Blog Elements

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Paediatric Bone Tumours

September 10, 2015

Vol 1 | Issue 2 | Sep- Dec 2015 | page:3 | Dr Subin Sugath. Author: Dr Subin Sugath [1]. [1]Orthopaedic Oncology Clinic, Pune, India. [2] Indian Orthopaedic Research Group, Thane, India [3] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India Address of Correspondence Dr. Subin Sugath MS Orth. Department of Ortho Oncology. Aster DM Healthcare […]

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

September 10, 2015

Vol 1 | Issue 2 | Sep- Dec 2015 | page:1-2 | Dr. Yogesh Panchwagh & Dr. Ashok Shyam. Author: Dr. Yogesh Panchwagh [1], Dr. Ashok Shyam [2,3]. [1]Orthopaedic Oncology Clinic, Pune, India. [2] Indian Orthopaedic Research Group, Thane, India [3] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India Address of Correspondence Dr. Yogesh Panchwagh. […]

Paediatric Bone Tumours

September 10, 2015

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

September 10, 2015

Full Sized Blog Element (Big Preview Pic)

Paediatric Bone Tumours

September 10, 2015

Vol 1 | Issue 2 | Sep- Dec 2015 | page:3 | Dr Subin Sugath.

Author: Dr Subin Sugath [1].

[1]Orthopaedic Oncology Clinic, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India
[3] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Subin Sugath MS Orth.
Department of Ortho Oncology.
Aster DM Healthcare Pvt Ltd. Kuttisahib Road, Near Kothad
Bridge, South Chittoor PO, Cheranallor, Kochi 682 027,
Kerala, India.
Email: drsubin.sugath@dmhealthcare.com

Paediatric Bone Tumours

Bone tumours are rare as they constitute less than 2% of all malignancies. Though they can affect any age group, paediatric age group forms one of the commonest subsets affected by this. Osteosarcoma and Ewings Sarcoma, two common primary malignant bone tumours are commonly seen in patients less than 20 years of age. Since Ewings sarcoma was discussed in details in the last issue of the journal, the present symposium tries to cover certain general aspects of paediatric bone tumors in some details rather than discussing individual tumors. The outcome of treatment of this malignancy has seen a drastic improvement with the use of more potent chemotherapeutic drugs, newer imaging modalities which tell you the exact extent of these tumours and improved surgical techniques. The overall survival and disease free survival have increased from the dismal levels prevalent in the eighties to promising new levels. Amputation which was the choice of treatment earlier has been replaced by limb preserving surgeries where only the diseased bone is removed rather than the entire affected limb. An adult and a paediatric patient cannot be equated when it comes to management of bone tumours. The challenges in treating a child with bone tumour are more considering the age, size of the patient and bone, the remaining growth potential and the difficulty in using conventional reconstruction options after tumour resection. An open physis can be considered as a thick barrier to tumour spread and can be taken as a margin while doing tumour resection in children. The concept of margin and their implications in tumour surgery in children has been discussed in the article by Prof. K.C Gopalakrishnan [1]. The article is written from a surgical anatomy/pathology point of view and will be very helpful in understanding the basic of natural barriers and spread of tumors. Conventional reconstruction technique using prosthesis causes limb length discrepancy at the time of skeletal maturity as the unoperated limb grows normally while the operated limb doesn’t as the growth plate is also removed during the tumour excision. Different reconstruction options which can overcome this are discussed in detail in the article by Prof. Robert Grimer [2]. The decision making between limb sacrifice and limb salvage is difficult one both for the patient and for the surgeon. Factors like life span, limb function, patient’s wishes and expected limb function will help guiding the decision. At times, this decision may be quite difficult and may challenge even a lifetime experience of an orthopaedic oncology surgeon [2]. Expandable implants which can be lengthened over a period of time to compensate for the growth of the contralateral limb has come a long way in making prosthetic replacement an acceptable option in children with bone tumours. Various biological methods of reconstruction using autografts and allografts have their own advantages as it can be a lifelong solution once they incorporate with the host bone. Reimplantation of the tumour bone after sterilisation is also now accepted as a reconstruction option in children. Intercalary resections where the natural joints can be preserved require precise surgical resections to attain both oncological clearance and also to have a viable reconstruction option. Computer Assisted Orthopaedic Surgery (CAOS) has come a long way in helping to attain this goal. The benefits of this technique are explained in the article by Prof. Lee Jeys where he also discusses the use of CAOS in complex pelvic surgeries [3]. The benefits of using high dose methotrexate has been debated for long. Although methotrexate is been use since 1960’s, the currently literature still does not have enough evidence to recommend for or against its use. Some studies have shown strong positive effect while others have shown no advantage. The use of high dose methotrexate based chemotherapy has been outlined in the article by Dr Vivek Radhakrishnan [4]. They have also tried to review the important existing literature and provide recommendation for use of high dose methotrexate in paediatric osteosarcomas. Applicability of high dose methotrexate is also discussed in the Indian scenario and this may be applicable to most developing world countries. In all keeping up with the multidisciplinary approach discussed in the editorial [5], the current symposium has tried to present anatomical/pathological, surgical and medical aspect of bone tumors along with recent advances in the field. Children with bone tumours need to be treated differently from adults while considering the management and I hope these series of articles will help to enlighten us in the management of these complex problems.

