The Importance of Treatment at a Specialty Center for Sarcomas

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There are numerous and important reasons why someone who has been diagnosed with sarcoma should be treated at a center where there is an interdisciplinary medical team that has experience in treating this rare disease.

Let's say you've received a new diagnosis of sarcoma. You have an initial diagnosis, as well as an expert second opinion to fine-tune that diagnosis, and are now faced with the decision of where to have your treatment. Understandably, most patients like you would prefer to be treated someplace close to home, perhaps at a local oncology clinic recommended by close friends, co-workers or relatives, who had good experiences using locally available medical services. However, when it comes to the treatment of sarcomas, the advice of the experts is to take the leap and find your way to a major medical center with a specialty in treating rare, life-threatening sarcomas.

Success Rates at Sarcoma Centers

Video: Sarcoma Centers

In a meticulous review of 4,205 sarcoma case records covering a 20-year period, researchers at the University of Miami School of Medicine found significantly higher success rates for patients treated at major sarcoma centers. The study entitled, "Should Soft Tissue Sarcomas Be Treated at High-volume Centers? An Analysis of 4205 Patients," compares patient demographics; tumor type, size and location; and therapy given at low volume (LVC) and high-volume (HVC) medical facilities.1 Patients seen at HVC were in more critical condition than those treated at the LVC, having higher-grade tumors and correspondingly worse prognoses. Yet, patients treated at the HVC had better outcomes than their less critical counterparts treated at LVC. Patients treated at HVC were offered a broader range of treatment options, including radiation and chemotherapy in addition to surgery. The study states "a greater proportion of patients treated at HVC received radiation therapy (43% vs 24.2%, P < 0.001) and chemotherapy (14.7% vs. 6.3%, P < 0.001)."1 The addition of radiation and chemotherapy is credited with the better outcomes for these patients.

Not only did patients at HVC benefit from the use of a combination of therapies, those who had sarcomas in their extremities were also less likely to have amputations. LVC amputated 13.8% of the time, in contrast to 9.4% at HVC, where doctors have more experience with limb preservation strategies.1 While this might not, at first glance, seem like a large margin, for those who are able to complete their cancer treatments without the loss of life or limb, this is huge!

What would explain this disparity? According to the authors, "STSs are rare. This paucity leaves most healthcare institutions with low case volumes and outdated or inadequate resources, which impede the ability to offer optimal treatment of these rare and often complicated tumors."1

Whoops Surgeries

A study in the UK finds that "The most significant factors affecting survival were grade (high versus low) and depth of the tumour" and the expertise of the treatment center.2 In this study, the argument is made that patients have better outcomes at large hospital centers largely because local control is much better.2 In performing surgery to remove a sarcoma, it is extremely important to remove the entire tumor and surrounding tissue to achieve a wide margin between cancerous cells and healthy tissue. There's even a name for one of the common errors, in which the surgeon performs a "whoops" procedure.2 According to the authors, "This is when a lump is excised, usually with little forethought and without a biopsy and the surgeon is then surprised when the pathologist reports it as a sarcoma (hence the term 'whoops') .... most authors now agree that wide re-excision to obtain clear margins is necessary as residual tumour will be found in anything between 30 and 60% of cases."2 Needless to say, one surgery is preferable to two surgeries especially where the second one is totally avoidable. Local recurrence (LR) rates are much lower when the surgery is done correctly.

Local Recurrence and Sarcoma Centers

Video: Sarcoma Centers

As the UK study states, "Patients with an adequate excision had a LR rate of 26% compared to a 40% risk in patients with an inadequate excision."2 This study concludes, as did the previous study above, that patients should be referred exclusively to specialized medical centers that see a high volume of rare cancers "for optimal treatment, survival and functional outcome."1,2

Fritz Eilber and Frederick Eilber of the University of California Los Angeles School of Medicine further underscore the importance of avoiding recurrence due to the use of incorrect surgical procedures. In their article "Surgical Management of Soft Tissue Tumors: Avoiding the Pitfalls," they conclude, "The optimal treatment of locally recurrent disease is to prevent it, which necessitates aggressive surgical treatment of the primary disease, because adjuvant therapies cannot compensate for inadequate surgery."3 The best way to avoid surgical errors for rare tumors (and all sarcomas are rare) is to be treated at a specialty center with an experienced multidisciplinary team.1-3

Some Additional Considerations

In addition to the benefits of experienced medical teams, reduced surgical risk and documented lower local recurrence rates, other factors to consider in selecting a treatment center include:

  • Use of precise diagnostic methods before treatment begins.
  • Knowledgeable staff that will counsel patients in making decisions not directly related to their cancer treatments, such as pre-treatment fertility choices.
  • Increased odds of being offered the latest, targeted therapies.
  • Availability of promising clinical trials.

