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Multicenter Study
. 2025 Jan 4;151(1):30.
doi: 10.1007/s00432-024-06063-z.

The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers

Siyer Roohani  1   2   3 , Jolina Handtke  4 , Kamal Hummedah  5   6 , Markus Albertsmeier  7 , Dimosthenis Andreou  8   9 , Leonidas Apostolidis  10 , Marinela Augustin  11 , Sebastian Bauer  12   13 , Moritz Billner  14 , Florian Bösch  15 , Christoph K W Deinzer  16 , Niklas Deventer  17 , Anna Duprée  18 , Franziska Eckert  19   20 , Lars Engel  21 , Katja Fechner  22 , Hagen Fritzsche  23 , Verena Gaidzik  24 , Saeed Ghani  25 , Robert Grützmann  26 , Wiebke K Guder  9   13 , Rainer Hamacher  12   13 , Judith S Hecker  27 , Anne Hendricks  28 , Axel Hillmann  29 , Philipp Houben  30 , Georg Hübner  31 , Philipp Ivanyi  32 , Christina Jentsch  33   34   35 , Maren Jordan  36 , Peter Kappl  37 , Moritz Kaths  13   38 , Torsten Kessler  39 , Johanna Kirchberg  35   40 , Carolin Knebel  41 , Robert Krempien  42   43 , Burkhard Lehner  44 , Ulrich Lenze  41 , Lars H Lindner  45   46 , Alisa Martina Lörsch  27 , Nadia Maguire  47 , Sophie Müller  28 , Pompiliu Piso  48 , Vlatko Potkrajcic  19 , Peter Reichardt  25   43 , Stephan Richter  35   49 , Simone Schewe  18 , Lars M Schiffmann  50 , Felicitas Scholten  36 , Jana Käthe Striefler  51 , Matthias Schwarzbach  36 , Katharina Seidensaal  52   53   54 , Sabine Semrau  55 , Joanna Szkandera  56 , Christoph J Szuszies  57 , Beate Timmermann  13   58 , Armin Tuchscherer  59   60 , Armin Wiegering  28   61 , Moritz T Winkelmann  62 , David Kaul  4   63   64 , Jens Jakob  65   66
Affiliations
Multicenter Study

The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers

Siyer Roohani et al. J Cancer Res Clin Oncol. .

Erratum in

  • Correction: The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers.
    Roohani S, Handtke J, Hummedah K, Albertsmeier M, Andreou D, Apostolidis L, Augustin M, Bauer S, Billner M, Bösch F, Deinzer CKW, Deventer N, Duprée A, Eckert F, Engel L, Fechner K, Fritzsche H, Gaidzik V, Ghani S, Grützmann R, Guder WK, Hamacher R, Hecker JS, Hendricks A, Hillmann A, Houben P, Hübner G, Ivanyi P, Jentsch C, Jordan M, Kappl P, Kaths M, Kessler T, Kirchberg J, Knebel C, Krempien R, Lehner B, Lenze U, Lindner LH, Lörsch AM, Maguire N, Müller S, Piso P, Potkrajcic V, Reichardt P, Richter S, Schewe S, Schiffmann LM, Scholten F, Striefler JK, Schwarzbach M, Seidensaal K, Semrau S, Szkandera J, Szuszies CJ, Timmermann B, Tuchscherer A, Wiegering A, Winkelmann MT, Kaul D, Jakob J. Roohani S, et al. J Cancer Res Clin Oncol. 2025 Apr 24;151(4):149. doi: 10.1007/s00432-025-06193-y. J Cancer Res Clin Oncol. 2025. PMID: 40272574 Free PMC article. No abstract available.

Abstract

Purpose: The management of soft tissue sarcoma (STS) at reference centers with specialized multidisciplinary tumor boards (MTB) improves patient survival. The German Cancer Society (DKG) certifies sarcoma centers in German-speaking countries, promoting high standards of care. This study investigated the variability in treatment recommendations for localized STS across different German-speaking tertiary sarcoma centers.

Methods: In this cross-sectional case-based survey study, 5 anonymized patient cases with imaging data of localized STS were presented to MTBs of 21 German-speaking tertiary referral hospitals. Centers provided recommendations on treatment sequence and modalities, along with the consensus level within their MTB. Agreement percentages were calculated, and consensus levels were rated on a scale of 1 to 10.

