Recent studies on therapies for soft-tissue tumors, prophylactic antibiotic regimens, and other key topics are presented in the new JBJS Guest Editorial “What’s New in Musculoskeletal Tumor Surgery.” Here, we spotlight the 5 most compelling findings and research initiatives, as selected by authors Aaron Gazendam, MD, MSc, and Michelle Ghert, MD, FRCSC.
Effects of the Health System on Soft-Tissue Sarcoma Outcomes
A 2021 study assessed the impact of the National Institute for Health and Care Excellence (NICE) guidelines on outcomes for patients with soft-tissue sarcoma in the U.K.1. The researchers retrospectively reviewed 1,775 patients referred to a tertiary sarcoma center before and after the 2006 issuance of the NICE guidelines. They found that, after the implementation of the guidelines, regional variation in survival was significantly reduced and tumor size and incidence of metastasis at time of diagnosis decreased significantly.
Systemic Therapy for Soft-Tissue Tumors
A multinational, Phase-3, randomized clinical trial (RCT) investigated whether carotuximab plus pazopanib improved progression-free survival compared with pazopanib alone in adult patients with advanced angiosarcoma2. The researchers found that median progression-free survival did not significantly differ between the groups.
Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Trial
The PARITY trial, a multinational RCT, evaluated the effect of 1- and 5-day regimens of postoperative prophylactic IV cephalosporin on the rate of surgical site infection in patients undergoing endoprosthetic reconstruction for lower-extremity bone tumors3. Antibiotic-related complications, unplanned reoperations, oncologic and functional outcomes, and mortality were included as secondary outcomes. A surgical site infection occurred in 44 (15.0%) of the 293 patients randomized to the 5-day regimen and in 52 (16.7%) of the 311 patients randomized to the 1-day regimen. As Guest Editorial authors Dr. Ghert and Dr. Gazendam note, “Although the results of the PARITY trial did not confirm a benefit of postoperative prophylactic antibiotics longer than 24 hours, the significantly higher risk of antibiotic-related complications in the 5-day regimen was a critical finding.”
Collaborative Prospective Research Initiatives
The Musculoskeletal Tumor Registry (MsTR), which was piloted starting in 2018 with guidance from the Musculoskeletal Tumor Society, was made a full registry in late 2019, making it the third subspecialty registry of the American Academy of Orthopaedic Surgeons4. The registry collects data on rare bone and soft-tissue tumors from institutions around the country, which will enable surgeons to track function, complications, and outcomes in patients treated for sarcomas.
The Surveillance After Extremity Tumor Surgery (SAFETY) trial, a pilot multinational RCT, seeks to address the question, “Does the frequency and mode of surveillance affect patient survival following extremity STS [soft-tissue sarcoma] surgery?”5 The >150 patients with soft-tissue sarcoma enrolled in the trial are randomized to more or less intense post-treatment surveillance (e.g., 3-month vs. 6-month lung imaging and CT scans vs. chest radiographs). Patients are followed for oncologic and quality-of-life outcomes. The definitive phase of the study is expected to begin in 2023.
“What’s New in Musculoskeletal Tumor Surgery” is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org.
Image reproduced, with modification, from: Xing Z, Scott B. Severe leukemoid reaction in a case of soft tissue sarcoma: a case report. JBJS Case Connect. 2019 Dec;9(4):e0368.
- Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer RJ, Abudu S. Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system: what has been the impact of national policies in the UK? Bone Joint J. 2021 Sep;103-B(9):1541-9.
- Jones RL, Ravi V, Brohl AS, Chawla S, Ganjoo KN, Italiano A, Attia S, Burgess MA, Thornton K, Cranmer LD, Cheang MCU, Liu L, Robertson L, Adams B, Theuer C, Maki RG. Efficacy and safety of TRC105 plus pazopanib vs pazopanib alone for treatment of patients with advanced angiosarcoma: a randomized clinical trial. JAMA Oncol. 2022 May 1;8(5):740-7.
- Ghert M, Schneider P, Guyatt G, Thabane L, Vélez R, O’Shea T, Randall RL, Turcotte R, Wilson D, Wunder JS, Baptista AM, Cheng EY, Doung YC, Ferguson PC, Giglio V, Hayden J, Heels-Ansdell D, Khan SA, Sampath Kumar V, McKay P, Miller B, van de Sande M, Zumárraga JP, Bhandari M; Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Investigators. Comparison of prophylactic intravenous antibiotic regimens after endoprosthetic reconstruction for lower extremity bone tumors: a randomized clinical trial. JAMA Oncol. 2022 Mar 1;8(3):345-53.
- Musculoskeletal Tumor Society. MSTS. Accessed 2022 Aug 4. www.msts.org/index.php/registry
- Surveillance After Extremity Tumor Surgery. What is the SAFETY trial? Accessed 2022 Aug 4. https://safetyrct.com/