A selection of recent publications from the London Sarcoma Service team can be found below:

Furtado, S., Godfrey, A., Del Din, S., Rochester, L., & Gerrand, C. (2019). Are Accelerometer-based Functional Outcome Assessments Feasible and Valid After Treatment for Lower Extremity Sarcomas? Clin Orthop Relat Res. doi:10.1097/corr.0000000000000883

This study investigated whether accelerometer-based body-worn monitor assessments (using AX3 Axivity monitors) of balance, gait, and timed up-and-go tests (TUG) feasible, acceptable and clinically valid In patients treated for lower extremity musculoskeletal tumors. This project was conducted in Newcastle Upon Tyne Hospitals and data analysis and manuscript revisions were undertaken in RNOH and Newcastle University. See details about project and impact https://sarcoma.org.uk/research/funded-projects/monitoring-physical-difficulties-faced-bone-and-soft-tissue-sarcoma

  • Project Team: Sherron Furtado (First Author), Alan Godfrey, Silvia Del Din, Lynn Rochester, Craig Gerrand 
  • Contact: sherron.furtado@nhs.net
  • Achievements: Published in CORR journal and Award-winning project at Musculoskeletal Society Tumour Rating Society (MSTS) 2018, New York USA. Dr Sherron Furtado won the Best Young Investigator Award for this novel work which solved a major gap of assessing postural control (balance), gait and other functional outcomes using inexpensive portable devices after sarcoma surgery. Such work was picked up after the 1980’s and was considered a valuable addition to this research area. See details in link: https://pubmed.ncbi.nlm.nih.gov/31390339/ CORR Insights: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145063/

Authors: Ibtissam Acem, Winan van Houdt, Dirk J Grunhagen, Winette T A Van der Graaf, Anja J. Rueten-Budde, Hans Gelderblom, Cornelis Verhoef, Michiel A.J. Van de Sande, Will Aston, Han Bonenkamp, Ingrid M.E. Desar, Peter C. Ferguson, Marta Fiocco, Robert J van Ginkel, Anthony M. Griffin, Rick L. Haas, Jos van der Hage, Andrew J. Hayes, Lee M. Jeys, Akira Kawai, Johnny Ø Keller, Minna K Laitinen, Katja Maretty-Kongstad, Koichi Ogura, Toshifumi Ozaki, Robin Pollock, Veroniek Muriel van Praag, Stefan Sleijfer, Myles Smith, Maria Smolle, Emelie Styring, Joanna Szkandera, Kazuhiro Tanaka, Per-Ulf Tunn, Madeleine Willegger, Reinard Windhager, Jay S. Wunder, Olga Zaikova

Abstract: Objective The aim of the study is to assess the effect of perioperative chemotherapy (CTX) in patients with grade II-III extremity soft tissue sarcoma (eSTS) on overall survival (OS) and evaluate whether the PERSARC prediction tool could identify patients with eSTS more likely to benefit from CTX. Methods Patients (18–70 years) with primary high-grade eSTS surgically treated with curative intent were included in the retrospective cohort study. The effect of any perioperative CTX and anthracycline + ifosfamide (AI)-based CTX on OS was investigated in three PERSARC-risk groups (high/intermediate/low). The PERSARC-risk groups were defined by the 33% and 66% quantile of the predicted 5-year OS of the study population equal to a 5-year OS of 65.8% and 79.8%, respectively. The effect of CTX on OS was investigated with weighted Kaplan–Meier curves and multivariable Cox models with an interaction between risk group and CTX. Results This study included 5683 patients. The weighted Kaplan-Meier curves did not demonstrate a beneficial effect of any CTX and AI-based CTX on OS in the overall population. However, in the high PERSARC-risk group the 5-year OS of AI-based CTX was significantly better than no CTX (69.8% vs 59.0%, respectively, p = 0.004) (HR 0.66, 95%CI 0.53–0.83). Conclusions This study demonstrated a beneficial effect of AI-based CTX on OS in a selected group of high-risk patients with an absolute survival benefit of 11% as stratified by the PERSARC prediction tool. However, no beneficial effect of CTX on OS was found in the overall population of patients with primary high-grade eSTS younger than 70 years.

Published: April 2022, European journal of cancer (Oxford, England: 1990) 165(3):71-80

DOI:10.1016/j.ejca.2022.01.013

Authors: Raja B. Rajasekaran, Robert Ashford, Jonathan D. Stevenson, Rob Pollock, Kenneth S. Rankin, James T. Patton, Sanjay Gupta, Thomas D. A. Cosker

Published: January 2022, Bone and Joint Journal 104-B(1):3-5

DOI:10.1302/0301-620X.104B1.BJJ-2021-1410

ProjectBritish Orthopaedic Oncology Society Collaborative Group

Authors: Sherron Furtado, Alan Godfrey, Silvia Del Din, Lynn Rochester, Craig Gerrand

Abstract: 

PurposeAmbulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient's homes using an accelerometer-based wearable (AX3, Axivity). (B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures.

Methods: In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. Twenty-seven had limb-sparing surgery and seven amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha), and variability (S2) of ambulatory activity were derived.

Results: AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability (walking outside (r=-418, p = 0.042*), social life (r=-0.512, p = 0.010*)). Disability negatively predicted alpha (unstandardised co-efficient= -0.001, R2=0.186, p = 0.039*).

Conclusions: A wearable can assess novel attributes of walking; volume, pattern, and variability after sarcoma surgery. Such outcomes provide valuable information about people's physical performance in their homes, which can guide rehabilitation. Implications for rehabilitation. Routine capture of ambulatory activity by sarcoma services in peoples' homes can provide important information about individuals "actual" physical activity levels and limitations after sarcoma surgery to inform personalised rehabilitation and care needs, including timely referral for support. Routine remote ambulatory monitoring about out of hospital activity can support personalised care for patients, including identifying high risk patients who need rapid intervention and care closer to home. Use of routine remote ambulatory monitoring could enhance delivery of evidence-based care closer to peoples' homes without disrupting their daily routine and therefore reducing patient and carer burden. Collection of data close to home using questionnaires and objective community assessment could be more cost effective and comprehensive than in-hospital assessment and could reduce the need for hospital attendance, which is of importance to vulnerable patients, particularly during the Covid-19 pandemic.

Published: June 2022, https://pubmed.ncbi.nlm.nih.gov/35710327/

DOI: 10.1080/09638288.2022.2083701