Cancer Today - Winter 2016

Breakthrough Treatments for Orthopaedic Cancers
Multidisciplinary expertise in treating musculoskeletal malignancy

There are many different types of bone and soft tissue sarcomas. These tumors commonly occur in the younger age group, and affect their ambulatory function, growth, and can cause symptoms that disrupt their activities. At Stony Brook University Cancer Center, the goal of treatment for soft tissue sarcomas is limb-preservation for optimal ambulation. This is achieved by safely removing the tumor with a multidisciplinary approach to surgery.  

The following is an example of limb-sparing treatment: A 32-year-old woman recently presented to Stony Brook Cancer Center with a very difficult medical issue. She had a large mass in the thigh and groin region that was initially treated as a hematoma before she was referred to the Cancer Center. She was evaluated by orthopaedic oncologist surgeon Fazel Khan, MD, who performed a biopsy of the lesion, which was actually encasing the femoral artery and nerve. The diagnosis was a synovial sarcoma involving the entire upper thigh. Amputation is the usual course of treatment for such an invasive tumor involving neurovascular structures.

This case was thoroughly discussed at an orthopaedic tumor board meeting, and the management team developed a well-orchestrated multidisciplinary plan. The initial step was preoperative neoadjuvant radiotherapy, which made the tumor more feasible for resection. Radiation oncologist Edward Valentine, MD, provided this treatment by using the most sophisticated intensity-modulated radiation toshrink the tumor and eradicate the invading tumors to the surrounding normal leg muscles. 

The patient then underwent an extensive surgery in a 14-hour procedure. Dr. Khan was able to remove the entire tumor along with the femoral artery, achieving negative margins around the femoral nerve to preserve the limb. For vascular reconstruction, David Landau, MD, a vascular surgeon, used the saphenous vein to bridge the cut portion of the artery. Duc Bui, MD, a plastic surgeon, harvested tissue from the patient’s abdomen to repair the significant defect resulting from the tumor removal.

The patient recovered remarkably well with a highly functioning leg. She is now being treated by medical oncologist Andrzej Kudelka, MD, who has designed a personalized chemotherapy regimen to help prevent recurrence.

Additional healthcare professionals comprised the comprehensive team, including anesthesiologists for theprolonged surgery and nursing staff for care during and after treatment. During postoperative care, physical therapists helped restore the patient’s ambulatory function and social workers attended to the patient’s psychosocial needs. This is a care model by the bone and soft tissue cancer management team.

For the full issue of Cancer Today • Winter 2016