Advancing sarcoma care in a developing country: Impact of centralization and long-term international collaboration.

Abstract

e23328 Background: Musculoskeletal sarcomas are rare and aggressive malignancies requiring multidisciplinary care, which frequently is not available in low- and middle-income countries (LMICs). In Armenia, the centralization of pediatric cancer care in 2019 at the Pediatric Cancer and Blood Disorder Center (PCBDC) marked a crucial turning point with the establishment of a multidisciplinary team (MDT). This was supported by a collaboration with the University Hospital of Münster in Germany. Our study aims to highlight the impact of these initiatives on improving sarcoma care in a resource-limited setting. Methods: A retrospective analysis of MDT meetings from 2019 to 2024 was conducted, reviewing data from 193 cases discussed during 85 meetings. After centralization (2019-2024) the data on patients aged 0-25 years was compared with a historical cohort from three Armenian hospitals (2008-2019) taking care of sarcoma patients before 2019, assessing changes in diagnostic accuracy, treatment practices, and outcomes. Results: The MDT reviewed 193 cases, including 80 pediatric cases (≤18 years). Treatment adherence to international guidelines improved from 49.0% before 2019 to 79.1% after 2019 (p = 0.0001). The review of paraffin blocks increased from 24.0% before 2019 to 88.4% after (p = 0.0001). Of 64 paraffin blocks sent internationally, 34% resulted in diagnostic changes. For the whole cohort, the 3-year overall survival (OS) rates were 60.0% for patients under 18 years and 47.4% for those aged 18 and above. OS was 66.7% for localized disease, compared to 27% for metastatic cases (p = 0.0001). Bone sarcomas had a 3-year OS of 52.4%, while soft tissue sarcomas had 61.0%. The treatment abandonment rate decreased from 22.0% before 2019 to 10.3% after 2019. When comparing 3-year OS before and after centralization, the rates were 45% and 50%, respectively. Among patients who did not abandon treatment, the 3-year OS was 48.7% before centralization and 57.6% after. Conclusions: This study highlights centralized care and collaboration as the lynchpin of advancing musculoskeletal sarcoma care, exemplified by the establishment of PCBDC and the Armenian-German partnership, which have significantly improved outcomes and management of these patients.