Therapeutic strategies for soft tissue malignancies in adults. Results of the CAD soft tissue tumor register study and approaches to improvement in quality of treatment

Introduction: This study, carried out by the Surgical Oncology Working Grou p (CAO) of the German Society for Surgery was performed to analyse the stra tegies in the treatment of soft tissue sarcomas in adults. Methods: In a pe riod of 19 months the data on 292 patients suffering from soft tissue sarco mas, treated in 99 surgical departments in Germany, were analysed prospecti vely. A special questionnaire was developed including pretherapeutic biopsy , previous treatment, definitive surgical treatment, combined modality appr oach and histopathological results. Results: Thirty-nine per cent of the tu mours were treated in university hospitals, 36% in medical centres, 24% in regional hospitals. During the observation period two patients were treated on average (median) by each hospital. Limb-sparing treatment was performed in 96% of the extremity tumours. There was no significant difference in th e frequency of RO resections between the different hospitals. At the univer sity hospitals local extended operations and additive measures were used mo re often. The indication for adjuvant radiotherapy differed: after compartm ental resection, adjuvant radiotherapy was performed in 39% of cases (19/49 ); after wide-excision of high-grade tumours, in 45% of cases (20/44) no ad juvant radiotherapy was necessary. In spite of less radical treatment in tu mours of the trunk, additional radiotherapy was not more frequently perform ed. Conclusion: To improve the quality in the treatment of soft tissue sarc omas it seems to be of great importance to avoid inadequate initial treatme nt (18%), to respect the rules of oncological surgery (tumour rupture in 7% of cases), to improve the histopathological examination (no R classificati on in 5-12%) and to develop guidelines for multimodality treatment.