Patients evaluating treatment centers should also know that even the best sarcoma centers may not inform patients of, or offer to refer patients to, outside facilities for specialized services that are only available in a limited number of locations. For example, according to The National Association for Proton Therapy, proton beam therapy, an effective treatment for some sarcomas, is only available at 5 sites within the United States. A hospital that has its own IMRT (Intensity-Modulated Radiation Therapy) technology is likely to encourage patients to use IMRT rather than go elsewhere in order to receive proton beam therapy. Patients wanting to know about a wide range of treatment options should make sure they get second opinions from more than one institution and do some research ahead of time regarding the therapies offered at each one.

Given this body of evidence that treatment at an HVC is superior to that at local facilities, British researchers did a study to find out why patients didn't find their way to sarcoma centers more quickly.4 The authors of "Delays in Referral of Soft Tissue Sarcomas" begin with the premise that "It is well established that soft tissue sarcomas are more effectively treated in a specialist centre."4 They go on to produce an involved analysis of patient demographics, key dates in patient contact with medical professionals and the type of initial treatments provided. The patients were rarely found to be the cause of extended delays, as the authors note "although some patients are more willing to tolerate symptoms, in general, patients present quickly to a medical professional and therefore do not contribute significantly to delay in reaching a specialist centre for treatment."4 In other words, people with life-threatening sarcomas are not ignoring sound medical advice; they often aren't receiving it in the first place! The researchers ultimately establish that medical professionals are responsible for most delays, primarily because they lack knowledge of published cancer treatment guidelines.4

Summary

Patients need help finding the right place of treatment. Online sarcoma self-help and support groups are two methods that patients are using to find their way to sarcoma centers. Patients depend on the medical professionals around them to tell them the truth about their condition and what they have to do to combat it, even when it means leaving a familiar local practice for the big city hospital centers. They also need help understanding that sarcoma-related clinical trials are not all wild experiments, but may be the fastest route to remission. And if you are that sarcoma patient, you do deserve nothing but the best!

by Elizabeth Goldstein-Rice
Last revised: 12/2008
Last medical review: 12/2008

References

1. "Should Soft Tissue Sarcomas Be Treated at High-volume Centers? An Analysis of 4205 Patients", by Juan C. Gutierrez, MD, Eduardo A. Perez, MD, Frederick L. Moffat, MD, Alan S. Livingstone, MD, Dido Franceschi, MD, and Leonidas G. Koniaris, MD, Annals of Surgery, Volume 245, Number 6, June 2007.

2. "Should Soft Tissue Sarcomas be Treated at a Specialist Centre?", by A. A. Bhangu, J. A. S. Beard, and R. J. Grimer, Sarcoma, V. 8 (2004), Issue 1, Pages 1-6.

3. "Surgical Management of Soft Tissue Tumors: Avoiding the Pitfalls", By Fritz C. Eilber, MD, and Frederick R. Eilber, MD, American Society of Clinical Oncology Educational Book. ASCO 2005.

4. "Delays in Referral of Soft Tissue Sarcomas", by G. D. Johnson, G. Smith, A. Dramis, and R. J. Grimer, Sarcoma, V. 2008, Article ID 378574, 7 pages.

V5N6 ESUN. Copyright © 2008 Liddy Shriver Sarcoma Initiative.

