Systematic Review

In order to assess the available evidence, we completed a systematic review of available randomized controlled trials (RCT) for surveillance in sarcoma management (published as a pre-print).

Bozzo A, Ghert M, Baldawi H, Simchovich G. Optimal surveillance strategies following curative surgery for extremity sarcoma: A systematic review of Randomized Control Trials. Open Sci Framew. May 2018. doi:None

Despite advances in surgical and chemotherapeutic interventions for extremity sarcomas, the optimal surveillance strategy remains unknown and current guidelines are not informed by high quality evidence. Surveys of members of the Musculoskeletal Tumor Society (MSTS) in 2011 and 2016 both show variation in surveillance protocol and continued lack of consensus on optimal surveillance strategies. Most surgeons polled indicated that they simply follow patients in the manner in which they trained. Crucially, 95% of the surveyed MSTS members believe more studies on surveillance are required and they indicated willingness to enrol patients in a large trial.

The purpose of our systematic review was to identify and assess the available evidence provided by randomized controlled trials (RCTs) regarding the optimal surveillance strategy for extremity sarcoma surgery.

We performed a librarian assisted search of two databases (EMBASE, MEDLINE) from inception until March 2017 for randomized controlled trials (RCTs) comparing surveillance strategies after extremity sarcoma surgery. We conducted this study according to the relevant guidance from the Cochrane Handbook for Systematic Reviews of Interventions and we report according to the relevant guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)statement. We judged the overall quality of evidence available using the GRADE recommendation criteria.

Our search yielded 1898 titles and abstracts, of which only one prospective randomized controlled trial (RCT) met our criteria for inclusion. A single center RCT of 500 patients assessed non-inferiority of surveillance protocols following sarcoma surgery. The quality of evidence according to the GRADE recommendation criteria is low.

There is true clinical equipoise within the MSTS regarding optimal surveillance strategies following extremity sarcoma surgery and there is a paucity of evidence to support this clinical question. Only one RCT to date has attempted to answer this question and the GRADE recommendation remains low. A larger, well designed multi-center RCT is needed to fully resolve the issue of surveillance after sarcoma surgery and direct the care of sarcoma patients