The American Cancer Society estimates approximately 13,040 soft tissue sarcomas and 3,450 bone sarcomas will be diagnosed in U.S. adults and children in 2018. To optimally treat sarcomas, health systems are developing multidisciplinary team approaches that include dedicated musculoskeletal expertise.
Research has shown that effective treatment of sarcomas requires a high level of coordination between multiple treatment modalities and specialists. In one study reported in Journal of Surgical Oncology, authors at Vanderbilt demonstrated that a well-orchestrated team approach results in fewer complications, improved survival and better functional outcome. Results of this investigation emphasize the importance of patient-centric multidisciplinary care, alongside evidence-based care guidelines and clinical trials.
Integrating the Role of Musculoskeletal Radiology
Jake Block, M.D., associate professor of Radiology and director of Musculoskeletal Radiology at Vanderbilt University Medical Center, explains that musculoskeletal radiologists are among the integrated group of specialists treating patients with sarcomas at Vanderbilt. “In radiology, we employ the most advanced diagnostic and therapeutic techniques in the evaluation and treatment of our patients with sarcoma. We are fortunate to have a number of radiologists on staff who are focused on musculoskeletal neoplasm and excel at these procedures.”
Block points to unique talents across the medical center. “The Department of Radiology is certainly not alone in bringing this expertise to the management of sarcoma patients at Vanderbilt. As you look across this large medical center, you find that there are devoted colleagues in many disciplines applying their passion for musculoskeletal disease and advancing the care of these patients.”
Sarcoma Tumor Boards
At Vanderbilt, sarcoma care is coordinated by weekly meetings of a multidisciplinary tumor board. Musculoskeletal radiologists are represented on the board alongside pathologists, orthopedic surgeons, medical oncologists, radiation oncologists, pediatrics, nurses and support personnel. In addition to reviewing new cases, the board discusses progress in patients undergoing treatment and those under surveillance.
“You can have all of the technology in the world, but if you don't have dedicated physicians and nurses with the best expertise in the room at the same time, then the treatment options and outcomes are not optimized,” said Block. “Open lines of communication between the various practitioners involved is what really makes a difference in choosing a treatment regimen that’s most fitting for a particular patient.”
Sarcoma Research and Innovation
Innovation has transformed the range of diagnostic and treatment options available, Block notes. “At Vanderbilt, we have more tools at our disposal now for both benign and malignant bone and soft tissue disease,” he said. “Minimally invasive biopsy techniques, cutting edge multimodality imaging, tumor genetic analysis and a wide range of individually tailored therapies including surgical and non-surgical approaches are now in our toolkit.”
Block also points to Vanderbilt’s advances in limb-sparing therapies for sarcoma patients, with effective, non-invasive and surgical options to spare amputation and maximize outcomes. “Our devoted group of orthopedic oncology surgeons are leaders in these techniques and have published pivotal research on the topic, highlighting optimal surgical techniques and treatment regimens. This vastly reduces the need to consider amputation in most patients.”[1]
Having a strong research program brings many translational benefits to patient care, says Block. Current research at Vanderbilt includes studies of soft tissue tumors such as Ewing sarcoma and rhabdomyosarcoma, as well as bony neoplasm such as osteosarcoma.
“A world-class sarcoma program includes a variety of physicians involved in research and clinical practice, all advancing our understanding of these rare cancers,” Block said. “At Vanderbilt, we are innovating together for the welfare of patients with musculoskeletal neoplasm.”
Jake Block, M.D., is associate professor and Vice Chairman for Clinical Operations within the Department of Radiology and Radiological Sciences at Vanderbilt University Medical Center. His research interests include musculoskeletal and emergency radiology and radiology practice management.
[1]See these studies, for example: Adelani, Muyibat A., et al. "Revascularization after segmental resection of lower extremity soft tissue sarcomas." Journal of Surgical Oncology 95.6 (2007): 455-460; Alamanda, V. K., et al. "Amputation for extremity soft tissue sarcoma does not increase overall survival: a retrospective cohort study." European Journal of Surgical Oncology 38.12 (2012): 1178-1183; Holt, Ginger E., Michael J. Christie, and Herbert S. Schwartz. "Trabecular metal endoprosthetic limb salvage reconstruction of the lower limb." The Journal of Arthroplasty 24.7 (2009): 1079-1085.
