Treatment

Musculoskeletal Extremity Treatments

At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. (Link to diagnosis tab)

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

Standard Treatments for Primary Bone Sarcoma

Much more often than having a primary bone sarcoma, bone tumors are metastasized (spread) from cancers in other places, such as the lung, breast or colon. They are treated differently than primary sarcomas that originate in the skeleton.

Surgery

With 50 percent of all sarcomas occurring in the arms or legs, Washington University School of Medicine has three fellowship-trained orthopedic oncology specialists who treat more than 300 surgical cases annually, and who also specialize in limb-sparing procedures that allow for the removal of a tumor while sparing surrounding healthy bone and tissue. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection). The team has extensive experience with all types of musculoskeletal tumors, including benign and malignant tumors of the extremities and spine, soft tissue sarcomas of the extremities, including difficult pelvic and sacral resections.

Surgery to remove the entire tumor will be done when possible. Chemotherapy may be given before surgery to make the tumor smaller, so that less bone tissue needs to be removed and there are fewer problems after surgery. The following types of surgery may be done:

Wide local excision: This removes the cancer and some healthy tissue around it.

Limb-sparing surgery: This surgery removes the tumor in an arm or leg without amputation, so the use and appearance of the limb is saved. Most patients with osteosarcoma in a limb can be treated with limb-sparing surgery. The tumor is removed by wide local excision. Tissue and bone that are removed may be replaced with a graft taken from another part of the patient’s body, or with an implant such as artificial bone.

Today, Siteman surgeons can replace any joint in the body – knee, hip, shoulder, or elbow – with custom-designed artificial prostheses or bone grafts. To replace structurally significant segments of bone, they often use bone grafts. The choice of technique depends upon the situation of the patient.

After the doctor removes all the cancer that can be seen at the time of the surgery, patients are then given chemotherapy to kill any cancer cells that are left in the area where the tumor was removed or that have spread to other parts of the body.

Radiation Therapy

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from putting materials that produce radiation in the area where the cancer cells are found (brachytherapy). Physicians at Siteman Cancer Center utilized image-guided techniques to maximize precision of radiation therapy. Siteman is the first cancer center in the world to use magnetic resonance imaging (MRI) to guide radiation therapy localization for treatment accuracy.

Radiation oncologists may use Intensity-Modulated Radiation Therapy (IMRT) and brachytherapy, internal treatment with radioactive sources laid in or against the tumor location, for highly targeted radiation treatments for sarcomas. Brachytherapy allows a high dose concentration immediately surrounding the radioactive source, with rapid dose fall-off within adjacent tissues.

Proton beam therapy is another option for patients who may have sarcomas in the chest or abdomen. Siteman Cancer Center operates the only Proton Beam Therapy Center in Missouri and the region. It houses the world’s first compact proton beam accelerator. Radiation oncologists and physicists here helped evaluate the system and developed the patient protocols and quality standards for this advanced technology.

Proton beam therapy’s main advantage is that radiation specialists can control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered past the tumor. This treatment is ideal for patients with solid tumors that are located near sensitive structures or tissues.

Radiofrequency Ablation: This procedure uses extreme high heat to kill cancerous tumor cells. The ablation procedure may be particularly beneficial for patients who have reached their maximum radiation dose limits due to previous radiation treatments. Siteman Cancer Center has one of the largest spine, bone, and soft tissue tumor ablation centers in the United States.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. In soft tissue sarcoma, chemotherapy is sometimes injected directly into the blood vessels in the area where the cancer is found. This treatment is called regional chemotherapy.

Chemotherapy and/or radiation therapy may be used to shrink the cancer so it can be removed without taking off an entire arm or leg.

Targeted therapy such as kinase inhibitors finds and attack specific cancer cells without harming normal cells.

Immunotherapy: Although still experimental, immunotherapy that uses your own natural immunity to fight the cancer is available in sarcoma clinical trials. Given as a personalized cancer vaccine, this approach boosts your immunity to fight the cancer cells.

The standard of care for the treatment of metastatic and unresectable sarcomas is clinical trials. Siteman Cancer Center has the largest number of sarcoma clinical trials available in the Midwest. Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.