title: Influence of specialty and clinical experience on treatment sequencing in the multimodal management of soft tissue extremity sarcoma.
abstract: OBJECTIVE
  Although multimodal management of extremity soft tissue sarcoma (STS) is the standard of care, considerable variation exists in the sequencing of radiotherapy (RT) or chemotherapy (CT). Our goal was to identify factors responsible for this variation.
  
  
  METHODS
  Members of specialty societies with an interest in STS were emailed a questionnaire about multimodal treatment of STS. Survey responses were scored on a 5-point Likert scale (1 = always preoperative and 5 = always postoperative) and analyzed by specialty, years in practice, and percentage of practice consisting of STS.
  
  
  RESULTS
  The questionnaire was completed by 320 (65%) of 490 physicians, including medical oncologists (18%), radiation oncologists (8%), orthopedic oncologists (22%), surgical oncologists (45%), and others (7%). Respondents were evenly split on the use of neoadjuvant RT (mean 3.03 ± 0.06) and showed a slight preference for neoadjuvant CT (2.89 ± 0.06). Radiation oncologists (2.52 ± 0.18), physicians with a >75% STS practice (2.58 ± 0.17), and those in practice <5 years (2.79 ± 0.12) preferred neoadjuvant RT. Neoadjuvant CT was preferred by orthopedic oncologists (2.62 ± 0.12) and physicians with >75% STS practice (2.51 ± 0.16). Factors influencing the choice for neoadjuvant RT were well-defined treatment volume, increased acute morbidity, and decreased late morbidity, while for CT, they were in-situ disease monitoring and early treatment of micrometastases.
  
  
  CONCLUSIONS
  Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. wasif.nabil@mayo.edu
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Robert M
authors.initials: RM
authors.lastname: Tamurian
authors.forename: Scott
authors.initials: S
authors.lastname: Christensen
authors.forename: Ly
authors.initials: L
authors.lastname: Do
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
mesh_terms: D059248:Chemoradiotherapy; D019468:Disease Management; D005121:Extremities / Q000473:pathology*; D006801:Humans; D008495:Medical Oncology; D020360:Neoadjuvant Therapy; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012509:Sarcoma / Q000628:therapy*