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The Importance of Second Opinions for Sarcoma

Because sarcoma is a rare cancer, most physicians may only encounter a few instances of it in their lifetime, if any at all. Patients need to be diagnosed and treated by physicians and interdisciplinary teams that have experience with sarcomas. If you are diagnosed with sarcoma, we encourage you to obtain a second opinion about your initial diagnosis and your proposed treatment plan from a sarcoma center. Good physicians are not offended when patients seek a second opinion about a rare cancer; it is fairly standard procedure. Moreover, some insurance companies require a second opinion before they will reimburse costs for a proposed treatment plan.

Patients, family and caregivers dealing with cancer get advice from a lot of people. They get advice about their eating habits (where to buy food, how to cook it, what’s healthy, and what’s not), their lifestyles (not enough of this, too much of that, too dangerous, too sedentary), the way they manage changes to their bodies (especially their hair! wig, no wig?) and how to settle their affairs (not just legally, but with the great beyond).

They also get advice regarding whether or not they should get a second opinion. While getting a second opinion is generally considered a useful thing to do, there is a common misconception that it is a time-consuming and possibly expensive activity that often produces no change to treatment plans or long-term prognosis. However, several studies show that, for sarcoma patients, getting input from more than one medical professional can indeed make a difference, not only in medical decision-making, but also in the patient’s ultimate outcome. This article examines evidence which proves the value of obtaining a second opinion from a sarcoma specialist at critical junctures in the diagnosis and treatment of sarcoma.

Second Opinion of the Initial Diagnosis

Video: Second Opinions for Sarcoma

Once a lesion has been determined to be a tumor that requires further evaluation, the patient’s journey begins. Getting a precise clinical assessment and finding out the exact type of a tumor is essential in getting patients onto the right treatment path quickly. The ideal time for a second consultation is before any incision has been made into the tumor.

In a 2005 article "Surgical Management of Soft Tissue Tumors: Avoiding the Pitfalls,"Drs. Fritz and Frederick Eilber of the UCLA School of Medicine state that, "In the presence of any clinical features that raise the suspicion of a sarcoma, appropriate cross-sectional imaging and tissue diagnosis are critical in guiding additional care." They go on to specify that "CT-guided core biopsy is the best method to obtain an accurate tissue diagnosis."1 Because the biopsy is guided by CT imaging, surgeons are able to collect samples with precision, improving the accuracy of the initial diagnosis.1 The view that excisional biopsy is superior to needle biopsy is at best controversial and not reflective of practice at most major centers.

The authors of a study conducted by researchers at St Thomas Hospital in London, England link the use of excisional biopsies (in which an attempt is made to remove the entire lesion or tumor), instead of needle biopsies, to contamination of surrounding tissue, making it difficult to ensure that sufficient margins are achieved during initial surgery for soft tissue sarcoma.2

Video: Second Opinons for Sarcoma

Further support for a second opinion of an initial diagnosis is found in a study of over 600 patients having sarcoma-related surgery at BG University Hospital Bergmannsheil in Bochum, Germany.3 The researchers first note the difficulty in obtaining a definitive diagnosis for soft tissue sarcoma because there are so many different types, stating "approximately 50 different histological subtypes of soft tissue sarcomas have been described."3 The results of their study reveal how important it is that the diagnosing pathologist has experience with the pathology of sarcoma. The findings of expert second opinions agreed with those of the primary diagnosis, by non-expert pathologists, as follows:

Comparing Initial Diagnosis with Expert Second Opinion
Type of Initial 
Diagnosing Institution
% Concordant with Expert Second Opinion
Private Clinics 28.3%
Hospitals 29.6%
Academic Medical Centers 36.8%
Department of Pathology at BG University Hospital 70.5%

These results make a striking case for review of initial diagnosis before treatment is selected. Regarding treatment, one popular web-based medical information resource, WebMD, lists a rare cancers diagnosis as the number one reason to see a specialist for a second opinion on the diagnosis. "After all," the authors state "the diagnosis will determine which treatment is best."4

Another very interesting study advocates for mandatory second opinions of the original tissue samples before any treatment is given. This study, "Mandatory Second Opinion Surgical Pathology at a Large Referral Hospital" was conducted at John Hopkins Medical Institution in Baltimore, MD. In this study, a changed diagnosis was defined as one that "resulted in a significant change in therapy or prognosis."5 It found not only that, "Of 6,171 cases reviewed, second opinion surgical pathology resulted in 86 changed diagnosis (1.4%)", but also estimates that "The financial benefit averaged $2-4 saved for every $1 spent to obtain the second opinion!"5

The studies discussed above certainly make the case that initial diagnoses can be wrong and should be double-checked. The question then becomes: what difference does it make if a sarcoma diagnosis is a bit off, maybe just in the determination of subtype or grade? How different are sarcoma treatment protocols? Are these differences significant? We will now address these questions.

