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Treating sarcomas with technology and a multidisciplinary approach

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Bone sarcomas are becoming more common in teenagers and young children reveals Arab Health 2022 speaker, Dr. Joel Mayerson.

At the online Orthopaedics conference as part of Arab Health 2022, Dr. Joel Mayerson, Director, Division of Orthopaedic Oncology, The James, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, U.S., will be presenting a live tumor board, where a group of sarcoma physicians that meet every week from all the specialities involved in the care of sarcoma, will come together to talk about patient cases and optimizing their care.

He said: “We will get patients who have a complicated problem for multidisciplinary input and try to make sure that there is a cutting-edge treatment involved for their care.”

Dr. Mayerson explained that there are two types of sarcomas – bone sarcoma and soft tissue sarcoma. Bone sarcomas cause immense pain in the limb, either when you’re walking or at night. For instance, when you’re walking, it destroys the bone and makes it weaker. He stressed that bone tumor pain doesn’t get better when you rest it. So, if you have a constant dull, toothache type pain that increases when you walk, you need to seek medical attention quickly to make sure you don’t have a bigger problem. Soft tissue sarcomas, on the other hand, do not hurt. They usually are a painless growing mass. So, if you have a bump in your arm or leg that you notice in the shower or when you are putting socks on that wasn’t there before, you need to keep an eye on it. If it’s growing, a physician needs to be consulted.

Dr. Mayerson is one of the physicians who takes care of bone tumors in children as well. While The James is an adult cancer hospital, children under 18 are cared for at Nationwide Children’s Hospital. “Bone sarcomas are more common in teenagers and young children. Many of the bone sarcomas in our region are treated at Nationwide Children’s. In contrast, soft tissue sarcomas are much more common in adults and are treated at The James. I have two partners, and the three of us take care of children with tumors at Nationwide Children’s,” he highlighted.

Advancements in orthopedic oncology

From a reconstructive standpoint, Dr. Mayerson shared that customized 3D printed implants are coming into the market. “We are also using 3D printing to devise cost custom cutting guides. When we know where the core is at, we can cut closer and accurately to the tumor and use the 3D printed implants that are made to fill the void accurately and decisively where we’ve removed the bone or the tumor to be put in.”

Another advancement is the use of osseointegration for patients who have had trouble after an amputation. Osseointegration involves placing a metal rod inside the amputated patient’s bone. A small portion sticks out of their skin, and the skin is treated in a particular way to adhere to the bone to try to decrease the risk of infection. They can then snap on the prosthetic to the end of that piece of metal that allows them not to have the problems they had while using a socket, and they can walk better.

Research is also being done on targeted muscle reinnervation. It is a process whereby the ends of a cut nerve are sewed to an intact motor nerve. They then grow into that nerve. It decreases the amount of pain that the patient has after they have the procedure. Moreover, it reduces the risk of having phantom pain, which is when the leg is not there anymore.

He explained: “We are also now working on trying to connect integration and targeted muscle reinnervation together. You can put an electrode on the patient’s skin, map it to where that nerve that was firing goes, hook it up to the prosthesis at the end and make the prosthesis move by using the patient’s thoughts. For example, if a patient is meant to bring their ankle toward their face or push their ankle towards the floor, their brain normally does that. If you take that electrode, it knows that nerve wise where it should have been, and the brain can sense what it wants to do and fires the electrode connected to the prosthesis that can move the prosthesis the way it would naturally. This is not standard of care yet, but we are working on it from a research standpoint. I hope that it will become the standard of care for amputees within the next decade and help them walk more naturally. One of the challenges is bringing the cost of that technology down. Right now, it costs about a million dollars, but the technology is there, and if we can make progress and get it cheaper, we can integrate it into normal society and healthcare.”

Also, shoulder prosthesis has come into the limelight in the past four to five years. It’s called reverse total shoulder arthroplasty and is done for people that have rotator cuff tears that have progressed and where it’s not normally reconstructable. Dr. Mayerson said that people are moving much better with reverse oncology shoulders, their shoulders are not dislocating, and their quality of life has improved quite a bit. In fact, he believes that it’s going to replace most of the shoulder oncology surgery that’s done for bone tumors over the next few years.

He concluded: “The biggest thing to know about sarcomas is that they are complex and require multidisciplinary care. One of the things that we will be doing in the presentation at Arab Health is showing how multidisciplinary care affects patients. If someone does have a sarcoma, they should be treated at a regional center that specializes in sarcomas.”

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Dr. Mayerson will be presenting the ‘Multidisciplinary Orthosarcoma tumor board’ on Wednesday, February 2, at the online Orthopaedics conference as part of Arab Health.

Physicians on the tumor board:

Joel Mayerson, MD, Professor and Director, Division of Musculoskeletal Oncology; Medical Director of Perioperative Services and the Sarcoma Service Line, OSUCCC – James

Prof Raphael E. Pollock, MD, PhD, Professor and Director of OSUCCC - James.  Klotz Chair in Cancer Research, Director of The Ohio State University Sarcoma Research Laboratory

Surgical oncology – Valerie Grignol, MD

Radiation oncology – David Konieczkowski, MD, PhD, Meng Welliver MD, PhD

Pathology – Hans Iwenof, MBBS

Medical oncology – Gabriel Tinoco, MD, FACP

Diagnostic radiology – Scott Lenobel, MD

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

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