Journal of Cancer Research and Clinical Oncology (Jan 2025)
The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers
- Siyer Roohani,
- Jolina Handtke,
- Kamal Hummedah,
- Markus Albertsmeier,
- Dimosthenis Andreou,
- Leonidas Apostolidis,
- Marinela Augustin,
- Sebastian Bauer,
- Moritz Billner,
- Florian Bösch,
- Christoph K. W. Deinzer,
- Niklas Deventer,
- Anna Duprée,
- Franziska Eckert,
- Lars Engel,
- Katja Fechner,
- Hagen Fritzsche,
- Verena Gaidzik,
- Saeed Ghani,
- Robert Grützmann,
- Wiebke K. Guder,
- Rainer Hamacher,
- Judith S. Hecker,
- Anne Hendricks,
- Axel Hillmann,
- Philipp Houben,
- Georg Hübner,
- Philipp Ivanyi,
- Christina Jentsch,
- Maren Jordan,
- Peter Kappl,
- Moritz Kaths,
- Torsten Kessler,
- Johanna Kirchberg,
- Carolin Knebel,
- Robert Krempien,
- Burkhard Lehner,
- Ulrich Lenze,
- Lars H. Lindner,
- Alisa Martina Lörsch,
- Nadia Maguire,
- Sophie Müller,
- Pompiliu Piso,
- Vlatko Potkrajcic,
- Peter Reichardt,
- Stephan Richter,
- Simone Schewe,
- Lars M. Schiffmann,
- Felicitas Scholten,
- Jana Käthe Striefler,
- Matthias Schwarzbach,
- Katharina Seidensaal,
- Sabine Semrau,
- Joanna Szkandera,
- Christoph J. Szuszies,
- Beate Timmermann,
- Armin Tuscherer,
- Armin Wiegering,
- Moritz T. Winkelmann,
- David Kaul,
- Jens Jakob
Affiliations
- Siyer Roohani
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Jolina Handtke
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Kamal Hummedah
- Sarcoma Unit, Department of Surgery, University Medical Center and Medical Faculty Mannheim, University of Heidelberg
- Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital
- Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz
- Leonidas Apostolidis
- Department of Medical Oncology, Heidelberg University Hospital, National Center for Tumor Diseases (NCT) Heidelberg
- Marinela Augustin
- Department of Hematology and Oncology, Paracelsus Medical University
- Sebastian Bauer
- Department of Medical Oncology and Sarcoma Center, West German Cancer Center, University Duisburg-Essen, Medical School
- Moritz Billner
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg
- Florian Bösch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen
- Christoph K. W. Deinzer
- Department of Internal Medicine VIII-Medical Oncology and Pneumology, University Hospital Tübingen
- Niklas Deventer
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster
- Anna Duprée
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf
- Franziska Eckert
- Department of Radiation Oncology, University Hospital Tübingen
- Lars Engel
- Department of Visceral-Thoracic and General Surgery, Paracelsus Medical University
- Katja Fechner
- Department of Surgery, University Hospital
- Hagen Fritzsche
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD, Dresden University of Technology
- Verena Gaidzik
- Clinic for Internal Medicine III, University Hospital Ulm
- Saeed Ghani
- Helios Klinikum Berlin Buch, Sarkomzentrum
- Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University
- Wiebke K. Guder
- Department of Orthopedic Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen
- Rainer Hamacher
- Department of Medical Oncology and Sarcoma Center, West German Cancer Center, University Duisburg-Essen, Medical School
- Judith S. Hecker
- Department of Medicine III, School of Medicine and Health, Technical University of Munich (TUM)
- Anne Hendricks
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg
- Axel Hillmann
- Department of Orthopedic and Trauma Surgery, Barmherzige Brüder Regensburg Medical Center
- Philipp Houben
- Department for General-, Visceral- and Transplant Surgery, University Hospital Muenster
- Georg Hübner
- Department of Radiation Oncology, Barmherzige Brüder Regensburg Medical Center
- Philipp Ivanyi
- Clinic for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School
- Christina Jentsch
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD, Dresden University of Technology
- Maren Jordan
- Varisano Klinikum Frankfurt Höchst
- Peter Kappl
- Department of Radiology, Neuroradiology, and Nuclear Medicine, Barmherzige Brüder Regensburg Medical Center
- Moritz Kaths
- DKTK Partner Site Essen, German Cancer Consortium (DKTK)
- Torsten Kessler
- Department of Hematology and Oncology, University Hospital Muenster
- Johanna Kirchberg
- Nationales Centrum Für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR)
