Treatment Options for Sarcoma

Interviewer: What are the treatment options for sarcoma? We'll talk about that next on "The Scope."

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is "The Scope."

Interviewer: Dr. Lor Randall is the director of the Sarcoma Services at Huntsman Cancer Institute. For somebody who's received the diagnosis of sarcoma and they're looking at what are some of their treatment options, let's breakdown what you would discuss with a potential patient. So let's just start out with what are the treatment options?

Dr. Randall: It does depend on the age of the patient and, again, expectations. Surgery for most sarcomas is a mainstay. Some of these patients will also undergo chemotherapy and radiation therapy either before or after, depending upon what we call the stage of the tumor. But how we develop a personalized plan really does depend upon age and expectation.

Interviewer: All right. So, just like many things, there's a lot of different variables that go in there. Give us an example of some of the more common ones, you know. Maybe you could breakdown . . . I know sarcomas affect a lot of younger people, children, and also somewhat older adults. Why don't we take a look at some of the common things that you might have a discussion. Dr. Randall: So let's role play at an unfortunate 10-year-old girl . . . or let's make it a boy because they develop a little bit slower. A 10-year-old boy with a distal femur, meaning lower thigh, just above the knee, osteosarcoma. This patient has a very good chance of beating this cancer after a year of treatment. It will usually get upfront what we call neoadjuvant chemotherapy. We will then see how the tumor is responding. And then, we will go in and remove the tumor. Usually, this is a lot of real estate that we're moving and we have to reconstruct it. What do we reconstruct it with?

In someone who is more sedentary, one might use something called an endoprosthesis, which is a big glorified knee replacement. In someone who envisions playing sport, we would do something called a rotationplasty where we actually use the joint below, meaning in this case, the ankle, and rotate it up and put it on backwards, if you will, to make it into a very functioning knee. And these kids can play competitive sports, contact sports like football and lacrosse. They can swim. They can do all the durable things.

Now, for some people, that is an esthetically, very unattractive option. And they put more emphasis on their body habitus and appearance, and so they might go with an endoprosthesis. But in someone with so much growth remaining, again, someone under the age of 10, they have a real chance of needing multiple revision surgeries down the road with an endoprosthesis. So we really will push, out of compassion, the use of the rotationplasty.

Interviewer: What about an older patient? Give us another scenario.

Dr. Randall: Yeah. And in an older patient, say, they have a chondrosarcoma this time in the upper femur or around the pelvic bone, we will usually not give chemotherapy. We will usually just use surgery to remove the tumor. And many of these patients do survive this surgery and this cancer, but they are left with some functional considerations that are sometimes a challenge. It's relatively easy to replace the upper femur bone. Sometimes when it's on the what we call the socket side or around the joint on the pelvis, the reconstructions are much more challenging and can be much more hard to recover from. But we are actually learning now that sometimes these simply options are better than the complicated hemi-pelvic replacement surgeries that we have done over decades.

Interviewer: And then, you yourself have done a few, a handful of some different types of procedures some might call innovative procedures. Explain those.

Dr. Randall: Well, one that we advocate for here in Utah is something called the clavicula pro humero procedure. This is a procedure where we actually have to remove the upper arm bone in a child. So, for an osteosarcoma, Ewing's sarcoma of the upper humerus bone which is about the shoulder joint, we'll replace that. And then, we will transport down the clavicle bone or collar bone, rotating it on its hinge, if you will, on the shoulder blade, and then attach the lower part of the humerus bone to the collar bone.

And I'd like to say I first saw this in action, if you will, when I was a visiting professor overseas in South Africa, in a place called Limpopo, where I went to the wards, and unfortunately, many of these children were abandoned by their families once they had the diagnosis. And so, there's these wards of surviving children from osteosarcoma out there playing soccer, out there playing basketball with the shortened limbs because the collar bone is shorter than the humerus bone that we removed, but playing all the sports that they want. And I asked them what the procedure was, and they said, "It's this CPH or clavicula pro humero. That's the only thing we have. We don't have access to the technologies that you do in the West and this is what we do."

And what I saw before me were beautiful, happy children playing in a gregarious way with one surgery. As I was supposed to go over there and tell them about the wonders of the West, I bought that back home to our country and I . . . again, I should not . . . there are people who do it here. I'm not professing that I'm the guy who does it. But I fell in love with this procedure because I knew what it offered children in their ability to live out their lives completely.

Interviewer: And in the collar bone procedure, you fell in love with it. Why was that? Was is because it was so elegant and simple and restored function in such just a great way?

Dr. Randall: Exactly, elegant and simple. It used nature's parts to give a sound, durable, stable reconstruction. The only thing that is foreign in that child is the plate that we use to attach the collar bone to the remaining arm bone. And they do remarkably well. I shouldn't say they're not at risk. They are at risk for complications. There are concerns. But overall, these patients do remarkably well.

Interviewer: And are there other possible treatment options on the horizon?

Dr. Randall: Well, surgical innovations are coming along all the time. As a surgeon, I work with surgeons around the country to push the envelope. We have new ways of attaching metal bones to femurs, things of that sort. But the real excitement is in the researches being done at major sarcoma centers like Huntsman Cancer Institute where we're looking at the molecular targets and doing sort of the personalized medicine already in that these signatures, these translocations that we've talked about in the past, have actually . . . we can actually develop therapeutic targets to knock those out or their downstream events. The biology, the molecular targets that are being done at these cancer institutes like Huntsman is really the future. And, you know, I'd rather be flipping burgers than cutting tumors out of kids.

Interviewer: Yeah. I was going to ask you, that would kind of put you out of a job, right, because the surgeries wouldn't be necessary anymore?

Dr. Randall: That's okay.

Interviewer: Yeah. And research equals hope, I've heard you say before.

Dr. Randall: Right. And that's what we talk about on the hill. It's all about the care today, but the future tomorrow for cure is for the research. And that's the Huntsman mission.

Interviewer: And it sounds like that a diagnosis of a sarcoma in a patient, you know, it's like a lot of cancer diagnosis, not something great, but it's very treatable and very survivable, and you could go on with life.

Dr. Randall: Yeah. There is a spectrum. I mean, like with any cancer, there's bad actors and good actors. But there's plenty of hope for the patient of today and there's even more hope for the patient of tomorrow.

Announcer: Want The Scope delivered to straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up!" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.