Results: Five patient cases were discussed resulting in 105 recommendations. Agreement percentages for case 1 to 5 were 14.3%, 61.9%, 33.3%, 52.4% and 9.3%, with a median agreement percentage of 33.3%. Grouping pre- and postoperative therapies as "perioperative" and including recommendations with and without regional hyperthermia raised the median agreement to 47.6%. The mean consensus level within each center across all 5 cases was 9.5.

Conclusion: This first case-based analysis of inter-center agreement for STS management in German-speaking countries reveals low inter-center agreement but high intra-center consensus. Our study includes nearly all tertiary sarcoma centers in German-speaking countries, affirming its strong external validity. These findings suggest potential and clinically very relevant differences in treatment standards among sarcoma centers. Enhanced case-based exchanges and collaborative efforts are needed to reduce discrepancies and standardize the management of STS patients.

Keywords: German Cancer Society; Guidelines; Inter-center agreement; Reference center; Ring trial; Soft tissue sarcoma.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interest related to the presented work. Ethics approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board (EA1/126/23).

Figures

Fig. 1
Fig. 1
Analysis of recommendations for case 1: Localized dedifferentiated liposarcoma (G2) in the right groin. Detailed treatment recommendations are outlined, including specific therapy modalities and sequences (A most detailed recommendations). Recommendations are then categorized into groups with and without regional hyperthermia (B grouped recommendations). Finally, recommendations are further summarized by also combining preoperative and postoperative treatment modalities into “perioperative treatment modalities” (C most grouped recommendations). The degree of consensus is displayed in D
Fig. 2
Fig. 2
Analysis of recommendations for case 2: localized myxoid liposarcoma (G3) in the right shoulder blade. Detailed treatment recommendations are outlined, including specific therapy modalities and sequences (A most detailed recommendations). Recommendations are then categorized into groups with and without regional hyperthermia (B grouped recommendations). Finally, recommendations are further summarized by also combining preoperative and postoperative treatment modalities into “perioperative treatment modalities” (C most grouped recommendations). The degree of consensus is displayed in D
Fig. 3
Fig. 3
Analysis of recommendations for case 3: locally recurrent dedifferentiated liposarcoma (G2) in the right retroperitoneum. Detailed treatment recommendations are outlined, including specific therapy modalities and sequences (A most detailed recommendations). Recommendations are then categorized into groups with and without regional hyperthermia (B grouped recommendations). Finally, recommendations are further summarized by also combining preoperative and postoperative treatment modalities into “perioperative treatment modalities” (C most grouped recommendations). The degree of consensus is displayed in D
Fig. 4
Fig. 4
Analysis of recommendations for case 4: Well-differentiated liposarcoma (G1) in the right retroperitoneum. Detailed treatment recommendations are outlined, including specific therapy modalities and sequences (A most detailed recommendations). Since regional hyperthermia is not commonly used for management in well-differentiated G1 liposarcoma, no grouping for this treatment modality was necessary. Recommendations are summarized by combining preoperative and postoperative treatment modalities into “perioperative treatment modalities” (B most grouped recommendations). The degree of consensus is displayed in C
Fig. 5
Fig. 5
Analysis of recommendations for case 5: localized pleomorphic rhabdomyosarcoma (G3) in the right popliteal fossa. Detailed treatment recommendations are outlined, including specific therapy modalities and sequences (A most detailed recommendations). Recommendations are then categorized into groups with and without regional hyperthermia (B grouped recommendations). Finally, recommendations are further summarized by also combining preoperative and postoperative treatment modalities into "perioperative treatment modalities" (C most grouped recommendations). The degree of consensus is displayed in D
Fig. 6
Fig. 6
Overview of treatment recommendations for all 5 cases. Detailed treatment recommendations for case 1 to case 5 are outlined, including specific therapy modalities and sequences (A–E most detailed recommendations). Recommendations for all 5 cases are then categorized into groups with and without regional hyperthermia (F–I grouped recommendations). Case 4 is not represented, as regional hyperthermia is not applied in low-grade soft tissue sarcoma. Finally, recommendations for all 5 cases are further summarized by also combining preoperative and postoperative treatment modalities into "perioperative treatment modalities" (J–N most grouped recommendations)
See this image and copyright information in PMC

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