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Sarcoma, Peritoneal and Rare Tumours (SPRinT)

The Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT) was set up in 2019 in SingHealth as part of the Division of Surgery and Surgical Oncology. Prior to the formation of the department, the surgical oncologists were practicing as a team within the Division of Surgical Oncology and has experience extending back 20 years. The SPRinT department is the first of its kind in the region and has extensive experience in treating patients with peritoneal-based cancers and advanced intra-abdominal malignancies. 

DSSO’s SPRinT team actively engages in a wide spectrum of research activities in a bid to advance cancer care for our patients, including clinical research, health services research (Palliative Surgery and Surgical Oncology (PSSO) Initiative) and translational research (Laboratory of Applied Human Genetics). Since our inception in 2019, we have published more than 60 articles in well-established journals including Top 10 and 20% journals such as Nature Communications, npj Precision Oncology, Oral Oncology, Annals of Surgical Oncology and European Journal of Surgical Oncology. In our recently published clinical audit, we found that the outcomes of sarcoma resections and cytoreductive surgeries performed by SPRinT are comparable to global standards (Tu et al., 2021). 

Multidisciplinary management of sarcomas: 

Malignant soft tissue tumours, or sarcomas, are rare and heterogeneous, and are best managed in tertiary units with a multidisciplinary team well-versed in this disease. On the research front, the SPRinT team has embarked on a clinical trial investigating the use of radical resection and hyperthermic intraperitoneal chemotherapy (HIPEC) for recurrent retroperitoneal sarcoma (NCT03792867). Trial recruitment has closed and data analysis is currently ongoing. We have also recently published a systematic review and meta-analysis on the use of cytoreductive surgery (CRS) with HIPEC in peritoneal sarcomatosis in EJSO (Wong et al., 2022). Additionally, the Laboratory of Applied Human Genetics published a paper in Cancers (Basel) that looked at gene expression changes associated with dedifferentiation in liposarcoma to predict overall survival (Shannon et al., 2021). 

Peritoneal surface malignancies and their treatment: 

Peritoneal surface malignancies refer to a wide variety of cancers that involve the peritoneum. The tumours may arise from the peritoneum or spread to the peritoneum from primary tumours in other organs. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in selected patients with peritoneal carcinomatosis. To date, the SPRinT department has performed more than 500 HIPEC procedures. In patients who are not suitable to undergo CRS and HIPEC, palliative surgery, systemic or intraperitoneal chemotherapy can be performed to relieve symptoms. 

An analysis of our department has shown that CRS and HIPEC can be safely performed with outcomes comparable to other international high-volume centres (Tu et al., 2021). Our research primarily revolves around identifying prognostic factors that determine patient outcomes, as well as quality of life (QOL) studies and cost-benefit analyses. Our latest QOL investigation revealed that several baseline factors could predict morbidity and survival following CRS and HIPEC, which could be used for better patient selection (Chia et al., 2022). We have also published several systematic reviews on peritoneal disease, including the effect of HIPEC on peritoneal recurrence following CRS (Yap et al., 2021) and the role of total parenteral nutrition in patients with peritoneal carcinomatosis (Ong et al., 2021). Additionally, the SPRinT team has initiated and completed several clinical trials focusing on peritoneal disease, such as the feasibility of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for patients with peritoneal disease (NCT04956068, recruitment ongoing), use of prophylactic HIPEC for patients with colorectal cancers at high risk of developing peritoneal disease (NCT03422432, completed and awaiting publication) and investigating the utility of perioperative immunonutrition for patients undergoing cytoreductive surgery and HIPEC (NCT03430128, Tan et al., 2023). The Laboratory of Applied Human Genetics also seeks to battle peritoneal disease by identifying novel mutations and biomarkers that could serve as diagnostic or prognostic markers of disease as well as identify novel therapeutic strategies. The Laboratory recently published a flagship article in Cell Reports Medicine detailing the phenomenon of paracrine addiction in peritoneal disease, with its message featured as the cover image of the reputable journal (Hendrikson et al., 2022).

Multidisciplinary approach to Rare Tumours 

The SPRinT department manages rare tumours referred to NCCS, including but not limited to, Asian subtypes of advanced melanoma, advanced squamous cell carcinoma, gastrointestinal stromal tumours (GIST), extramammary paget disease (EMPD) and dermatofibrosarcoma protuberans (DFSP). In order to understand the biology of rare tumours, the SPRinT team has established multiple collaborations with clinicians and scientists. We recently published an article in International Journal of Clinical Oncology detailing the role of neoadjuvant tyrosine kinase inhibitors in rectal GIST (Yong et al., 2021). 

Surgical Palliation 

Due to widespread disease, patients with advanced cancers may not be candidates for curative treatment. In a select group of these patients, palliative surgery can serve to both prolong lifespans and improve quality of life by directly eliminating the problem, challenging the current paradigm of palliative care. Surgical intervention can also help alleviate some symptoms, allowing patients to live their remaining lives in relative comfort and dignity. SPRinT’s mission is to deliver quality palliative surgical care through the incubation and implementation of novel healthcare services delivery strategies, interdisciplinary collaboration, the use of innovative technologies and education. 

We recently published our clinical experience and the development of a predictive model for palliative patients with advanced peritoneal carcinomatosis in Frontiers in Oncology (Wong et al., 2022). In the last 2 years, SPRinT has initiated numerous strategies via a 3-pronged approach to develop research efforts in this field. Firstly, health service delivery models such as the first specialist-led community-based palliative care service tailored to the unique needs of surgical patients (SUR-PORT care model) and an integrated palliative and surgical oncology care delivery model combining surgeons and specialist palliative care teams providing a comprehensive end-of-life care for advanced cancer patients (PSO model) have been put in place. Secondly, using artificial intelligence, the SPRinT team seeks to develop and test automated approaches to identify quality indicators of optimal palliative care delivery and predict QOL amongst palliative surgical patients. Lastly, a prospective palliative surgical patient registry has been set up to better capture the treatment details of our patients in a bid to develop better strategies for patients to live comfortably for their remaining lives. 

The SPRinT Doctors 
Clinical Associate Professor Claramae Chia Shulyn – Head and Senior Consultant 
Associate Professor Ong Chin-Ann Johnny – Senior Consultant and Principal Investigator of Laboratory of Applied Human Genetics 
Dr Jolene Wong Si Min – Consultant 
Dr Jane Seo Chin Jin – Associate Consultant