title: Improvement of the initial management of sarcomas after the dissemination of evidence-based guidelines depends on the primary sarcoma location: a population-based study.
abstract: BACKGROUND
  Improvement of the initial management of sarcomas after the dissemination of evidence-based guidelines depends on the primary sarcoma location: a population-based study. To improve the initial management of adult sarcomas, a regional expert team in Northern France performed two actions: dissemination of evidence-based guidelines (EBG) for the management of soft tissue/visceral sarcoma and yearly educational symposia. The aim of this study was to measure the impact of the dissemination of EBG on the key-indicators of adult sarcoma management.
  
  
  METHODS
  We conducted a before-after population-based study (before: 2005 with 63 cases, after: 2008-2009 with 86 cases) in the Lille area (Northern France urban/sub-urban area with 800,000 inhabitants). The following were the key-indicators of adult sarcoma management: pre-therapeutic biopsy, appropriate tumour and chest imaging, expert interdisciplinary discussion, expert interdisciplinary discussion before the first treatment and in operated cases, the rate of R0 resection.
  
  
  RESULTS
  There was no statistically significant difference in patient and tumour characteristics for the two time periods in terms of gender, prior cancer, primary location, histological subtype, grade, size, metastasis and lymph node involvement. There was no statistically significant improvement in primary tumour imaging (83 versus 87%), chest imaging (67 vs 71%), pre-therapeutic biopsy (57 vs 58%). There was an improvement in expert multidisciplinary discussion (37 vs 45%) or discussion before the first treatment (26 vs 44%) but no statistically significant. However, when soft tissue and bone sarcomas were analysed separately, we observed statistically significant improvements in expert multidisciplinary discussion (50 vs 74%, p = 0.02) and R0 resection rate (58 vs 91%, p = 0.002). In contrast, in cases of visceral sarcoma, there was no improvement in expert multidisciplinary discussion (10 vs 16%, p = 0.7) or in R0 resection (88 vs 81%, p = 0.7).
  
  
  CONCLUSIONS
  The dissemination of EBG was associated with a limited improvement in sarcoma management when measured in this before-after population-based study, and this improvement was dependent on the primary location of the tumour. Efforts to implement these guidelines by all surgical teams that could treat sarcoma, including visceral sarcoma, need to be made.
authors.affiliation: Registre général des cancers de Lille et de sa région, GCS C2RC, CHRU de Lille, Hôpital Calmette - Pavillon Breton, Boulevard du Professeur Jules Leclercq, 59037, Lille, Cedex, France. kligier@registrecancers59.fr.|SIRIC ONcoLille, Plateforme 4 (Méthodologie et Recherche Clinique), Lille, France. kligier@registrecancers59.fr.
authors.forename: Karine
authors.initials: K
authors.lastname: Ligier
authors.affiliation: Département d'Orthopédie A, Hopital Roger Salengro, CHRU de Lille, Lille, France. carlos.maynou@chru-lille.fr.
authors.forename: Carlos
authors.initials: C
authors.lastname: Maynou
authors.affiliation: Département de Pathologie, CHRU de Lille, Lille, France. xavier.leroy@chru-lille.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Leroy
authors.affiliation: Département de Pathologie, Centre Oscar Lambret, Lille, France. ym-robin@o-lambret.fr.
authors.forename: Yves-Marie
authors.initials: YM
authors.lastname: Robin
authors.affiliation: Service de Cancérologie, Clinique du Bois, Lille, France. pmartin@centre-bourgogne.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Martin
authors.affiliation: SIRIC ONcoLille, Plateforme 4 (Méthodologie et Recherche Clinique), Lille, France. s-clisant@o-lambret.fr.|Unité de Recherche Clinique, Centre Oscar Lambret, Lille, France. s-clisant@o-lambret.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Clisant
authors.affiliation: SIRIC ONcoLille, Plateforme 4 (Méthodologie et Recherche Clinique), Lille, France. florence.richard@pasteur-lille.fr.|Institut Pasteur Lille, INSERM U744, Lille, France. florence.richard@pasteur-lille.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Richard
authors.affiliation: SIRIC ONcoLille, Plateforme 4 (Méthodologie et Recherche Clinique), Lille, France. n-penel@o-lambret.fr.|Département de Cancérologie Générale, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille, Cedex, France. n-penel@o-lambret.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011787:Quality of Health Care; D012509:Sarcoma / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000453:epidemiology / Q000473:pathology*