The Impact of the Diagnosis on the Treatment Plan

Indeed, one significant risk of an incorrect or imprecise diagnosis is the impact on the treatment plan, including the choice to employ chemotherapy, whether to radiate, if and when to perform surgery and the surgical method to be used.

An area of particular concern is the risk of surgical error in the initial surgery done to remove the primary tumor. In the study "Surgical Resection of Primary Soft-Tissue Sarcoma," researchers from St Thomas’ Hospital in London examine records of patients who had previously undergone surgery to remove sarcoma tumors, but then had to have additional surgery because the initial surgery failed to remove all of the sarcoma cells from the area around the tumor.2 Of the patients studied, over 56% were found to have residual tumor and 33% had tumors visible to the naked eye.2 How does this happen?

What they found was that the first surgery had often used what is called a "shell out" procedure, done without having first obtained a complete pathological diagnosis.2 They state "… the commonest reason was surgical excision without a prior biopsy for histological diagnosis, and … this had led to the use of a shell-out procedure."2 The shell-out procedure is a surgical method used for benign tumors that are well-defined masses. They’re easy to scoop out along the existing division between the tumor and the healthy tissue around it. Because some sarcomas look as if they have clear boundaries, surgeons can get the misleading impression that the tumor is benign and that it can safely be removed along its borders without excising additional tissue around it.2 That study concludes, in part, that "surgical assessment of the adequacy of excision is very inaccurate and that most local recurrences are the consequence of inadequate primary surgery."2

The National Comprehensive Cancer Network provides Clinical Practice Guidelines in Oncology, which are detailed yet concise planning documents that are extremely useful in understanding how decisions are made in the management of sarcoma therapy.6-7 The guidelines cover the various activities and principles associated with sarcoma treatment, including initial diagnostic evaluation, primary treatment, pre- and post- surgical therapy, radiation therapy, chemotherapy, progressive and recurrent disease, and follow-up.6 Unique guidelines exist for soft tissue sarcomas of the extremities, retroperitoneal/abdominal, intra-abdominal and desmoid types.6 For bone-related sarcomas, there are separate guidelines for chondrosarcoma, Ewing’s sarcoma, osteosarcoma, plus some variants.7 Even a quick overview of these guidelines makes it clear that the assessments of the disease must be accurate in order for treatment based on these guidelines to be effective.

Financial Assistance for Second Opinions

Patients, caregivers and families grappling with the enormity of their diagnosis and the strain of day-to-day care may not believe they have the means or the energy to advocate on their own behalf and actively search for the best source(s) of a second opinion.  However, help is available.  Sarcoma support groups are great resources to get up-to-date information from people who are familiar with the process.  They can help members locate local resources as well as connect each other with national programs that provide assistance with the costs of travel, lodging, and other expenses that insurance won’t cover. 

A good example is the Sarcoma Alliance’s Hand in Hand program. This program "offers financial assistance for second opinion consultations by reimbursing expenses related to travel, phone bills, costs of the evaluation, and related expenses."

Major sarcoma centers can supply information on the availability of free or discounted housing provided by organizations including The American Cancer Society's Hope Lodge, the Ronald McDonald Houses, and the local hotel industry. 

Expenses (and patient stress!) can be further reduced when a working relationship is developed between a local oncology practice and a major sarcoma center. Sarcoma centers are often willing to provide the expert diagnosis and the treatment protocol, which can then be carried out closer to the patient’s home. For adults, outpatient treatment may also be an option.

Financial Assistance

For more information about financial assistance,
view our Sarcoma Support Resources.

