A Review of the British Sarcoma Group Conference 2008
An ESUN Article
Over 150 delegates attended the British Sarcoma Group annual conference held at the Hilton Hotel, Sheffield, on Thursday January 31st and Friday 1st February 2008.
Every clinical discipline was represented and almost all UK specialist treatment centres were represented too. In the best traditions of a multi-disciplinary meeting there were also patients present, notably those representing patient interests in research and those working as advocates in the wider sarcoma community. Four supporting pharmaceutical companies attended and were available to discuss issues with interested delegates. Sadly, through illness, one further company was unable to attend. Two of the sector’s charities were also directly represented.
The first session on Thursday gave 10 minutes each to a number of small research projects which have been undertaken around the country in individual hospitals. This is often the first time a registrar or student has spoken to a professional audience and some interesting debate often follows. The work presented is also interesting as it usually reviews experiences. This year the studies covered retroperitoneal sarcomas, angiosarcoma, endoprostheses, radiotherapy set-up errors, surgery for breast sarcoma and functional outcome in bone tumour surgery.
This was followed by a review of treatment for fibromatosis (Desmoid tumour) continuing a theme from the 2007 event. Mr Andrew Hayes (surgeon) and Professor Ian Judson (oncologist) looked at the surgical and systemic issues from the base of the Royal Marsden’s extensive practice – possibly the largest UK treatment centre. [Photo: Professor Ian Judson discussing issues of systemic treatment for fibromatosis (Desmoid tumour).
[Photo courtesy of Grant Peterson.]
Professor Malcolm Reed who chaired the programme committee for the event had been keen to schedule a review of the work of colleagues at Sheffield University’s Cancer Research Centre. After lunch a session on late-effects of treatments and other associated supportive and palliative care issues proved quite challenging. New ideas came from several speakers, suggesting ways in which current clinical practice might evolve. It was followed by a short review of patient involvement in research, another area where Sheffield and its local cancer network have been leading the development of good practice.
On Thursday, a poster session with 14 selected posters was reviewed. The programme committee awarded a prize to Mr Lee Jeys (a medical student in Birmingham) who worked with a consultant surgeon and others on a research project at the Royal Orthopaedic Hospital in Birmingham.
At the end of the day two educational workshops were held, one on the current VORTEX radiotherapy clinical trial, and one hosted by PharmaMar, presenting its newly licensed drug for second-line, trabectedin (Yondelis). Both were well attended and appreciated by those attending.
The BSG Annual Dinner is held on the first evening of the conference and this year was attended by 93 people and was a relaxed and friendly evening.
Patients and Carers at the BSG dinner (L to R): Karen Delin, Barry Collings, Grant Peterson, Nicky Mellows, Lesley Abraham, Shirley Collings, Peter Jay. Photo courtesy of Grant Peterson.
Two sessions which stand out in the whole conference were those on Friday morning. Mr Rob Grimer (consultant surgeon at ROH Birmingham) led a discussion based on clinical problems, using real cases. Each started with an unusual image from x-ray, CT or MRI scan. In a number of examples opinions around the room did vary and the differing clinical/surgical approaches were discussed, together with the reasons for the differences.
This was followed by an oncology session. Professor Penella Woll (Sheffield) gave a review of adjuvant imatinib therapy for GIST, an area where transatlantic practices differ. The absence of data on overall survival benefit is the main reason that both clinicians and health economies in Europe are taking the adjuvant issue cautiously. Unfortunately the US trial did not have overall survival as an endpoint and its early termination has made retrospective analysis of survival data impossible. Mrs Judith Robinson then followed with a patient viewpoint on adjuvant imatinib, drawing on the views of the patient members of GIST Support UK.
Dr Beatrice Seddon (UCLH) then offered a presentation which is a systematic review of the ‘state of the science’ for uterine leiomyosarcoma. The differing practices of gynae oncologists (for whom sarcoma is a tiny percentage of their workload) and sarcoma oncologists (who have a better all round understanding of these tumours) is a problem faced by patients around the world. The limited value of radiotherapy and of adjuvant chemotherapy, except in specific patients, was touched upon. But perhaps most importantly Dr Seddon also reviewed the value of hormone testing and the use of aromatase inhibitors. Her conclusion was that although only a percentage of ULMS patients show hormone sensitivity, testing should be routine as there is potential benefit for those testing positive from stopping HRT and using aromatase inhibitors to treat recurrence. There is little data and what we have is inconclusive but the potential is there. Mrs Shirley Collings gave a patient viewpoint on uterine leiomyosarcoma. She is a patient who has benefited from an aromatase inhibitor. She welcomed Dr Seddon’s recommendation.
During the break which followed, a number of pathologists and oncologists confirmed that this was an issue they had been watching. Following Dr Seddon’s presentation they will now be working with their colleagues to undertake hormone receptor testing on uterine sarcomas in the future.
Prof Mike Richards, the National Cancer Director for England, gave a presentation on the Cancer Reform Strategy, a topic that is new to many practitioners. The Strategy was launched before Christmas 2007 and sets out some very specific developments which follow up on the success of the Cancer Plan, launched in 2000. Professor Richards was followed by a review of two key issues which mentioned in the Strategy, the treatment of teenage and younger adult patients was considered by Dr Jeremy Whelan (UCLH) and the management of follow-up at a time when the numbers of surviving cancer patients is rapidly increasing (Dr Diana Greenfield from Sheffield University).
The final session started with an educational presentation on histopathology from Dr David Hughes (Sheffield) and went on to look at the development of the National Cancer Intelligence Network from Dr Gill Lawrence of the West Midlands Cancer Intelligence Unit, which is taking the lead role in standardising sarcoma data in the cancer registries. The final presentation was a return to the thorny issue of cost reimbursement to hospitals for complex sarcoma surgery. Mr Mike Robinson (Nottingham) looked at the costs involved in retroperitoneal surgery and concluded that on average hospitals were losing £3500 per patient per year.
There was a lot for delegates to get their minds around. Some headlines:
- We are beginning to understand late effects for patients treated with amputation and endoprostheses and to be able to relate that back to treatment decisions
- The fertility implications of the treatment of younger patients are being addressed but there is a need to review options prior to treatment
- There is a continuing deep need for viable treatments for patients with lung metastases
- Angiosarcoma patients present needs which are not always being well addressed
- The jury is out on adjuvant imatinib for GIST – overall survival data from trials is needed
- Hormone receptor testing for uterine leiomyosarcoma should be standard practice
- With growing survival new approaches to follow-up must be considered
- Implementation of the NICE Improving Outcomes Guidance is proceeding well but there are issues still to be resolved in some regions
- The National Cancer Intelligence Network provides a strong reason for all clinical units to push for data accuracy
The presentations and abstracts of the conference that can be downloaded can be accessed by clicking here.
V5N2 ESUN Copyright © 2008 Liddy Shriver Sarcoma Initiative.