Irish Sarcoma Group

Inaugural Meeting Review

Theme: Raising Awareness and Centralising National Services for Sarcoma

Over 150 delegates from all over Ireland attended the inaugural meeting of the Irish Sarcoma Group at Dublin’s Gibson Hotel in November, representing all the major disciplines involved in diagnosing, treating and caring for people (children and adults) with sarcoma. The event was opened by Mr. Michael Noonan, Minister for Finance, and included an impressive line-up of key national and international speakers.  The meeting was made possible by the generous sponsorship provided by PharmaMar, Janssen, Implantcast, Novartis, Takeda, Macromedics and an educational grant from MerckSerono.

Mr. Noonan, who was treated with pre-operative radiotherapy followed by surgical resection of a sarcoma that developed on his right shoulder earlier this year, delivered a heartfelt and very personal message.

“Very significant progress has been made by the National Cancer Control Programme over the last number of years by centralizing services and pooling expertise. From my own personal experience I understand how critical it is for patients with the more rare tumours, such as sarcoma, to be treated in this way. This can only happen through the development of a coordinated national service and so I am delighted to support this meeting, the initiation of the Irish Sarcoma Group and its website.”

The programme began with an introduction to the current state of Irish sarcoma services presented by Dr Charles Gillham (Chair of the Organising committee and co-founder of the Irish Sarcoma Group).

First session – Epidemiology and Diagnosis

The first session focused on the epidemiology and diagnosis of sarcoma in Ireland delivered by Professor Linda Sharp from the National Cancer Registry. She stressed the importance of accurate data capturing at both diagnosis and follow-up and presented figures about national survival figures. These appear to be in line with the UK but perhaps somewhat less good than mainland Europe and North America. Professor Adrienne Flanagan (lead pathologist for sarcoma at the London Sarcoma Unit) delivered an impassioned talk about the evolution in molecular diagnostics and cytogenetics in the work-up of bone and soft tissue sarcomas. She stressed the need for centralisation of national histopathology expertise and the importance of making an accurate pathologic diagnosis to guide subsequent treatment pathways. The value of plain and cross-sectional imaging was eloquently presented by Dr Eric Heffernan, Consultant Musculoskeletal radiologist at St Vincent’s University Hospital. He highlighted the importance of this being done within the context of a multi-disciplinary team incorporating the findings of clinical and pathology colleagues. 

Second Session – Surgical Management of Sarcoma

The second session covered the surgical management of some of the more common sites at which sarcomas present. Surgery forms the cornerstone of treatment of most sarcomas in the curative setting and these most frequently present in the limb. Mr. Craig Gerrand, Consultant Orthopaedic Oncologist and Vice Chair of the UK Clinical Reference Group for Sarcoma Commissioning discussed the importance of appropriate initial surgery of limb tumours in terms of local control and, importantly, function and quality of life thereafter.

He was followed by Mr. Vincent Young, Consultant Cardiothoracic Surgeon at St James Hospital, Dublin who centered his talk on primary sarcoma of the lung and chest wall. He too, stressed the need for centralisation and the importance of working within a specialised multidisciplinary team.

Professor John Reynolds, Consultant Upper Gastrointestinal Surgeon at St James Hospital, Dublin then presented data on gastrointestinal tumours – the most common malignant soft tissue tumour found within the abdomen. He has set up the National GIST database and presented data on the importance of accurate histological and gene mutation analysis to facilitate decisions regarding adjuvant (or neo-adjuvant) therapies.

The following talk was given by Dr Alessandro Gronchi. He is a specialised abdominal and retroperitoneal sarcoma surgical oncologist in Milan, the chairman of the soft tissue sarcoma committee of the Italian Sarcoma Group, the vice chair of the EORTC Soft Tissue and Bone Sarcoma Group and the secretary of the Connective Tissue Oncology Society (CTOS). He delivered a superb talk about the rare group of sarcomas that arise within the retroperitoneum. He stressed the importance of always obtaining pre-operative histology and dismissed concerns (when surgery was performed in large volume, specialized centers) regarding potential “seeding” of the biopsy tract. He highlighted the need, where appropriate, for multi-visceral resections and the importance of delivering pre (rather than post) operative radiotherapy if there was concern that the tumour was not going to be easy to completely excise.

The final surgical talk was delivered by Mr. Eoin O’Broin, consultant plastic and reconstructive surgeon at Cork University hospital. He focused on the value of his discipline in the management of frequently complex surgical procedures particularly when they arise within the limbs. He stressed the need for careful reconstruction to maintain function and aid wound healing especially when operating in a previously irradiated field.

