title: Assessment of multimodality therapy use for extremity sarcoma in the United States.
abstract: BACKGROUND
  Extremity sarcoma national guidelines offer several stage-specific treatment options; therefore, treatment approaches are not standardized. Our objectives were to examine multimodality treatment trends, practice patterns, and factors associated with neoadjuvant or postoperative adjuvant therapy utilization.
  
  
  METHODS
  Using the National Cancer Data Base (2000-2009), treatment of non-metastatic extremity sarcoma was examined. Regression models were developed to identify factors associated with neoadjuvant or postoperative adjuvant therapy receipt and treatment sequence.
  
  
  RESULTS
  Twenty-two thousand fifty-one patients underwent resection (stage I: 45.2%, stage II: 27.7%, stage III: 27.1%). Over 10 years, neoadjuvant radiation (6.4-11.6%, P < 0.001) and chemotherapy utilization (1.4-1.8%, P = 0.037) increased, while postoperative radiation (34.3-29.2%, P = 0.023) and trimodality therapy decreased (10.5-9.6%, P = 0.002). After adjusting for age, comorbidities, and histology, patients with large high-grade tumors treated at high-volume academic centers were more likely to receive neoadjuvant therapy (all P < 0.001). Postoperative chemotherapy utilization was associated with younger age, synovial histology, high grade, and surgical margins (all P < 0.001).
  
  
  CONCLUSIONS
  Utilization of neoadjuvant therapy for extremity sarcoma has increased over time. Practice patterns are not only related to tumor size, grade, histology, and margins but also hospital type. Opportunities remain to better define the most effective multimodality treatment for extremity sarcoma.
authors.affiliation: Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Sherman
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
authors.forename: Jeanette
authors.initials: J
authors.lastname: Chung
authors.forename: Mark
authors.initials: M
authors.lastname: Agulnik
authors.forename: Samer
authors.initials: S
authors.lastname: Attar
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.forename: William B
authors.initials: WB
authors.lastname: Laskin
authors.forename: Terrance D
authors.initials: TD
authors.lastname: Peabody
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005121:Extremities; D005260:Female; D005354:Fibrosarcoma / Q000628:therapy; D051677:Histiocytoma, Malignant Fibrous / Q000628:therapy; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007890:Leiomyosarcoma / Q000628:therapy; D023821:Limb Salvage / Q000706:statistics & numerical data; D008080:Liposarcoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D013584:Sarcoma, Synovial / Q000628:therapy; D014481:United States
keywords: cancer; chemotherapy; neoadjuvant; radiation; soft tissue