Orthopaedic Tumor Treatments

Working closely with the James P. Wilmot Cancer Institute, UR Medicine's Orthopaedics & Physical Performance can offer the full range of diagnostic and treatment options for your orthopaedic tumor.

Treatment options are selected based on whether the tumor is benign (non-cancerous) or malignant (cancerous), the type and stage of the cancer, the possible side effects of any treatment, and your overall health. You will work with a team of doctors from a range of specialties to create a treatment plan that combines a number of different treatment options.

We also take your personal preferences for treatment into account. We will provide information to help you make decisions about your treatment. Our doctors will answer all of your questions to help you understand what you will experience during treatment, and what options may be available to you.

In all cases, we will always recommend the least invasive procedure that can still deliver the best possible outcome over the long term.

Surgical Procedures

Our goal is to safely treat cancer in the arm or leg while sparing the limb. A surgical oncologist, a doctor who specializes in cancer surgery, will perform your surgery. Depending on the size and location of your tumor, he or she will use one of these options:

• Excision: Up to 80 percent of patients can be treated with surgery that spares the limb. The surgeon removes the tumor and the bone surrounding it, with the goal of removing all of the cancerous cells. As an excision often involves removal of a significant amount of bone, we are skilled in replacing this bone with metal prostheses, or with bone from another part of your body. Your surgeon also will use muscle and other soft tissue to cover the area from which the bone was removed, to aid in healthy healing.

• Curettage: In some cases, a surgeon can remove a tumor without taking the surrounding bone. The tumor cavity is then treated to kill any remaining cancerous cells, and filled with transplanted bone or an artificial implant to prevent future bone fractures.

• Amputation: When absolutely necessary because of tumor location, stage, or type, your surgeon may perform an amputation. For some patients, this is the best option for continued life. We recommend amputation when the patient cannot tolerate reconstruction of the limb, or when the cancer cannot be removed completely through surgery. Our Orthotics and Prosthetics division will work with you to provide an artificial limb that can restore your ability to walk or to function independently.

Radiation Therapy

Radiation therapy is the use of high-energy rays—x-rays or other particles—to kill cancer cells. In patients with bone cancer, radiation may be used before surgery to shrink the tumor, allowing your surgeon to remove less bone in your limb. After surgery, radiation may be used to kill any lingering cancer cells. It also can be effective with patients who have a tumor that cannot be removed surgically.
In general, there are three kinds of radiation therapy:

• External-Beam Radiation Therapy uses a device outside of the body to generate high-energy rays that focus on the targeted area.

• Internal Radiation Therapy or Brachytherapy uses radioactive pellets (needles, seed, wires or catheters) implanted in the affected area to release radiation in exactly the right spot.

• Intensity-Modulated Radiation Therapy (IMRT): This advanced therapy uses computer-controlled devices to deliver high doses of radiation precisely to the tumor, while sparing the surrounding healthy tissue. For example, IMRT is used to treat spinal tumors without damaging the spinal cord.

Chemotherapy

Some bone cancers must be treated with drug therapy as well as surgery, to keep the cancer cells from growing and multiplying. Chemotherapy can prevent these cancer cells from metastasizing, moving through your body and reappearing in a different place.

Your chemotherapy may begin before your surgery, both to shrink the tumor and to kill cancer cells that may already be moving into other parts of your body. This is called preoperative chemotherapy (or induction chemotherapy), and it may involve three or four visits to the Wilmot Cancer Center in the weeks before your surgery.

In most cases, the drug therapy is delivered directly into your bloodstream. Your medical team will expand to include the oncologists (doctors who specialize in treating cancer) at the James P. Wilmot Cancer Center, who will plan your treatment using one or a combination of drugs. You will receive your treatment at the Wilmot Cancer Center. Most patients receive chemotherapy on an outpatient basis, so you can go home right after your treatment. Your medical team will help you understand the medications used in your therapy, and they will work with you to help you tolerate any side effects that may result.

Biological Therapy

Biological therapy uses the strength of your own immune system to help your body fight cancer.

Usually, the immune system uses its white blood cells to detect and battle foreign invaders like bacteria and viruses. The immune system can find and destroy some kinds of cancer cells—and it may be doing this within your body right now—but other cancer cells can disguise themselves from white blood cells, changing their own genetic makeup (or mutating) so the disease-fighting cells can't find them.

Biological therapy can help white blood cells overcome this barrier to fighting cancer, by working against the disguises cancer cells create. The therapy may use a special kind of protein called monoclonal antibody (MAb) that can detect the protein on the surface of a cancer cell. The MAbs coat the cancer cell and attract the white blood cells to it, assuring its destruction. In some cases, the MAb keeps the cancer cells from signaling one another to develop blood vessels, causing their death.

Another protein called cytokines have emerged as a tool in biological therapy. Several kinds of cytokines, including interferons (INFs), interleukins (ILs) and T cells, can activate special white blood cells to boost a patient's immune response. Researchers are now working to determine if using these cytokines in combination can be effective in fighting cancer.

These and a range of other biological therapies are available to you at UR Medicine, while others may be accessible through clinical trials.

If a biological therapy is indicated for your bone cancer, your medical team will work with specialists to help you decide if these new therapies are right for you.