Third session – Adjunctive Therapies

Dr Beatrice Seddon, Consultant Clinical Oncologist from the London Sarcoma Unit gave an incredibly comprehensive overview of the role of radiotherapy in the management of, predominantly, limb sarcomas emphasizing the evolution of highly conformal techniques and presenting data with regard enhanced local control and limb function thereafter. She explained how pre-operative radiotherapy was increasingly becoming the standard of care for intermediate and high-grade tumours and for those where wide local excision was unlikely to be achieved.

Professor Paolo Casali followed to discuss the role of systemic therapy in advanced disease. He is a medical oncologist and head of the Adult Mesenchymal Tumour Medical Oncology Unit at Istituto Nazionale Tumori, Milan. He is a member of the Executive Board of ESMO (European Society for Medical Oncology) and a member of the Board of Directors of ECCO (European Cancer Organization). He is Secretary of the Italian Sarcoma Group and Editor in Chief of Clinical Sarcoma Research, and founded and chairs the Italian Rare Cancer Network and coordinates Rare Cancers Europe, an ESMO-launched multi-stakeholder initiative to work out, promote and exchange new solutions to the many issues posed by rare cancers.

Unsurprisingly, therefore, his talk was impressive and thought provoking and it is encouraging to see the revolution in new-targeted agents currently in routine use and under investigation in what was previously felt to be a relatively chemo-resistant group of cancers.

Dr Deirdre O’Mahony, Consultant Medical Oncologist and sarcoma MDT lead at Cork University Hospital followed Prof Casali with a spectacular update of the seminal data that helps guide the difficult decision making process when considering chemotherapy in the adjuvant setting. Interpretation of the data is hampered by the inclusion of multiple different sarcoma types, sizes and grades within innumerable international trials and so deciding which patients, if any, should receive such treatment should only be made by a specialized sarcoma medical oncologist working within a multidisciplinary team.

Fourth session- Bone Sarcomas

The penultimate session focused on bone sarcomas and was therefore chaired by Dr Michael Capra, Paediatric Medical Oncologist at Our Lady’s Hospital, Dublin and Dr Catriona O’Sullivan, Paediatric Radiation Oncologist at St Luke’s Hospital, Dublin.

The first talk was delivered by Prof Stefan Bielack, Consultant Paediatric Oncologist at Stuttgart. His main scientific and clinical interest lies in the field of bone sarcoma, particularly osteosarcoma. He is the chairman of the Cooperative German-Austrian-Swiss Osteosarcoma Study Group (COSS), ECT project leader of the European and American Osteosarcoma Study (EURAMOS1), and leader of the bone tumour work package of the European Network for Cancer Research in Children and Adolescents (ENCCA). He brought us all up to date with the latest osteosarcoma studies and where future trials might take us.

He was followed by Prof Jeremy Whelan. Jeremy has worked exclusively in the field of sarcomas and young people’s cancer for nearly 20 years. He has taken an active role in national cancer policy developments in his areas of expertise working with NICE, the Department of Health and specialist commissioning bodies. He is chair of the National Cancer Research Institute Teenage and Young Adult Clinical Studies Group, the NHS England Sarcoma Clinical Reference Group and a member of the NCRI Sarcoma Clinical Studies Group. He leads research programmes in bone sarcomas ( and young people’s care ( Unsurprisingly his talk on Ewing’s was enlightening and made it very clear, in particular, how much we need to address the needs of teenagers and young adults with sarcomas.

Following Prof Whelan, Prof Des Carney from the Mater presented his extensive experience into the management of Irish patients with osteosarcoma; impressive survival figures and the importance of centralising these rare tumours and, of course, maintaining a comprehensive database.

Final session – Developing a National Service 

The final session incorporated talks by Mr. Craig Gerrand and Prof Jeremy Whelan coupled with Dr Jerome Coffey, Interim Director of the NCCP – the aim being to highlight where we need to focus our energies in the challenges of developing a national service. Many challenges lie ahead but the following probably dominate:

  • Collaboration – nationally and internationally.
  • The need for the relevant centre(s) to be determined and appropriately resourced.
  • A similar molecular diagnostics service to that provided by Our Lady’s Hospital in Crumlin for adult tumours.
  • Enhanced awareness amongst the general public, general practitioners and other hospital doctors
  • How very important it is that every patient with sarcoma be discussed at a specialised MDT

Provisional work for the second Irish Sarcoma Group Meeting is underway.

In the meantime let us maintain the momentum of what, so the feedback suggests, was a very successful first meeting.