|
|
|
|
The British Sarcoma Group met in Manchester on 1st and 2nd February 2007 for its 3rd annual conference. Over 130 delegates, which included a group of patients and carers were informed by a range of high quality presentations and discussions, entertained by an evening quiz and dinner, and intellectually challenged by a philosophical debate. The meeting is
good at giving younger doctors undertaking research projects as part of
their training the opportunity to present their work to a distinguished and
expert audience. Ten younger doctors and a smaller number of professional
support staff were able to present their work, which covered a wide range of
activity from diagnostic processes to surgical cases, chemotherapy response
and audits of patient outcomes. First day Key headline presentations on the first day looked at the role of PET/CT scanning in managing sarcomas, at angiogenesis inhibition and at the treatment of retroperitoneal sarcomas. Dr Mike O’Doherty from Kings College London crafted a strong case for the use of PET/CT (combined positron emission tomography and computed tomography) in areas of the patient pathway including diagnostic (biopsy), staging and surveillance (both local recurrence and extrathoracic metastasis). Its role in detecting the malignant transformation of neurofibromatosis (NF1) was also highlighted. Professor Ian Judson gave a clear description of what angiogenesis is and the part it plays in tumour development and growth. He expanded on the role of anti-angiogenesis and talked about the new treatments which are now coming into clinical trials, discussing what is known about their effectiveness in treating sarcoma and their progress towards possible licensing. Mr Andrew Hayes, one of the sarcoma specialist surgeons from the Royal Marsden Hospital, looked at advances in the management of retroperitoneal sarcoma, and the search for better outcomes for a group of patients who often have a poor prognosis when diagnosed. He emphasised that it is crucial to have a complete resection as the first surgical procedure and that while a core biopsy is safe it should be done with a view to defining management, rather than as a diagnostic process. Although organ resection is common (about 57%) the major factors which affect outcome are tumour clearance and grade. Sessions during the first day looked more generally at work on the diagnostic pathway and at research which impacts on the management of treatment. Two current clinical trials were reported and discussed – EURAMOS (the international osteosarcoma study) and VORTEX (the trial of adjuvant radiotherapy for extremity sarcoma). Dr Jeremy Whelan also reported on trials for children and young adults, and the rate at which patients entered these trials. Social life The first day of the Conference ended with a quiz before dinner. Intended to challenge the outer limits of the contestants' sarcoma knowledge the competition was between a London based team led from the Royal Marsden (Chelsea) and a team from the north of England led from Manchester (United). Chaired by BSG Secretary Mr Rob Grimer it challenged their general knowledge before they could demonstrate the extent of their specialist sarcoma knowledge. The Chelsea team won by 4 – 3. Second Day Day two started with parallel sessions on surgery and oncology. Delegates to the surgical session were challenged by the drama and complexity of bone sarcoma surgery in the pelvis with Mr Steve Cannon, and surgery within the chest wall, including lung metastases, from Mr Alan Kirk. Dr Jai Kulkarni, a consultant in rehabilitation medicine, gave a thoughtful view on how the best patient outcome can be achieved following amputation. The oncology session started with a look at the science of sarcoma. Chromosomal imbalances shared between leiomyosarcoma and GIST led into a full discussion of mutational analysis for GIST from Dr Maria Debiec-Rychter of Leuven University. Dr Mike Leahy then gave a comprehensive run down of where GIST trials had reached and looked forward to new trials now in discussion. He demonstrated that the management of GIST is one of the fastest moving fields in oncology today, stimulated by the introduction of highly active targeted therapies. However the optimization of management of patients with GIST is complex and current advice from NICE is obsolete and misleading. Dr Paolo Casali, of Istituto Nazionali Tumori in Milan, picked up the story there and took it towards all sarcomas with illustrations from liposarcoma and chordoma as well as GIST. Cytotoxic and targeted treatments are both relevant and a future development will be in combination therapies. Recognising and understanding the patterns and the nature of tumour response to treatment will be a key challenge in developing such treatments. Sarcomas with a proven genetic translocation are likely to be the first targets. After coffee the meeting came together again. Dr Ian Lewis looked at why fifteen years of Ewings sarcoma clinical trial results from Germany and the UK presented a different range of patient outcomes, despite the trials being nominally the same protocol. The conclusions, although preliminary, challenge specialists in both national groups. Dr Sue Burchill talked about her work looking at the molecular basis of Ewings sarcoma, pointing to how a better understanding of the disease was leading to identification of prognostic indicators and to new approaches to treatment. Dr Ros Ferner, a
consultant neurologist at Kings College Hospital, and specialist in the
treatment of neurofibromatosis presented the work of her group and discussed
the transition to malign The conference moved on to discuss the introduction of the NICE Improving Outcomes Guidance and to look at approaches to audit from the south-west and from Leeds before hearing a philosophical discussion about adjuvant chemotherapy with the Italian viewpoint offered by Dr Paolo Casali and the UK viewpoint from Dr Mike Leahy. Two thoughtful presentations to give delegates something to reflect upon on their journey home. Additional reports: Tariffs and funding for surgery Royal College of Radiologists Discussion Board
|
ancy which many of her patients suffer from. MPNST
(malignant peripheral nerve sheath tumour) is the commonest sarcoma
resulting from the inherited condition NF1, though it has been identified in
a number of other sarcomas too. This disfiguring complaint presents many
challenges to doctor and patient.