(P 204) PERCEPTIONS AND MANAGEMENT PRACTICES OF SARCOMA EXPERTS ABOUT SOFT TISSUE SARCOMA PATIENTS WITH ISOLATED LUNG METASTASES ACROSS EUROPE

Objective: Management of soft tissue sarcoma (STS) with isolated lung metastases poses a challenge, and no controlled comparative data exist regarding optimal treatment strategy. The lack of formal prospective controlled evidence hampers the possibility for informed therapeutic recommendations from the physician, as well as decision making for the patients. In addition, comparison of different approaches is hindered by the heterogeneity of the data available. Our aim was to map different practices and institutional traditions regarding management of isolated lung metastases of STS across different European countries with varying healthcare systems.

Methods: An online, anonymous survey was disseminated in 11 countries with the help of contact persons in the Scandinavian Sarcoma Group (SSG), the Spanish Group of Research in Sarcoma (GEIS), the Italian Sarcoma Group (ISG), the Greek Sarcoma Group and contact persons in different countries. The survey consisted of 20 questions, including demographics of the responders, general perceptions regarding lung metastases in STS and finally the respondents´ preferred approach on typical case scenarios that were provided as examples.

Results: In total 113 persons responded. There was a male overrepresentation (64% versus 36%), while 60% of the responders have been working with sarcoma patients for 10 years or more and 39% were  50 years old. Table 1 presents country distribution of the responders. The majority (n=80; 71%) were oncologists (medical or clinical) with a lesser proportion from surgical specialties (Table 2). N=67 (59%) reported newly diagnosed lung metastases to be regularly discussed at a multidisciplinary conference (MDT). Regarding the best approach, 41% replied that “any of the following would be a valuable option: active surveillance, surgery, external beam (EBRT) or stereotactic radiotherapy (SBRT) or chemotherapy” (Table 3). The number of metastases (97%), time from diagnosis to development of metastases (84%) and histologic type of sarcoma (83%) were the three most common factors reported to be considered when deciding on treatment strategy (responders could choose more than one factor of importance). Age was the least considered factor with 59% (n=67), whereas fitness for thoracic surgery was more important (80%). When asked to define early relapse, two-thirds of the responders classified as “early relapse” the cases in which lung metastases occur within six months from primary tumor surgery, either taking into consideration time from completion of potential adjuvant chemotherapy (44%) or an absolute interval of max 6 months, regardless chemotherapy (21%). Some typical case scenarios were provided requesting a reply on what would be the best management, with varying responses. Finally, when asked to assess the quality of the available evidence to support deciding on the optimal approach (more than one answer was possible), 67% reported that more evidence would be required, 44% supports a consensus meeting to define upon best practice would be required, while 8% considered available evidence sufficient to guide therapeutic decisions in this setting.

Conclusion: Although there seems to be some agreement on some aspects, there is still heterogeneity on how the patients with STS and newly diagnosed isolated lung metastases are assessed and, managed. The majority of the responders agreed on a lack of robust data, which probably plays an important role in the heterogeneity of management reflected by the survey. There is undoubtably a need for the community to work out consensus recommendations, if possible, and, not least, to develop collaborations aiming to improve available evidence. The survey is still open and available for more responders at https://survey.ki.se/21285.

Table 1.docx

Table 2.docx

Table 3.docx