Diagnosis and treatment should be given in specialist centres

Musculoskeletal sarcomas comprise 1% of all malignancies and have traditionally been associated with a poor prognosis. However, the past two decades have shown a dramatic improvement in prognosis for osteosarcoma and Ewing's sarcoma when treated by teams of pathologists, radiologists, oncologists, and surgeons who can provide the necessary combination of chemotherapy, surgery, and radiotherapy. A similar evolution has also occurred in some places in the treatment of soft tissue sarcoma. However, whereas no one questions that patients with bone sarcomas should be treated at specialist tumour centres, many patients with soft tissue sarcoma (which is at least twice as common) are treated outside such centres, often with a poor outcome.

Last December Clasby et al reported recent treatment outcomes for soft tissue sarcoma in the South East Thames region of England.1 The first surgical procedure was a marginal excision (shelling out) in two thirds of cases. Less than half of these patients were given radiotherapy or had a re-excision with wider margins. This means that almost half of the patients had …