Soft Tissue Sarcomas New Developments In The Multidisciplinary Approach To Treatment

Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology textbooks are generally out of date. Single papers in specialized journals are informative, but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in-depth reviews of cancer topics, and published symposium lectures are often the best overviews available. Unfor tunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes that aim to meet this need. It is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, which is revised frequently to keep the coverage up to date, and which is easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion: first, by dividing the oncology literature into specific subdivisions, such as lung can cer, genitourinary cancer, pediatric oncology, etc.; and second, by asking eminent authorities in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each topic and tumor type is covered in a volume appearing frequently and predictably, discussing current diag nosis, staging, markers, all forms of treatment modalities, basic biology, and more.

One of the major advances of the last decade concerning the treatment of patients with soft tissue sarcomas is that an increased number of patients are being discussed in multidisciplinary teams prior to the initial treatment. The present volume on soft tissue sarcomas in the series Cancer Treatment and Research reflects the multidisciplinary approach with a focus on recent developments. The availability of new histopathologic techniques has reduced the number of unclassified sarcomas and has furhter increased the importance of the histo pathologist in providing estimates of the prognosis of the patient as well as data for the planning of treatment strategy. Further data for this strategy will be provided by diagnostic imaging. In this field, the role of magnetic reson ance imaging has been further defined. Of utmost importance is the recent trend toward consensus in staging. The modification of the staging system of the American Joint Commission for Cancer Staging and End Results Report ing brings the possibility of a single staging system within reach in the next decade. As surgery still provides the only chance for cure, the importance of being the most sparing as possible is obvious. For this reason, radiotherapy has been applied with success. The introduction of relatively new radiation tech niques is therefore being observed with interest.

The previous volume of this series on soft tissue sarcomas highlighted the importance of the multidisciplinary approach to treatment, the focus of which is continued in the present edition. Proper diagnosis and staging remain the cornerstone of the treatment strategy. Sophisticated histopathology techniques and growing consensus on grading systems have further increased the importance of the histopathologist in providing estimates of the prognosis of the patient as well as providing data for the planning of treatment strategy. The use of cytogenetics is relatively new in this field. This might enable the distinction of subgroups in specific histological tumor types. Furthermore, molecular biological studies not only help to reveal inherited predispositions and details in oncogenesis in tumor development, but they may also provide additional predictive factors for tumor behavior. Further data on treatment strategy will be provided by diagnostic imaging, a field in which the role of magnetic resonance imaging is rapidly developing. As far as actual treatment is concerned, surgery still provides the major chance for cure. In view of the endeavor to be as sparing as possible, the addition of radiotherapy to surgery is of utmost importance. Usually radiotherapy is given after surgery, but the optimal sequence of the two modalities still needs to be defined. The combined use of surgery with radiotherapy and/or chemotherapy does have an impact on wound healing.

The purpose of this book is to define and demonstrate how a multidisciplinary team can be organized, integrated, and utilized in the care of sarcoma patients. Real world experiences related by multiple sarcoma specialists working as members of a multidisciplinary team along with specific case examples highlighting sarcomas of bone and soft tissue in children and adults are presented in a framework geared toward practicing oncologists and surgeons in order to foster the creation and development of care teams for sarcoma patients. It is explained how a truly multidisciplinary approach, with "one stop shopping," offers better standardization and delivery of care, streamlines patient education, facilitates discussions and decision making, and provides comprehensive support throughout the treatment process. All aspects of treatment are covered, from first-line treatments for different tumor types through to salvage therapy and the development of novel investigational agents. This book will be of benefit to all members of the medical community who have a role to play in the care of these complex patients, including therapists, nurses, mid-level practitioners, primary care doctors, and subspecialists.

The previous volumes in this series on soft tissue sarcomas highlighted the importance of the multidisciplinary approach to treatment, and this focus is continued in the present volume. Proper diagnosis and staging remain the cornerstone of the treatment strategy. Sophisticated histopathology tech niques and growing consensus on grading systems have further increased the importance of the histopathologist in providing estimates of patient prognosis as well as in providing data for planning the treatment strategy. The use of cytogenetics in this field is rapidly increasing and might enable the distinction of subgroups in specific histological tumor types. Furthermore, molecular biological studies not only help reveal inherited predispositions and details in tumor oncogenesis, but they may also provide additional predictive factors for tumor behavior. Further data on treatment strategy will be provided by diag nostic imaging, and in this volume the value of PET imaging, a relatively new achievement, is highlighted. As far as the actual treatment is concerned, surgery still provides the major opportunity for cure. The addition of radiotherapy to surgery is of utmost importance in efforts to spare as much tissue as possible. The chapters on the planning of radiotherapy, brachytherapy, and the treatment of benign soft tissue lesions using radiotherapy are new contributions to this book. One of the potential late problems of radiotherapy is the occurrence of secondary soft tissue sarcomas, which is discussed in Chapter 10.

This book aims to compile an expert text on the multidisciplinary approach to treating sarcoma at a sarcoma centre. Separate chapters and sections highlight the specialist diagnostic and therapeutic approaches employed in treating bone and soft tissue sarcoma. This comprehensive book covers sarcoma and its management across specialties. It brings together the experience of the editor at a major centre for sarcoma management in Australia along with chapter contributions from various experts on the topic. The real-life, pragmatic approach is a distillation of the evidence and intends to make much of what is written translatable. This book serves as a reference for managing this tumour type and as an indispensable guide for daily use across the spectrum of providers.

Bone and soft tissue sarcomas represent only about 2% of all malignancies; however, their treatment – with the goal of curing the patient while preserving the functionality of the affected body part – can, unlike other malignancies, only be successful with therapy concepts devised by interdisciplinary teams. This volume provides an extensive up-to-date overview of the specific diagnostics and current treatment standards of these rare entities, presenting the various limb-sparing modalities for patients with bone and soft tissue sarcomas with special regard to innovative reconstructive options. The evaluation of quality of life based on validated scores and the individual methods of coping with the illness through creative artistic projects are also acknowledged and integrated in the whole concept.

Clinical trials have two purposes -- to treat the patients in the trial, and to obtain information which increases our understanding of the disease and especially how patients respond to treatment. Statistical design provides a means to achieve both these aims, while statistical data analysis provides methods for extracting useful information from the trial data. Recent advances in statistical computing have enabled statisticians to implement very rapidly a broad array of methods which previously were either impractical or impossible. Biostatisticians are now able to provide much greater support to medical researchers working in both clinical and laboratory settings. As our collective toolkit of techniques for analyzing data has grown, it has become increasingly difficult for biostatisticians to keep up with all the developments in our own field. Recent Advances in Clinical Trial Design and Analysis brings together biostatisticians doing cutting-edge research and explains some of the more recent developments in biostatistics to clinicians and scientists who work in clinical trials.