IDOWU OK, AKINMADE A, HABEEBU MYM, EYESAN SU, GIWA SO, ABDULKAREEM FB

SICOT MONTREAL, Oct 2018 — No conflict of interest

INTRODUCTION: CHALLENGES

– Late presentation

– Limited facilities (only 10 radiotherapy centers for ~170 million people)

– Limited specialists and inadequate funding

– Services divided along geographical lines

INTRODUCTION – LAGOS

– Coastal city along West Africa coast

– Most populous city in Africa (~17 million people, 10% of Nigerian population)

– No dedicated sarcoma MDT prior to 2012

NARRATIVE REVIEW OF STS PROFILE IN NIGERIA

– Electronic search of 236 articles (from 1940 onward)

– 1064 patients from 9 studies with complete epidemiologic data

– Mean age: 34.4 years, slight male preponderance

– Common histotypes: Rhabdomyosarcoma, Liposarcoma, Fibrosarcoma

– Many patients present with advanced disease due to poor infrastructure and interdisciplinary gaps

LAMON

– Multi-institutional MDT for bone and soft tissue cancers in Lagos

– Communal format — meets monthly at NOH Lagos

– 26 volunteer specialists across multiple hospitals: Orthopaedic surgeons, general & plastic surgeons, pathologists, radiologists, oncologists, nurses, physiotherapists, social workers, pharmacists

METHOD I

– Patients with musculoskeletal tumours from multiple Lagos institutions included for discussion

– Cases reviewed at monthly LAMON meetings

– Surgery, radiotherapy, chemotherapy and timing decisions planned by MDT

METHOD II

– Patients reviewed between Oct 2012 – Sept 2017 included

– Data collected: demographics, referral source, anatomic location, grade, histological type

– Surgical treatment, limb salvage rate, complications recorded

RESULTS

– 642 suspected musculoskeletal tumour cases reviewed over 60 months

– Age range: 3–95 years

– 136 confirmed soft tissue sarcoma cases

– Symptom duration: 2 weeks – 10 years (mean 68 weeks)

– Only 26% referred directly from GPs

– 103 patients underwent surgery

ANATOMIC LOCATION

– Thigh — 48%

– Leg — 13%

– Foot, Arm, Shoulder, Popliteal fossa, Gluteal region, Back — smaller proportions

HISTOLOGICAL PROFILE

– Liposarcoma — 24%

– Fibrosarcoma — 24%

– Leiomyosarcoma — 18%

– Epithelioid sarcoma, Angiosarcoma, MPNST, Synovial sarcoma — smaller proportions

GRADE

– High grade — 46%

– Intermediate — 16%

– Low grade — 38%

RESULTS — TREATMENT OUTCOME

– Limb salvage rate: 67%

– 24% marginal excisions, 43% wide local excisions

– 2 neoadjuvant & 37 adjuvant radiotherapy cases

– 6 neoadjuvant & 4 adjuvant chemotherapy cases

– Common complications: seroma, local recurrence, wound infection

– Local recurrence rate: 12.5%

– Common metastatic sites: Lung, Spine, Liver

DISCUSSION

– Communal MDT resulted in better data collection and follow-up

– Improved limb salvage outcomes for extremity sarcoma

– Appears to improve short-term outcomes for STS management

CONCLUSION

– Communal tumour boards like LAMON may serve as a model for multidisciplinary sarcoma care in resource‑limited settings

THANK YOU

End of document.