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      The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework

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          Abstract

          The rarity of bone and soft tissue sarcoma, the difficulty in interpretation of imaging and histology, the plethora of treatment modalities, and the complexity and intensity of the treatment contribute to the need for systematic multidisciplinary team management of patients with these diseases. An integrated multidisciplinary clinic and team with a structured sarcoma tumor board facilitate team coordination and communication. This paper reviews the rationale for multidisciplinary management of sarcoma and details the operational structure of the Multidisciplinary Sarcoma Clinic and Sarcoma Tumor Board. The structured Multidisciplinary Sarcoma Tumor Board provides opportunity for improvement in logistics, teaching, quality, and enrollment in clinical trials.

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          Most cited references 13

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          Bone cancer.

          Primary bone cancers are extremely rare neoplasms, accounting for fewer than 0.2% of all cancers. The evaluation and treatment of patients with bone cancers requires a multidisciplinary team of physicians, including musculoskeletal, medical, and radiation oncologists, and surgeons and radiologists with demonstrated expertise in the management of these tumors. Long-term surveillance and follow-up are necessary for the management of treatment late effects related to surgery, radiation therapy, and chemotherapy. These guidelines discuss the management of chordoma, giant cell tumor of the bone, and osteosarcoma.
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            Multidisciplinary Management of Soft Tissue Sarcoma

            Soft tissue sarcoma is a rare malignancy, with approximately 11,000 cases per year encountered in the United States. It is primarily encountered in adults but can affect patients of any age. There are many histologic subtypes and the malignancy can be low or high grade. Appropriate staging work up includes a physical exam, advanced imaging, and a carefully planned biopsy. This information is then used to guide the discussion of definitive treatment of the tumor which typically involves surgical resection with a negative margin in addition to neoadjuvant or adjuvant external beam radiation. Advances in imaging and radiation therapy have made limb salvage surgery the standard of care, with local control rates greater than 90% in most modern series. Currently, the role of chemotherapy is not well defined and this treatment is typically reserved for patients with metastatic or recurrent disease and for certain histologic subtypes. The goal of this paper is to review the current state of the art in multidisciplinary management of soft tissue sarcoma.
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              Impact of Unplanned Excision on Prognosis of Patients with Extremity Soft Tissue Sarcoma

              Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and MR was 14.3% and 8.3%, respectively, in patients undergoing first resection, whereas it was 21.4% and 13.7%, respectively, in patients undergoing revision surgery. Average duration from previous unplanned excision was 8 months. Twelve patients were referred immediately after excised specimen revealed STS, while 39 patients presented after evident local recurrence. Wide reexcision was attempted in 48 patients while three patients need amputation. Adjuvant radiotherapy was administered in all patients undergoing limb-sparing surgery. Ten patients needed adjuvant chemotherapy. We conclude that wide reexcision of STS has poorer outcomes compared to planned excision. Therefore, patients with soft tissue masses should be managed by multidisciplinary oncology team at specialized cancer centers.
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                Author and article information

                Journal
                J Multidiscip Healthc
                J Multidiscip Healthc
                Journal of Multidisciplinary Healthcare
                Journal of Multidisciplinary Healthcare
                Dove Medical Press
                1178-2390
                2015
                19 February 2015
                : 8
                : 109-115
                Affiliations
                [1 ]Department of Orthopedics, University of Michigan, Ann Arbor, MI, USA
                [2 ]Department of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
                [3 ]Department of Radiology, University of Michigan, Ann Arbor, MI, USA
                [4 ]Department of Pathology, University of Michigan, Ann Arbor, MI, USA
                [5 ]Department of Radiation, University of Michigan, Ann Arbor, MI, USA
                [6 ]Department of Surgery, University of Michigan, Ann Arbor, MI, USA
                [7 ]Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
                Author notes
                Correspondence: J Sybil Biermann, Department of Orthopedics, University of Michigan, Cancer Center Floor B1 Reception C, 1500 E Medical Center Dr SPC 5912, Ann Arbor, MI 48109, USA, Tel +1 734 647 8902, Fax +1 734 647 8672, Email biermann@ 123456med.umich.edu
                Article
                jmdh-8-109
                10.2147/JMDH.S49805
                4340372
                fbf8bece-c236-4032-b519-d4e2d68f8904
                © 2015 Siegel et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Review

                Medicine

                sarcoma, sarcoma care, sarcoma tumor board, collaborative approach

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