Download CTOS 2005 - Connective Tissue Oncology Society

CLINICAL PRACTICE GUIDELINES
Vivien Bramwell
Chair, NCIC-CTG Sarcoma Committee
Canadian Sarcoma Group
Connective Tissue Oncology Society
2005 Meeting, Boca Raton
CTOS 2005 - CPG
Canada Health Act
Federal mandate
Provincial delivery of services
Canadian Strategy for Cancer Control (CSCC)
Representation
NCIC
CCS
CIHR
CAPCA
CCAN
PHAC
Council
Chair: Dr. S. Sutcliffe
Interprovincial Drug Strategies & Guidelines Group (IPDSGG)
Links to
Program in Evidence-Based Care (Ontario)
BC Cancer Agency CPG (British Columbia)
CTOS 2005 - CPG
Program in Evidence-Based Care (PEBC)
Supported by Cancer Care Ontario
Ontario Ministry of Health
htpp://www.cancercare.on.ca
14 Disease Site/Discipline Groups
Produce
Practice Guidelines
Evidence Summaries
Sarcoma Group
Chair
1994 – 2000
V. Bramwell
(London)
2000 
S. Verma
(Ottawa)
CTOS 2005 - CPG
PEBC
Format
Core activity is development of PG by
multidisciplinary DSG using methodology of
Practice Guidelines Development Cycle*
Questions
Patient population
Choice of topic and rationale
Methods
Results (includes quantatative meta-analysis)
Interpretive Summary
Ongoing trials
Disease Site Group Consensus Process
External Review of Practice Guideline Report
Practice Guideline
Journal Reference
Acknowledgements
References
*Browman G et al
J. Clin. Oncol. 13: 502, 1993
CTOS 2005 - CPG
CPG 11-1 (Original: Nov. 1999, Update: July 2004)
This recommendation applies to adult patients with
symptomatic unresectable locally advanced or metastatic
STS who are candidates for palliative chemotherapy:
Recommendation
• single agent doxorubicin is an appropriate first-line
chemotherapy option for advanced or metastatic
soft tissue sarcoma. Some doxorubicin-based
combination chemotherapy regimens, given in
conventional doses, produce only marginal increases
in response rates at the expense of increased toxic
effects, and no improvements in overall survival
CTOS 2005 - CPG
CPG 11-2 (Original: Nov. 2000, Update: Feb. 2005)
These recommendations apply to adult patients with
resected soft tissue sarcoma
Recommendations
• it is reasonable to consider anthracycline-based adjuvant
chemotherapy in patients who have had removal of a
sarcoma with features predicting a high likelihood of
relapse (deep location, size > 5 cm, high histological
grade). These features correspond to UICC Stage III
• although the benefits of adjuvant chemotherapy are most
apparent in patients with extremity sarcomas (7% risk
difference [RD] for overall survival at 10 years), patients
with high-risk tumors at other sites should also be
considered for such therapy
NB: Several qualifying statements
CTOS 2005 - CPG
PEBC Sarcoma DSG Draft CPG
PG 11.3 Localized treatment of extremity soft tissue sarcoma
*PG 11.4 Ifosfamide-based combination chemotherapy in
advanced soft tissue sarcoma
*PG 11.5 Dose-intensive chemotherapy with growth factor or
autologous marrow/stem cell support in advanced
soft tissue sarcoma
*PG 11.7 Imatinib mesylate (Gleevec) for the treatment of
adult patients with unresectable or metastatic
gastrointestinal stromal tumors (GIST)
PG 11.8 Adjuvant radiotherapy for retroperitoneal sarcoma
*completion November 2005
CTOS 2005 - CPG
British Columbia Cancer Agency (BCCA)
htpp://www.bccancer.bc.ca
Health Professionals - Cancer Management Guidelines
Based on accumulated experiences of BCCA together with
“best” practice evidence derived from major cancer
centres throughout the world
Developed by Tumor Groups:
oncologists, radiologists, pathologists, oncology nurses,
pharmacists, other practitioners from health disciplines
contributing to oncology care at BCCA & U of BC
CTOS 2005 - CPG
BCCA Cancer Management Guidelines
Musculoskeletal & Sarcoma
01. Surgical management of sarcoma
02. Surgical management of metastatic disease
03. Special surgical considerations
Retroperitoneal
GIST
Cystosarcoma phyllodes
Dermatofibrosarcoma protuberans
04.
05.
Radiotherapy
Chemotherapy
Curative
Palliative
06.
Combined multi-modality treatment for specific
Ewing’s/small round blue cell
Osteosarcoma (+ MFH bone, other high-grade spindle)
Rhabdomyosarcomas
Adjuvant chemotherapy for other STS
Follow-up