Impact of subspecialty, clinical volume, and years of practice in selection of treatment sequencing in the management of localized extremity soft tissue sarcoma.

Abstract

10085 Background: Although the treatment of localized extremity soft tissue sarcoma (STS) is multimodality in nature, considerable variation exists in the use and timing of radiation (RT) and chemotherapy in relation to surgical resection. Our objective was to identify factors responsible for this variation. Methods: A questionnaire was emailed to active members of ASCO who specialize in the management of STS. Questions pertained to the multimodality management of STS. Survey responses were scored on a five-point Likert scale. Means were compared using independent samples ANOVA with post-hoc Bonferroni correction as indicated. Results: The questionnaire was viewed by 490 potential respondents and completed by 320 (65%). Respondents self-identified by specialty: Medical Oncology (18%), Radiation Oncology (8%), Surgeons (67%), and Other (7%). Sarcoma volume in relation to overall clinical practice comprised: >75% (12%), 25-75% (39%), and <25% (49%). Respondents were evenly distributed on the use of preoperative versus postoperative radiation (mean 3.03 ± 0.06), a decision not influenced by specialty. However, physicians with a >75% STS practice preferred preoperative RT compared to those with <25% (2.58 ± 0.17 vs. 3.19 ± 0.08, p 0.003). Similarly, physicians in practice <5 years preferred preoperative RT compared to those in practice >15 years (2.79 ± 0.12 vs. 3.21 ± 0.09, p 0.025). Factors identified as being important in receipt of RT included tumor size >10cm, high grade, positive margins and proximity to neurovascular bundle. Overall, respondents preferred preoperative chemotherapy (mean 2.89 ± 0.06). No significant difference existed by specialty or years in practice. Physicians with >75% STS practice preferred preoperative chemotherapy compared to those with <25% (2.51 ± 0.16 vs. 3.22 ± 0.07, p <0.001). Factors important for chemotherapy were tumor size >10cm, high grade, age <50, and synovial sarcoma histology. Conclusions: Treatment sequencing in the management of STS is influenced by clinical volume and years in practice but not by physician specialty. This may reflect the recent trend towards regionalization of multimodality STS care. No significant financial relationships to disclose.