Referral patterns, treatment and outcome of high-grade malignant bone sarcoma in Scandinavia--SSG Central Register 25 years' experience.
OBJECTIVE
The objectives of this study were to present changes in referral patterns, treatment and survival in patients with high-grade malignant bone sarcoma in Sweden and Norway based on data in the Scandinavian Sarcoma Group (SSG) Central Register.


METHODS
Data on 1,437 patients with diagnosis 1986-2010 was analyzed.


RESULTS
Osteosarcoma was the most frequentl diagnosis (45%), followed by Ewing sarcoma (21%) and chondrosarcoma (17%). Thirty-one percent of Swedish and 41% of Norwegian patients had tumors in the axial skeleton. Eighty-six percent of extremity tumors and 66% of axial tumors were referred to a sarcoma center prior to unplanned surgery or biopsy. During the past decade, limb salvage surgery has risen from under 50% to over 80%. Five-year overall survival in non-metastatic osteosarcoma was 70% for extremity tumors, and 35% for axial tumors. No improvement in osteosarcoma survival was observed during the last decade. Five-year survival in Ewing sarcoma improved from 50% to 69%.


CONCLUSIONS
Referral patterns in bone sarcomas have improved. However, greater efforts should be dedicated to improving referral of patients with possible tumors in the axial skeleton to multidisciplinary teams (MDTs). Overall survival of patients with high-grade malignant bone sarcomas in Sweden and Norway is in line with other reports.
Department of Orthopedics, Oslo University Hospital, The Norwegian Radium Hospital, Norway.
Olga
O
Zaikova
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Norway.
Kirsten
K
Sundby Hall
Department of Orthopedics, Lund University and Skane University Hospital, Lund, Sweden.
Emelie
E
Styring
Department of Oncology, Skane University Hospital, and Lund University, Lund, Sweden.
Mikael
M
Eriksson
Department of Orthopaedics, Haukeland University Hospital, Bergen, Norway.
Clement S
CS
Trovik
Department of Orthopaedics, Sahlgren University Hospital, Gothenburg, Sweden.
Peter
P
Bergh
Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Norway.
Bodil
B
Bjerkehagen
Department of Molecular Medicine and Surgery, Diagnostic Radiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Mikael
M
Skorpil
Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
Harald
H
Weedon-Fekjaer
Department of Molecular Medicine and Surgery, Section for Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Henrik C F
HC
Bauer
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D012509:Sarcoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Ewing sarcoma; SSG; bone sarcoma; chondrosarcoma; osteosarcoma; overall survival; referral pattern