Should Soft Tissue Sarcomas be Treated at a Specialist Centre?

Abstract

Objective. We have investigated whether there is evidence that patients with soft tissue sarcomas do better if treated in a specialist centre compared with district general hospitals.Patients. All patients diagnosed with soft tissue sarcomas who were residents of WMRHA between 1994 and 1996, with minimum follow up of 5 years, excluding head and neck or retroperitoneal tumors.Methods. We reviewed data from the Royal Orthopaedic Hospital Oncology Service (ROHOS) database and the Cancer Intelligence Unit (CIU) Database, with medial record review where necessary. Main outcome measures were local recurrence and overall survival.Results. A total of 260 patients were diagnosed as having STS over the 3-year period (incidence=1.62per 100000 per year): 37% of patients had the majority of treatment at the specialist centre under the care of three surgeons, whilst the other 63% were treated at a total of 38 different hospitals. The rate of local recurrence was 39% at the district general hospitals compared with 19% at the specialist centre despite the fact that tumours treated at the district hospitals were smaller and of lower grade. The most significant factors affecting survival were grade (high versus low) and depth of the tumour. Patients treated at the specialist centre had a small survival advantage after multivariate testing.Conclusion. Soft tissue sarcomas are rare. Centralization of treatment improves local control in all patients and survival in some. Appropriate mechanisms for ensuring that patients with soft tissue sarcomas are seen and treated at specialist centres should be developed.