Summary

In summarizing the results of the "Mandatory Second Opinion" study, John Hopkins researchers point out that "Although a policy of mandatory second opinion surgical pathology for referred patients makes good clinical and risk management sense .... current trends in medical economics has placed this and other quality assurance practice at possible risk."5

From a caregiver perspective, this author sees that patients with a new sarcoma diagnosis need to be advised of the value of a second opinion on the diagnosis. There is always a great sense of urgency to begin treatment as soon as possible, so patients and their families may be wary of any delays. They need to be assured that expedited communication between the diagnosing facility and a major sarcoma center regarding diagnosis will reduce the amount of time between diagnosis and treatment and this is time well spent. No patient can afford to lose time pursuing the wrong treatment due to incorrect diagnosis. Remediating the effects of wrong treatments and procedures, after the mistake is recognized, cannot always be done.

by Elizabeth Goldstein-Rice
Last revised: 12/2008
Last medical review: 12/2008

References

1. "Should Soft Tissue Sarcomas Be Treated at High-volume Centers? An Analysis of 4205 Patients", by Juan C. Gutierrez, MD, Eduardo A. Perez, MD, Frederick L. Moffat, MD, Alan S. Livingstone, MD, Dido Franceschi, MD, and Leonidas G. Koniaris, MD, Annals of Surgery, Volume 245, Number 6, June 2007.

2. "Should Soft Tissue Sarcomas be Treated at a Specialist Centre?", by A. A. Bhangu, J. A. S. Beard, and R. J. Grimer, Sarcoma, V. 8 (2004), Issue 1, Pages 1-6.

3. "Surgical Management of Soft Tissue Tumors: Avoiding the Pitfalls", By Fritz C. Eilber, MD, and Frederick R. Eilber, MD, American Society of Clinical Oncology Educational Book. ASCO 2005.

4. "Delays in Referral of Soft Tissue Sarcomas", by G. D. Johnson, G. Smith, A. Dramis, and R. J. Grimer, Sarcoma, V. 2008, Article ID 378574, 7 pages.

V5N6 ESUN. Copyright © 2008 Liddy Shriver Sarcoma Initiative.

Sarcoma Centers and Specialists

 

Australia

Peter Mac’s Bone and Soft Tissue Service is the largest bone and soft tissue sarcoma group of its kind in Australia, and treats adolescents and adults. Patients will receive care from expert surgery oncologists, radiation oncologists and medical oncologists in association with specialist bone and soft tissue nurse coordinators, psychologists, dietitians, physiotherapists, social workers and pain and palliative care professionals.

Australasian Sarcoma Study Group provides the infrastructure for collaboration between multi-disciplinary teams (MDT), which comprise specialist health professionals that work together to discuss cases and to determine how best to manage treatment and care (for example, specialist cancer doctors and nurses and supportive care clinicians such as social workers, psychologists and physiotherapists).

Canada - Toronto

Ontario Cancer Care Sarcoma Disease Site Group: A list of physicians with interest or experience in sarcomas.

China

医院网址及科室网址: 中文版本请点击此处 

France

Centre Léon Bérard
28, rue Laënnec - 69373 LYON Cedex 08 
Téléphone : 04.78.78.28.28

Institut de cancérologie Gustave Roussy Villejuif
Rue Camille Desmoulins - 94805 VILLEJUIF Cedex 
Téléphone : 01.42.11.42.11 

Institut Curie
26, rue d'Ulm 75231 - PARIS Cedex 05 
Téléphone : 01.44.32.40.00

Institut Bergonnié
180, rue de Saint-Genès/229,cour de l'Argonne - 33076 BORDEAUX Cedex 
Téléphone : 05.56.33.33.33

Groupe Sarcomes Français

Germany

Innerer Klinik – Tumorforschung
(Westdeutsches Tumorzentrum-Universitätsklinikum-Essen)

Chirurgische Klinik, Universitätsklinikum Mannheim gGmbH

KID Deutsches Krebsforschungszentrum Heidelberg

Japan

大阪府立成人病センタ (Osaka Medical Center for Cancer and Cardiovascular Diseases): Dr. Katsuhito Takahashi is a leading sarcoma specialist at this hospital.

Okayama University Hospital - Dr. Junji Matsuoka is member of the CureSarcoma board and is a palliative care specialist who is experience with sarcoma at this hospital.

