The science of sarcomas has advanced rapidly in the last decade. Recognition of the heterogeneity and complexity of this disease has highlighted the importance of a multi·disciplinary team approach to achieve better treatment outcomes for our patients. As an academic institution and a quaternary referral center for sarcoma care in Hong Kong, The Chinese University of Hong Kong (CUHK) and Prince of Wales Hospital (PWH) established an Adult Sarcoma Multidisciplinary Tumour Board (MDT) in 2012. In recent years, we have continued to advance our collaborative efforts between disciplines.
While this MDT approach has facilitated seamless patient journeys through the health care system, through the establishment of this collaborative effort, we have taken the additional step of providing continual medical education for our local and regional colleagues. Given the large patient population and heterogeneity in access to quality health care, this is especially important in the Asia-Pacific region. The 1st CUHK Sarcoma Preceptorship was successfully held in May 2017, during which we invited over 20 local, regional, and international attendees for a full-day discussion on the multi·disciplinary and complex nature of optimal sarcoma management. We were also honored to have Dr. Akira Kawai, Head of Musculoskeletal Oncology of National Cancer Center Hospital, Japan, and recent president of the Connective Tissue Oncology Society (CTOS), as our inaugural plenary speaker. Fast-forwarding two successful years, we recently held our 3rd CUHK Sarcoma Masterclass on September 21, 2019. With the generous support of philanthropy and our industry partners, we brought together 100 physicians of various specialties from across the Asia-Pacific region for a one-day interactive workshop. In our most recent masterclass, we had the privilege of inviting Professor Angela Hong of the University of Sydney to provide us insights into the roles and advancements of radiotherapy in multi·disciplinary sarcoma care.
Our CUHK Sarcoma Masterclasses are organized annually with five different themes in mind. We started the day with “Updates in the Multidisciplinary Management of Sarcoma Patients,” during which Dr. Alex W.H. Ng, consultant radiologist, provided an overview and practical tips on reading X rays. He brought home the point that conventional X rays contain a “treasure trove” of information, and proper interpretation can also help triage patients' necessity for more advanced imaging techniques. This was followed by Dr. Maribel D. Lacambra, clinical lecturer in the Department of Anatomical Pathology, who gave us a timely and lively lecture, titled “Sarcoma Pathology for Non-Pathology Savvy Clinicians.” Her 25-minute talk taught clinicians in the room how to “dissect” a seemingly confusing pathology report. She also highlighted the importance of molecular diagnostics in this contemporary era of sarcoma care. We also had two orthopedic colleagues, namely, my cochair, Dr. Kwok-chuen Wong, and Dr. Wang-kei Chiu, discuss their views on advancements in surgical management in extremity bone sarcomas and surgical management of giant cell tumors of bone in the era of adjunctive medical management, respectively. These were very insightful talks, especially for nonorthopedic surgeons in the room who may not truly appreciate the complexities of precise surgical planning.
We were extremely honored to have Prof. Angela Hong deliver her plenary lecture, titled “Advancing Radiotherapy in the Immuno-oncology Era – Implications for Sarcoma Care.” With recent advances in immunotherapy, Prof. Hong has helped reconfirm the role of the radiation oncologist on the sarcoma multi·disciplinary team, and how there is potentially room for treatment collaboration between the medical oncologist and the radiation oncologist in both the neoadjuvant and metastatic settings. Better understanding of radiobiology, newer radiotherapy techniques, and potential synergism between immunotherapy and radiotherapy has opened a new era for further advancements in the field.
This year, we chose the theme of retroperitoneal sarcomas for our Controversies and Consensus in Multidisciplinary Sarcoma Care session. We were delighted to have had Prof. Roger Ngan and Dr. Jeremy Yip from The University of Hong Kong give us their insights and share their experiences in tackling this complex disease from a radiation oncology and a surgical perspective, respectively. Dr. Herbert Loong summed up the discussion and provided the current views on the use of neoadjuvant chemotherapy in the management of retroperitoneal sarcomas, which may be indicated in selected patients. The discussions during this session were particularly lively and timely, given the recent publication of the STRASS trial data, which suggested a possible survival benefit of neoadjuvant radiation in patients with retroperitoneal liposarcomas, but not of other histologies.
From the initial inception of the masterclass program, we emphasized the need for interactive discussions, and wanted to make sure that attendees would feel that the day was well spent with a good balance of didactic sessions, hands-on breakouts, and participants' presentations. In the spirit of multi·disciplinary care, we felt that it was important for clinicians of different disciplines to have a more in-depth understanding and appreciation of the challenges (and joys) of other specialties involved in sarcoma patients' care. We were pleased that our Hands-on and Breakout sessions continued to be a well-recognized success. Three Hands-on stations were created. In the Orthopaedics & Surgical Hands-on stations, attendees were provided a more in-depth understanding of the complexities of computer-navigated surgeries. Moreover, under the guidance of Dr. Teresa Tan of our Plastics and Reconstructive Surgery team, nonsurgeons were given the rare opportunity of performing mock microsurgery on a freshly purchased piece of chicken wing from the market! As the radiation oncologist in our sarcoma MDT, Dr. Teresa Tse and Dr. Darren Poon led the Oncology Hands-on for the Non-Oncologist station; they also gave an insightful overview on the procedures and steps required for radiotherapy planning and provided an opportunity for attendees to perform radiotherapy contouring. Lastly, together with assistance from colleagues in Stryker and Pacific Medical Systems, Dr. Cina Tong and Dr. Alex Ng, both key members of our radiology team, led the Interventional Radiology Hands-on for Non-radiologists session. This was arguably the most well-received session, where among other activities, attendees had a chance to perform bone biopsies on Sawbone.
The day ended with our final session, titled “Multidisciplinary Case Discussions,” during which over 10 attendees from across the region were given the opportunity to present a recent challenging or controversial sarcoma case in order to obtain the collective insight of all attendees and faculty in the room. These included controversies in surgical management, optimal use of radiotherapies and systemic therapies, and diagnostic challenges. The discussions were so well received that this session was extended well into the night and became the focus of the course dinner.
The faculty and organizers valued the evaluation and feedback that was received after the meeting. Over 92% of respondents felt that the masterclass met their needs, as well as identifying and addressing their professional practice gaps. The overriding theme of our workshop was to promote a MDT practice in sarcomas; 25% respondents felt that while they appreciated the advantages of having a sarcoma MDT, there remained barriers including costs as well as cultural practices within the Asia-Pacific region, which may hamper such collective efforts. This event also provided a platform for networking between different young physicians in the Asia-Pacific region, and we sincerely hope that our masterclass can serve as a platform for multi·national sarcoma research and collaborations.
In conclusion, all faculty members want to thank our in-house conference team for their support, including Ms. Vengie Lau, Ms. Vivian Che, Ms. Karen Kwong, Mr. Keith Ho, Ms. Yuen-ling Lam, and Dr. Frankie Mo, without whom this conference would not have been possible. We are also grateful for the unrestricted educational grants provided by our industry partners, including Amgen, Bayer, Eisai. and Roche, for supporting this meaningful annual event.
We looked forward to our 4th CUHK Sarcoma Masterclass, earmarked to be held on December 4, 2020 in Hong Kong.