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Soft tissue sarcoma in children, adolescents and young adults: Outcomes according to compliance with international initial care guidelines
- Source :
- EJSO-European Journal of Surgical Oncology, EJSO-European Journal of Surgical Oncology, WB Saunders, 2020, 46, pp.1277-1286. ⟨10.1016/j.ejso.2019.11.518⟩
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Outcomes for adults with soft tissue sarcoma are better when managed at referral centers. Care guidelines advise for 5 main criteria: 1-Imaging before biopsy; 2-Tumor biopsy before surgery; 3-Multidiscipinary team discussion (MTD) before biopsy; 4-Biopsy in "expert centers"; 5-Somatic molecular biology feasible. The aim is to describe and assess the prognostic impact of initial management of STS according to the type of referring centers and the number of optimal criteria.Monocentric retrospective analysis of the management of 127 youths (0-25 years) with localized STS treated from 2006 to 2015.Median age at diagnosis was 9.6 years (range: 025). Overall, only 41% patients had 5/5, 28% 3-4, 31% ≤2. No adequate imaging was performed before surgery/biopsy for 18% patients, no biopsy before treatment for 29%. Patients referred by "expert centers" had higher compliance to guidelines (P = 0.025). Upfront surgery was performed in 59/127 patients. Immediate re-operation was inversely related to the number of criteria (0% when 5 criteria vs. 14% for 3-4, 46% if ≤ 2; P 0.001). For malignant tumors, outcome was better when 5 criteria were reached: 5 year EFS 90.8% (81.4-100.0%) vs. 71.6 for (60.4-84.9%; ≤4 criteria; p = 0.033), OS 93.6% (85.5-100%) vs. 79.5% (68.9-91.8%; p = 0.11), and LRFFS 90.6% (81.0-100.0) vs. 73.1% (62.0-86.3%; p = 0.047).Less than half of the youths with STS are initially managed according to international guidelines, highlighting the need for better information about optimal management. These results plead for immediate management in reference centers to reduce initial burden of therapy.
- Subjects :
- Male
0301 basic medicine
Pediatrics
Biopsy
[SDV]Life Sciences [q-bio]
Age at diagnosis
Soft Tissue Neoplasms
0302 clinical medicine
Medicine
Young adult
Child
Referral and Consultation
ComputingMilieux_MISCELLANEOUS
medicine.diagnostic_test
Soft tissue sarcoma
Sarcoma
General Medicine
Neoadjuvant Therapy
Optimal management
3. Good health
Survival Rate
Treatment Outcome
Oncology
Chemotherapy, Adjuvant
Child, Preschool
030220 oncology & carcinogenesis
Practice Guidelines as Topic
Female
Guideline Adherence
Adult
Reoperation
medicine.medical_specialty
Adolescent
Referral
Cancer Care Facilities
Young Adult
03 medical and health sciences
Humans
Retrospective Studies
Patient Care Team
business.industry
Infant, Newborn
Infant
medicine.disease
Pediatric cancer
030104 developmental biology
Early adolescents
Radiotherapy, Adjuvant
Surgery
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 07487983
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- European Journal of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....fb729a22298c2980e85de8661bf5cf22
- Full Text :
- https://doi.org/10.1016/j.ejso.2019.11.518