciplinary care.296 Such a recommendation has been suggested by others also. 297 299  