Advancing the Treatment of Orthpaedic Cancer

It wasn’t that long ago that cancer in the bone or soft tissue was a serious diagnosis that usually meant amputation of the affected limb. The orthopaedic oncology program at Penn Medicine has a long history of successfully treating these tumors and is one of the largest musculoskeletal tumor referral practices in the country.

Richard Lackman, MD, Penn orthopaedic surgeon, established the program in Philadelphia in the 1980s. He sees approximately 1,100 new orthopaedic tumor patients each year and performs about 700 surgical procedures. He specializes in the treatment of malignant (cancerous) and benign (non-cancerous) tumors of bone and soft tissue with a special interest in limb preservation.

“I was the first fellowship-trained orthopaedic tumor surgeon in Philadelphia,” Dr. Lackman said, “and I was part of the early movement to treat these tumors. Over the years, we have advanced that treatment so patients have other options besides amputation.”

Bone and soft-tissue sarcomas mainly occur in the spine, pelvis and extremities. The most common bone sarcomas—osteosarcoma and Ewing’s sarcoma—normally occur in adolescents and young adults, and chondrosarcoma usually occurs in older adults.

Treating Sarcoma

A three-pronged treatment approach can be used to treat sarcoma—chemotherapy, radiation and surgery. Most tumors start in the bone and then quickly spread beyond, making them too difficult to treat surgically without other treatment. Many of the new chemotherapy agents shrink the size of sarcomas and radiation stops their growth. The smaller tumor can then be safely removed.

If part of the bone is removed with the tumor, modular prosthetics are now available to preserve the limb. The replacement can be exactly sized, allowing patients to maintain their mobility.

A Team Approach

Patients at Penn are treated by a multidisciplinary orthopaedic oncology team. The team meets weekly to discuss all patients and the next steps in their treatment plan. Team members specialize in:

• Orthopaedic oncology
• Pathology
• Musculoskeletal radiology
• Hematology-oncology
• Radiation oncology
• Interventional radiology
• Surgical oncology
• Plastic surgery

“The team is vital to our program,” said Dr. Lackman. “All of the team members are based at Pennsylvania Hospital so that we can meet and collaborate. We all have experience treating these tumors and together we develop the appropriate treatment plan for every patient.”

Future Treatments

The Roberts Proton Therapy Center at Penn could provide another treatment option for bone and soft-tissue sarcomas.

Proton therapy allows the most precise targeting of dosage to the tumor and lowest unintended radiation dose to normal tissues. The protons can be energized to specific energies or velocities that precisely target the tumor, with little dose beyond the target area.

“Little research currently exists on using proton therapy to treat sarcoma,” said Dr. Lackman. “This puts Penn in the unique position of researching this technology and the role it may play in treating bone and soft-tissue tumors in the future.”