Primary Bone Sarcoma

Surgery for primary malignant bone tumours such as osteosarcoma, Ewings sarcoma  and chondrosarcoma. The aim of surgery to do the least radical surgery possible  compatible with ensuring local control – for example to avoid amputation wherever  possible.

Challenge for rare disease

The challenges for bone sarcoma are:

• Rarity of bone sarcomas (Ewings sarcoma, osteosarcoma and chondrosarcoma)
• Infection or loosening of the prosthetic implant
• Recurrence of tumour or metastatic

Due to the low numbers of the different bone sarcomas, the knowledge and learning from individual centres was limited. Centres shared their outcomes and reviewed cases to improve expertise. Centres also established a national virtual MDT for Ewing sarcoma due to the very low numbers, to share experience throughout England.

Network

The network was developed with care and treatment centralised to five centres for bone sarcoma. Each bone sarcoma centre was also a centre for soft tissue sarcoma. Centres were required to have an annual volume of 50 cases of bone sarcoma or 100 cases of soft tissue sarcoma.

Successful learning in the network was dependant on trust and mutual respect between colleagues built up over many years. This in turn requires regular face-to-face contact. It is very difficult to achieve strong personal relationships if units send  different representatives each year to network meetings.

The largest UK networks have six members (i.e. six treating hospitals). The learning environment at a meeting with 30 or 40 members would be very different.

Clinical Outcomes

• Amputation
• Local recurrence
• Death
• Wound infection
• Loosening or loss of prosthesis

Emerging best practice and innovation from peer learning

The learning at surgical network meetings often consists of discussion of different ways of tackling a surgical problem, especially where (as with cancers) no two patients are quite alike. Cases are presented with their imaging and discussion centres on matters such as the operative approach, the best type of prosthesis to use, the extent of the resection and so on.

Other best practice learning included:

• Silver coated prosthesis to reduce the risk of infection
• Computer-aided surgery for complex surgery. For example, in a patient
  needing complex pelvic reconstruction, patients would have a bespoke
  prosthesis implanted that was a direct copy of their pelvis from MRI scan;
  computerised planning also guides the tumour resection.
• Specialised physiotherapist support immediately following surgery enables
  quick recover following complex surgery.
• National Ewings sarcoma MDT (virtual) meeting to discuss complex or rarer
  cases of Ewings sarcoma to enable increase knowledge and optimal
  treatment.