Orthopaedic Oncology Newsletter July 2014
A 24-year-old female is referred to the Orthopaedic Oncology Service at Rothman Institute for evaluation for a pelvis bone lesion seen on imaging. About eight months ago she first developed right-sided low back pain and pain radiating down her right leg. An MRI of the lumbar spine was done. A large bone lesion was seen, involving a significant portion of her right hemipelvis, and a portion of the sacrum and spine.
A CT scan of the pelvis was ordered to better evaluate this lesion, which confirmed an aggressive appearing tumor of the pelvis, sacrum and spine. Once this imaging was completed, the patient was referred to Dr. Abraham, chief of the Orthopaedic Oncology service at Rothman Institute for further workup and management of this malignant pelvis tumor.
Workup and Treatment
Based on the appearance of the tumor on the imaging, the suspected diagnosis is pelvic osteosarcoma. A biopsy is performed, which confirms the diagnosis. Staging studies are performed, which
confirms that the tumor is localized to the pelvis only, with no sign of metastatic disease. Osteosarcomas of the pelvis are rare, with only about 100 such tumors seen in the entire US per year. Treatment of Pelvic Osteosarcoma requires the expertise of a multidisciplinary team familiar with osteosarcoma treatment, such as the Musculoskeletal Oncology Center at Jefferson. The patient is referred to Dr. Basu-Mallick, a Sarcoma Medical Oncologist, for initiation of the neoadjuvant chemotherapy protocol.
The surgical treatment of Pelvic Osteosarcoma is extremely challenging. Only a few centers in the country have the expertise necessary to safely and adequately remove these tumors. Dr. John Abraham, chief of the division of Orthopaedic Oncology at the Rothman Institute, and Director of Jefferson’s Musculoskeletal Oncology Center, has
pioneered the use of technology known as surgical navigation to assist in the resection of complex tumors such as this one. Using this system, a highly precise 3 dimensional image of the tumor and surrounding tissues can be seen intra-operatively in real time. This makes the resections not only safer, but also increases the surgeon’s ability to achieve a negative margin resection, which is critical to the patient’s disease free survival.
Preoperative planning was done at the weekly Sarcoma and Musculoskeletal Oncology treatment planning conference, with the input from the Musculoskeletal Radiology and Bone and Soft Tissue Pathology teams. In this Did You Know? case, an extremely complex 12 hour operation was performed by Dr. Abraham. A navigation assisted resection including the right hemipelvis, right hemi sacrum, and the right half of the L5 vertebral body was performed.
The tumor was evaluated by the Bone and Soft Tissue Pathology service. The resection demonstrated anegative margin in all planes of the resection. This is the best surgical result that can be achieved when dealing with these aggressive tumors, and significantly improves the patient’s chance for survival.
Did You Know?
The Orthopaedic Oncology service at Rothman Institute is the only center in the region with expertise in the utilization of surgical navigation for resection of bone tumors. As demonstrated by this case, achieving a negative margin is extremely challenging, yet is absolutely critical to the best patient outcome. Dr. Abraham believes this technology has increased his ability to safely and completely remove even the most challenging of skeletal tumors like this one, and is thrilled about the benefits that it can offer his patients with difficult bone tumors.
To Refer A Patient
Call our Physician Referral hotline, RI Connect: 800-411-6626
Visit us at: www.rothmaninstitute.com, click on “make an appointment.” For more information visit www.rothmaninstitute.com, click on Orthopaedic Oncology under the Specialties section.
John A. Abraham
Chief, Orthopaedic Oncology