SELNET clinical practice guidelines for bone sarcoma

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Global Forum of Cancer Surgeons: Cancer Surgery During the COVID-19 Pandemic: Impact and Lessons Learned

Background

The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of COVID-19 pandemic on cancer surgery.

Methods

A panel session (virtual) was held at the annual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care to address the impact of COVID-19 on cancer surgery globally. Following the virtual meeting, a questionnaire was sent to all the leaders to gather additional opinions. The input obtained from all the leaders was collated and analyzed to understand how cancer surgeons from across the world adapted in real-time to the impact of COVID-19 pandemic.

Results

The surgical oncology leaders noted that the COVID-19 pandemic led to severe disruptions in surgical cancer care across all domains of clinical care, education, and research. Several new changes/protocols associated with increased costs were implemented to deliver safe care. Leaders also noted that preexisting disparities in care were exacerbated, and the pandemic had a detrimental effect on well-being and financial status.

Conclusions

The COVID-19 pandemic has led to severe disruptions in surgical cancer care globally. Leaders of the GFCS opined that new strategies need to be implemented to prepare for any future catastrophic events based on the lessons learned from the current events. The GFCS will embark on developing such a roadmap to ensure that surgical cancer care is preserved in the future regardless of any catastrophic global events.

Surgical treatment in bone metastases in the appendicular skeleton

INTRODUCTION

Metastatic bone disease is the most common neoplastic process that affects the skeletal system. Eighty percent of bone metastases come from carcinomas of the breast, lung, kidney, thyroid and prostate. The Katagiri scale enables an estimation of the survival of patients based on the presence or absence of visceral metastases, multiple bone metastases and functional status according to the ECOG scale.

MATERIAL AND METHODS

A retrospective, descriptive and observational study conducted between March 1, 2013 and June 30, 2015. Thirty-two patients were studied with a diagnosis of metastatic bone disease and who had undergone some type of orthopaedic surgical treatment for pathological fracture or impending fracture.

RESULTS

28 cases (87.5%) presented pathological fracture and 4 cases (12.5%) impending fracture according to the Mirels score. Fifteen cases (46.875%) were treated by placing a central medullary nail + spacer in the long bone diaphysis, 15 cases (46.875%) with modular arthroplasties and 2 patients (6.25%) with forequarter amputation. Eleven patients (34.375%) died during the course of this study, all with a Katagiri greater than or equal to 4.

DISCUSSION

The presence of a fracture in previously damaged territory is a catastrophic complication for most cancer patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent errors and failures in treatment.

Chemotherapy alternating gemcitabine and cisplatin concomitant with radiotherapy in locally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN)

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Background: In the Pignon’s meta-analysis, the OS benefit was 8% with chemoradiation in LA SCCHN. Unfortunately it is still unclear what scheme is the best, cisplatin (CDDP) being the most widely used drug. Other drugs such as gemcitabine (GMZ) has promising results, although toxicity has been severe but tolerable. We have published an initial study using GMZ and radiotherapy (ann oncol. 2004;15:301). In the present study we wished to determine if a scheme in which GMZ is alternated with CDDP and concomitant radiotherapy reduced toxicity yet maintains our previously described therapeutic effectiveness. This is a preliminary report with a short follow-up period. Methods: Inclusion criteria: patients with SCCHN (EC: III, IVa and IVb ) or with recurring disease, and no sytemic metastases or patients rejection of surgery between 03/2003 and 09/2004. Chemotherapy scheme consisted of GMZ at 100 mg/m2 once a w, ws 1, 3, 5, 7 and CDDP at 50 mg/m2 once a w, ws 2, 4, y 6. Radiotherapy consisted of 2 Gy/day, for a total of 70 Gy during the 7 ws. Toxicity evaluation focused on mucositis, xerostomia, dysphagia y leukopenia. Results: 28 patients were treated. 7 (25%)/ stage III, 11 (39.3%) IVa, 10 (35.7%) IVb. The tumor sites distribution was as follows: 9 patients with oropharynx and larynx disease (32.1%), 6 patients with oral cavity disease (21.4%), 3 patients with paranasal sinus disease (10.7%), and 1 hypopharinx (3.5%). A CCR was observed in 21 patients (75%), a partial response was observed in 5 patients (17%). Organ preservation was achieved in 68% of the patients. Toxicity: mucositis Grade 3–4 was in 42% of patients, leucopenia grade III in 29%, dysphagia in 19% and xerostomia in 10%. 40%of the patients stopped treatment for one or two weeks due to toxicity without affecting the doses of both treatments. Conclusions: The scheme with alternating GMZ and CDDP concomitant with radiotherapy is safe and effective. We observed a lower incidence in mucositis and few systemic toxic effects. Our findings support further studies in which alternating chemotherapeutic schemes are utilized given that tumor response is increased without an increment in toxicity.

No significant financial relationships to disclose.