Poland

Centrum Onkologii-Instytut im. Sklodowskiej-Curie 
Klinika Nowotworów Tkanek Miekkich i Kosci 
ul. Roentgena 5 02-781 Warszawa 
Dr. Piotr Rutkowski 

Sweden

Scandinavian Sarcoma Group - The goal of the SSG is to advance the care of patients with sarcoma and to increase knowledge of all aspects of the biology of these tumors, including basic and clinical research. The SSG has developed treatment protocols for different sarcoma types and participates in international clinical trials.

United Kingdom

The Royal Marsden Sarcoma Unit: The Royal Marsden offers a full range of soft-tissue sarcoma diagnosis, treatment and care services for patients at its hospitals in Chelsea, London, and Sutton, Surrey.

Christie Hospital Sarcoma Team in Manchester: The Christie offers clinical trials for patients with various types of sarcoma including gastrointestinal stromal tumours, osteosarcomas and various soft tissue sarcomas.

The British Sarcoma Group maintains a list of sarcoma specialist centres.

Sarcoma UK: Support and Information.

United States centers and specialists are organized by state below.

Arizona

Mayo Clinic specialists work as a multidisciplinary team to diagnose and treat all types of sarcoma. Physicians and researchers are dedicated to providing the most effective treatment possible. Mayo Clinic has earned an international reputation for its expertise in treating soft tissue sarcomas in adults and children, and hundreds of patients with bone tumors receive treatment at Mayo Clinic each year.

California

The Cedars-Sinai Cancer Program, located in Los Angeles, is a patient-centered, comprehensive and specialized cancer program. On their website, they state, "At the Cedars-Sinai Cancer Program, dozens of nationally recognized programs and services are all under one interconnected, medical "roof"--an important benefit to cancer sufferers. Patients can be confident that every resource of this remarkable organization is brought to bear in delivering leading-edge healthcare services."

The UCLA Sarcoma Program provides innovative multidisciplinary treatment for adults and children with sarcoma at any stage of the disease. UCLA is one of the three busiest sarcoma centers in the nation. On an annual basis they evaluate over 800 patients with sarcoma, 500 of which undergo surgery at UCLA. At our weekly sarcoma conference physicians specializing in sarcoma from surgical oncology, orthopedic oncology, medical oncology, radiation oncology, pediatric oncology, pathology and radiology formulate and coordinated optimal treatment strategies for individual patients.

Washington, DC

Washington Cancer Institute and Lombardi Cancer Center, located in Washington, DC, is affiliated with Georgetown University. On their website, they state, "We have extensive experience treating both bone and soft tissue tumors of the extremities, pelvis and shoulder girdle. We have performed more than 3,000 tumor operations since 1979. We are leaders in limb-sparing surgery and have pioneered many surgical techniques in use at this and other cancer centers."

Florida

H. Lee Moffitt Cancer Center and Research Institute, located at the University of South Florida in North Tampa, Florida, brings together experts from a variety of cancer specialties to determine the best treatment plan for each patient, while linking together the Center’s extensive array of support services. As part of a group of National Cancer Institute Comprehensive Cancer Centers, Moffitt focuses on the development of early stage translational research aimed at the rapid translation of scientific discoveries to benefit patient care. The Sarcoma Program at the center takes an interdisciplinary approach to treating sarcomas.

Mayo Clinic specialists work as a multidisciplinary team to diagnose and treat all types of sarcoma. Physicians and researchers are dedicated to providing the most effective treatment possible. Mayo Clinic has earned an international reputation for its expertise in treating soft tissue sarcomas in adults and children, and hundreds of patients with bone tumors receive treatment at Mayo Clinic each year.

Sylvester Cancer Center's sarcoma specialists have expertise in standard and experimental therapies for all bone and soft tissue tumors, including gastrointestinal stromal tumors (GIST) as well as "benign" tumors such as desmoid fibromatosis, chordoma, giant cell tumors of bone, or pigmented villonodular sclerosis (PVNS). Their multidisciplinary team includes medical oncologists, pediatric oncologists, radiation oncologists, surgical oncologists, musculoskeletal radiologists, and pathologists who work together to diagnose and treat even the most complex and challenging cases of these rare cancers. In addition to standard therapy, they also offer clinical trials for newly diagnosed as well as metastatic or recurrent sarcomas.