- Carolin Knebel
- Department of Orthopaedics and Sports Orthopaedic, Klinikum Rechts Der Isar, Technical University of Munich (TUM)
- Robert Krempien
- Clinic for Radiotherapy, HELIOS Klinikum Berlin-Buch, Schwanebecker
- Burkhard Lehner
- Department of Orthopaedics, Heidelberg University Hospital
- Ulrich Lenze
- Department of Orthopaedics and Sports Orthopaedic, Klinikum Rechts Der Isar, Technical University of Munich (TUM)
- Lars H. Lindner
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich
- Alisa Martina Lörsch
- Department of Medicine III, School of Medicine and Health, Technical University of Munich (TUM)
- Nadia Maguire
- Department of Oncology and Hematology, Krankenhaus Barmherzige Brüder Regensburg
- Sophie Müller
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg
- Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder
- Vlatko Potkrajcic
- Department of Radiation Oncology, University Hospital Tübingen
- Peter Reichardt
- Helios Klinikum Berlin Buch, Sarkomzentrum
- Stephan Richter
- Nationales Centrum Für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR)
- Simone Schewe
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf
- Lars M. Schiffmann
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne
- Felicitas Scholten
- Varisano Klinikum Frankfurt Höchst
- Jana Käthe Striefler
- Department of Internal Medicine II, Oncology/Hematology/BMT/Pneumology, University Medical Center Hamburg-Eppendorf
- Matthias Schwarzbach
- Varisano Klinikum Frankfurt Höchst
- Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital
- Sabine Semrau
- Department of Radiation Oncology, University Hospital Erlangen
- Joanna Szkandera
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz
- Christoph J. Szuszies
- Department of Hematology and Medical Oncology, University Medical Center Göttingen
- Beate Timmermann
- DKTK Partner Site Essen, German Cancer Consortium (DKTK)
- Armin Tuscherer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne
- Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg
- Moritz T. Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen
- David Kaul
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Jens Jakob
- Sarcoma Unit, Department of Surgery, University Medical Center and Medical Faculty Mannheim, University of Heidelberg
- DOI
- https://doi.org/10.1007/s00432-024-06063-z
- Journal volume & issue
-
Vol. 151,
no. 1
pp. 1 – 16
Abstract
Abstract Purpose The management of soft tissue sarcoma (STS) at reference centers with specialized multidisciplinary tumor boards (MTB) improves patient survival. The German Cancer Society (DKG) certifies sarcoma centers in German-speaking countries, promoting high standards of care. This study investigated the variability in treatment recommendations for localized STS across different German-speaking tertiary sarcoma centers. Methods In this cross-sectional case-based survey study, 5 anonymized patient cases with imaging data of localized STS were presented to MTBs of 21 German-speaking tertiary referral hospitals. Centers provided recommendations on treatment sequence and modalities, along with the consensus level within their MTB. Agreement percentages were calculated, and consensus levels were rated on a scale of 1 to 10. Results Five patient cases were discussed resulting in 105 recommendations. Agreement percentages for case 1 to 5 were 14.3%, 61.9%, 33.3%, 52.4% and 9.3%, with a median agreement percentage of 33.3%. Grouping pre- and postoperative therapies as "perioperative" and including recommendations with and without regional hyperthermia raised the median agreement to 47.6%. The mean consensus level within each center across all 5 cases was 9.5. Conclusion This first case-based analysis of inter-center agreement for STS management in German-speaking countries reveals low inter-center agreement but high intra-center consensus. Our study includes nearly all tertiary sarcoma centers in German-speaking countries, affirming its strong external validity. These findings suggest potential and clinically very relevant differences in treatment standards among sarcoma centers. Enhanced case-based exchanges and collaborative efforts are needed to reduce discrepancies and standardize the management of STS patients.
Keywords
- Soft tissue sarcoma
- Ring trial
- Reference center
- Inter-center agreement
- German Cancer Society
- Guidelines
