DÄ internationalArchive49/2008Biopsy of Tumors of the Musculoskeletal System: Patients Should be Referred to Centers

Correspondence

Biopsy of Tumors of the Musculoskeletal System: Patients Should be Referred to Centers

Dtsch Arztebl Int 2008; 105(49): 863. DOI: 10.3238/arztebl.2008.0863a

Kluba, T; Hartmann, J T

LNSLNS Both case reports illustrate the problems that arise from an incorrect biopsy. In our own experience, only one in two sarcoma patients is presented before biopsy.

We therefore wish to emphasize the following additional points:

- The biopsy should be undertaken only after cross-sectional imaging (MRI).
- A detailed report of the operation should be prepared, with details of every step of the procedure (for example, opening up the fascia)
- Infiltration of local anesthesia is not an adequate procedural approach.
- In case of a fracture without an adequate history of trauma showing osteolysis (pathological fracture), complete staging is needed before stabilizing the patient.

Equivalent to practice in Scandinavian countries, patients in Germany who have soft tissue tumors of the extremities with a diameter of >5 cm or subfascial tumors should also be referred directly to a certified interdisciplinary sarcoma center (www.ssg-org.net). The reasons for this include the specialist expertise held in such centers, which includes radiology and pathology departments, close coordination of diagnostic and therapeutic steps, and the availability of all possible therapeutic options. The result is speedy initiation of better-quality treatment. Furthermore, treatment studies can be undertaken only when the number of sarcoma patients is sufficiently large, and this is the only hope for improvements for future patients with a rare disease (1).

As an aside, radiotherapy is undertaken according to the staging; monocenter studies have shown that including preoperative radio-chemotherapy (and/or regional hyperthermia as phase III) result in clinically significant improvements in long term survival of high risk patients (2, 3) and that in some types of soft tissue sarcoma with specific oncogenic mutations molecular based therapies are available that have revolutionized treatment (dermatofibrosarcoma protuberans, gastrointestinal stromal tumor). DOI: 10.3238/arztebl.2008.0863a


Dr. med. Torsten Kluba
Universitätsklinik für Orthopädie
Hoppe-Seyler-Str. 3
72076 Tübingen, Germany

Prof. Dr. med. Jörg Thomas Hartmann
Medizinische Universitätsklinik
Otfried-Müller-Str. 10
72079 Tübingen, Germany
1.
Bauer S, Hartmann JT: Locally advanced and metastatic sarcoma (adult type) including gastrointestinal stromal tumors. Crit Rev Oncol Hematol 2006; 60(2): 112–30. MEDLINE
2.
Mack LA, Crowe PJ, Yang JL et al.: Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma. Ann Surg Oncol 2005; 12(8): 646–53. MEDLINE
3.
Issels RD, Lindner LH, Wust P et al.: Regional hyperthermia (RHT) improves response and survival when combined with systemic chemotherapy in the management of locally advanced, high grade soft tissue sarcomas (STS) of the extremities, the body wall and the abdomen: A phase III randomised prospective trial. J Clin Oncol 2007; 25 18S (20 Suppl.): 10009.
1. Bauer S, Hartmann JT: Locally advanced and metastatic sarcoma (adult type) including gastrointestinal stromal tumors. Crit Rev Oncol Hematol 2006; 60(2): 112–30. MEDLINE
2. Mack LA, Crowe PJ, Yang JL et al.: Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma. Ann Surg Oncol 2005; 12(8): 646–53. MEDLINE
3. Issels RD, Lindner LH, Wust P et al.: Regional hyperthermia (RHT) improves response and survival when combined with systemic chemotherapy in the management of locally advanced, high grade soft tissue sarcomas (STS) of the extremities, the body wall and the abdomen: A phase III randomised prospective trial. J Clin Oncol 2007; 25 18S (20 Suppl.): 10009.