Indiana

The Sarcoma Program of the Indiana University Simon Cancer Center offers multidisciplinary care for both adults and children with benign or malignant bone or soft tissue lesions and patients with metastatic bone cancer. The multidisciplinary team is comprised of specialists in medical oncology, orthopedic surgery, as well as dietitians, physical and occupational therapists, psychologists and social workers.

Iowa

The Holden Comprehensive Cancer Center, located at the University of Iowa Hospitals & Clinics, has a focus group called the "Sarcoma Tumor Board Multidisciplinary Team." This is a group of physicians who meet twice a month to discuss cases and care plans and to gain a better understanding of the roles they each play in the treatment of sarcoma.

Kansas

The University of Kansas Cancer Center - Sarcoma Center brings together the region’s premier multidisciplinary sarcoma team to treat these uncommon and aggressive tumors and benign, soft-tissue diseases. Specialists from adult and pediatric medical, radiation and surgical oncology, pathology, orthopedics and cancer rehabilitation work together to provide the most accurate diagnosis and individualized treatment plans. The Institute is located in Overland Park, Kansas.

Maryland

The Johns Hopkins Sarcoma Center, located in Baltimore, Maryland, provides comprehensive care for pediatric and young adult patients with bone and soft tissue sarcomas. The Center uses a multidisciplinary team approach to care and treatment, which includes pediatric and adult medical oncology, surgery, pathology, diagnostic radiology, orthopaedics, radiotherapy and plastic surgery. Cases are reviewed by a multidisciplinary team at weekly conferences.

Massachusetts

The Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute has dedicated specialty expertise in the pathologic and radiologic assessment of sarcoma, the application of novel soft-tissue and bone reconstructive techniques permitting limb salvage, and access to the most promising new therapies for these malignancies.

The Center for Sarcoma and Connective Tissue Oncology at Massachusetts General Hospital Cancer Center specializes in the diagnosis and treatment of bone and soft tissue tumors, both malignant and benign. The team represents one of the largest sarcoma treatment groups in the country. The hospital also has one of the five proton therapy centers in the country.

Michigan

University of Michigan Comprehensive Cancer Center, located in Ann Arbor, Michigan, is associated the UM's Medical School. On their website, they state, "The Center was established in 1986, and soon after was designated a "comprehensive" center by the National Cancer Institute. he U-M Cancer Center has more than 200 cancer clinicians and researchers. These specialists work together in multidisciplinary teams to rapidly bring new prevention, detection and treatment discoveries to more than 25 cancer care clinics."

Minnesota

Mayo Clinic specialists work as a multidisciplinary team to diagnose and treat all types of sarcoma. Physicians and researchers are dedicated to providing the most effective treatment possible. Mayo Clinic has earned an international reputation for its expertise in treating soft tissue sarcomas in adults and children, and hundreds of patients with bone tumors receive treatment at Mayo Clinic each year.

The University of Minnesota has a team of expert physicians that treat a high volume of patients with bone and soft tissue tumors each year. Their multidisciplinary team works with patients to develop a customized treatment plan. They are continually improving treatment for patients with bone and soft tissue cancers through laboratory work, clinical research and education.

New York

Columbia Weill Cornell Cancer Center, located in New York City, is part of the Herbert Irving Comprehensive Cancer Center in the New York-Presbyterian complex, which forms the university hospitals for Columbia University and Cornell University. On their website, they state, "Columbia Weill Cornell Cancer Centers provide comprehensive care for children and adults with primary and metastatic bone and soft tissue tumors."

Memorial Sloan-Kettering Cancer Center (MSKCC), located in New York City, has been dealing in cancer treatment and care for over 100 years. On their website, they state, "Memorial Sloan-Kettering doctors generate more than half of the world's research publications on soft-tissue sarcomas and have probably the largest experience with these tumors of any medical group."

