Specialist sarcoma treatment centres

There is good evidence from around the world that treatment of rare diseases in specialist centres improves outcomes for the patients.

Initial treatment for sarcoma may be local but in many cases a patient will be referred to a sarcoma specialist on diagnosis and before any treatment. All patients should be followed-up and monitored in association with a specialist centre.

Bone sarcomas, where treatment involves radical surgery which can include amputation or the use of replacement artificial bones (endoprostheses), are treated at specialist orthopaedic oncology units. The two largest centres are in London (Stanmore) and Birmingham, with centres in Newcastle and Bristol also each handling significant numbers. There are numerous smaller units linked to these centres which handle diagnosis, some surgery, follow-up and,, because they are closer to the patient's home, they may also give chemotherapy treatment. In each case medical oncology support may come from a neighbouring university hospital.

Soft tissue sarcomas on the limbs will also be treated at these orthopaedic centres while most of the leading teaching hospitals and specialist cancer hospitals also have sarcoma units and will treat all kinds of soft tissue sarcoma, not just sarcoma on limbs.

The UK's largest treatment centre for soft tissue sarcoma is at the Royal Marsden Hospital in London. Other specialist treatment centres include the Christie (Manchester), Weston Park (Sheffield), UCH (London), (St James) Leeds and there are units in many teaching hospitals around the country.

The key requirement of a specialist centre is that it has a team of at least surgeon, medical and clinical oncologists, pathologist, radiologist and specialist cancer nurses who have a focus for a significant part of their time on sarcoma treatment. This 'multi-disciplinary team' should operate as a team, considering together the most appropriate treatment at every stage for every one of their patients.

An evaluation process is being developed to assess the standard of such teams. Some professional disciplines (notable pathology) already have a quality assurance approach using both self-assessment and peer-review in an attempt to drive up standards.

The larger specialist centres also have a research capability, with staff dedicated to running clinical trials and laboratory resources to support them.

The doctors involved in clinical research are also likely to be in regular contact with their international colleagues treating sarcoma, whether in Europe, America or Asia. They may be members of the leading international associations which provide a professional forum for research papers and discussion on sarcoma - the Connective Tissue Oncology Society and the European Musculo-Skeletal Oncology Society.