Mount Sinai Hospital, located in New York City, offers a multidisciplinary team approach that brings together specialists who provide compassionate, personalized care. Their team of experts oversee all aspects of therapy to ensure optimal outcomes for patients with all forms of sarcoma. They meet weekly in the Sarcoma and Orthopedic Oncology Conference to review the best approach to each patient’s situation.

Roswell Park Cancer Institute (RPCI), located in Buffalo, New York, is a National Cancer Institute designated comprehensive cancer center. Roswell Park Cancer Institute’s (RPCI) experts in soft-tissue sarcoma include specialists in surgery, medical oncology, radiation oncology, diagnostic radiology, pathology and rehabilitation support. Treatment approaches for this disease include conservative operations, combined with radiation therapy and/or chemotherapy, which offer patients a high rate of tumor control while avoiding amputation.

North Carolina

The Duke Sarcoma Program at Duke University Medical Center is a multi-disciplinary team of physicians, nurses, and allied health professionals dedicated to the care and treatment of patients with sarcoma. From infants to seniors, this team of  professionals treat patients with both primary sarcomas of the bone and soft tissues,as well as metastatic sarcoma.. We provide state-of-the-art treatments including surgical oncology, adult and pediatric medical oncology and radiation oncology, in a multi-disciplinary clinical setting to offer patients the most effective care. Our specialists work closely together on basic scientific and clinical research in hopes of identifying improved detection and treatment of sarcoma. Duke University Medical Center is located in Durham, North Carolina.

Ohio

The Arthur James Cancer Hospital at The Ohio State University is the largest sarcoma program in Ohio and one of the largest in the Midwest. The hospital has a complete sarcoma program with all specialties including orthopedic oncology, surgical oncology, adult and pediatric medical oncology, plastic surgery, pathology, radiation oncology, and radiology. Physicians in the program take care of more than 175 new sarcoma patients each year and have thousands of patients in long term follow-up.

Oregon

Oregon Health & Science University Sarcoma Program: The sarcoma team at OHSU Knight Cancer Institute is the only coordinated care team in Oregon specializing in sarcoma diagnosis and treatment. Our sarcoma doctors are fellowship trained and have extensive knowledge of sarcoma .

Pennsylvania

Fox Chase Cancer Center (FCCC), Located in Philadelphia, Pennsylvania, is an independent, nonprofit institution devoted to improving cancer treatment and prevention. In 1904, the Fox Chase Cancer Center Hospital, which was then called the American Oncologic Hospital, became the country's first cancer hospital. The Center was formed in 1974 to unite the Hospital with the Institute for Cancer Research, founded in 1927.

Kimmel Cancer Center at Thomas Jefferson Hospital: Dr. John Abraham directs the Musculoskeletal Oncology Center at Kimmel Cancer Center in Philadelphia. The team sees about 100 sarcoma patients each year.

Texas

M. D. Anderson Cancer Center (MDACC), located in Houston, Texas, has built a "worldwide reputation for excellence in cancer patient care, research, education and prevention". On their website, they state, "Patients at M. D. Anderson's Sarcoma Center have a five-year survival rate well above the national average, and an outstanding 80% rate for classical osteosarcoma. Our center diagnoses, treats and manages sarcomas of the soft tissue and bone, using the latest technology available."

Utah

Huntsman Cancer Institute (University of Utah), located in Salt Lake City, Utah, operates a hospital-based patient care center in association with the Health Sciences Center at the University of Utah. On their website, they state, "The Huntsman Cancer Institute Sarcoma Service, in addition to engaging in comprehensive clinical care, has ongoing, state of the art, basic science studies investigating the causes of sarcomas." 

Washington

The Seattle Cancer Care Alliance Sarcoma Service, which began in 1986, offers sarcoma patients the best of the Pacific Northwest's world-class cancer research and patient-care practices. It sees about 500 adults and 200 children a year who are newly diagnosed with sarcomas of various types. The majority of its patients come from outside the Western Washington region. It offers a multidisciplinary approach to sarcoma treatment, including access to new treatments and procedures through clinical trials, innovative programs such as the Sarcoma PET Imaging Program, Sarcobase one of the first sarcoma patient registries in North America and the first at a cancer center, as well as overlapping pediatric and adult programs, to provide continuity of care to young patients who can continue to see the same doctors as they grow to adulthood.