Dr Subin Sugath

References
1. K C Gopalakrishnan. Natural “Barriers” Its Relevance To The Spread Of Bone Sarcoma. Journal of Bone and Soft Tissue Tumors Sep-Dec 2015;1(1):5-9.
2. Parry M, Grimer R. Limb Salvage in Paediatric Bone Tumours. Journal of Bone and Soft Tissue Tumors Sep-Dec 2015;1(2):10-16.
3. Archer JE, May PL, Jeys LM. CAOS in Paediatric Bone Tumour Surgery. Journal of Bone and Soft Tissue Tumors Sep-Dec 2015;1(1):17-21.
4. Reghu K S, Radhakrishnan V S. High dose Methotrexate in Paediatric Osteosarcoma – a brief overview. Journal of Bone and Soft Tissue Tumors Sep-Dec 2015;1(1):22-24.
5. Panchwagh Y, Shyam AK. M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must ! Journal of Bone and Soft Tissue Tumors Sept- Dec 2015; 1(2):1-2.

How to Cite this article: Sugath S. Paediatric Bone Tumours. Journal of Bone and Soft Tissue Tumors Sep-Dec 2015; 1(2): 3-4.

Dr.Subin Sugath

(Abstract) (Full Text HTML) (Download PDF)

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

September 10, 2015

Journal of Bone and Soft Tissue Tumors

Vol 1 | Issue 2 | Sep- Dec 2015 | page:1-2 | Dr. Yogesh Panchwagh & Dr. Ashok Shyam.

Author: Dr. Yogesh Panchwagh [1], Dr. Ashok Shyam [2,3].

[1]Orthopaedic Oncology Clinic, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India
[3] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Yogesh Panchwagh.
Orthopaedic Oncology Clinic, 101, Vasanth plot 29, Bharat Kunj Society -2, Erandwana, Pune – 38, India.
Email: drpanchwagh@gmail.com

Editorial: M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

“Coming together is beginning, keeping together is progress, working together is success”: Henry Ford.

Henry Fords quote can be aptly extrapolated to the clinicians working in the field of orthopaedic oncology. Many a time, it is seen that interaction between various specialties is of paramount importance to reach to a logical conclusion while dealing with bone and soft tissue tumors. The rarity of these lesions and often-encountered complex clinical scenarios makes it mandatory for the treating clinicians to sit together to decide the diagnosis and further line of management. The multi disciplinary team (M.D.T.) that thus ensues is the key to success in management of bone and soft tissue tumors.
A typical M.D.T. comprises of (but may not be limited to) the sarcoma surgeons, medical and radiation oncologists, Pathologists, radiologists, Palliative care and rehabilitation specialists. It is expected that the institute where the M.D.T. is located should have reasonable experience in managing sarcoma patients. This number may vary from country to country. For example, In the U.K., it is expected that such an M.D.T. should be seeing at least 100 new soft tissue sarcoma cases every year or 25 primary bone sarcoma cases every year [1,3].
It is expected that all cases or suspected cases of sarcomas should have a speedy access to diagnosis and treatment. All diagnosed cases also need to be reviewed by a specialist in the M.D.T. The surgical management including the initial biopsy and definitive resection, chemotherapy and radiotherapy are to be carried out by member of a sarcoma MDT. In case that a surgeon who is a M.D.T. member is not available, the surgery should be done by a surgeon with tumor site-specific or age-appropriate skills, in consultation with the sarcoma MDT. Informing patients about relevant clinical trials and support to enroll into the trials as appropriate also forms a responsibility of the M.D.T [1,2,3,4].
Such MDT’s should be developed at individual centers that specialize in management of sarcomas. The advantages of such MDT approach is manifold. First it will allow complete and detailed assessment of patient and the disease at single center which will help in early and accurate diagnosis of the disease and extent of the disease. It will also help in more precise planning of management strategies and much better patient care. Sarcomas are unique diseases in the sense that they invoke a great sense of anxiety in the patients and their caregivers. These diseases have strong emotional responses and many a times lot of confusion exists in minds of the affected. In our country this leads to a varied response which many a times includes patient being referred and consulted by many doctors and surgeons before reaching a proper channel of care. A single coordinated MDT will help the patients to reach this channel much earlier. A coordinated approach at single center will help curb the patient’s and caregivers anxieties to a large extent and will also be much more convenient to them. The Australian Sarcoma Study Group have gone through the literature and produced evidence supporting MDT approach through following conclusions [1,2,3] :
1. MDT: Treatment at a dedicated MDT center results in better patient survival, decreased amputation risk, better chances of disease free survival. Also MDT center follow the clinical practice guidelines and have appropriate use of preoperative imaging and biopsy.
2. Supportive care: This is one of the most important aspect of patient care that help in providing better care for the patient as a whole. It helps in improving the quality of life, patients stay fewer days in the hospital, require fewer home visits and have better physical, social and emotional responses.
3. In MDT scenario the expert panel of radiologist will be able to diagnose the disease early and also pathological diagnosis is much more accurate in MDT settings.
There have been some attempt to bring together various specialties in our country too. Specifically there have been common forum and meetings where specialties have come together to share their views. Few centers have regular interspeciality meetings too. The Indian Musculoskeletal Oncology Society has organized a multifaculty meeting in Pune in October 2015 and hopefully they will continue to foster this development. Centers that specialize in sarcoma care should realize the importance of MDT approach. Although specialized centers do have coordinated approach, a more formal MDT body will help make the system more organized and effective. Journal of Bone and Soft Tissue supports the multidisciplinary approach and the first issue had authors from almost all specialist involve in sarcoma care. We wish to involve more specialties and specialist involved in sarcoma care with JBST and in coming issues our focus will be to publish articles with more coordinated approach to oncology care.
The MDT approach has been successfully used in many countries. In fact the U.S. National Cancer Control Network (NCCN) (www.nccn.org) and the U.K.s National Institute for Health and Clinical Excellence (NICE) (www.nice.org.uk) both have detailed recommendation for use of MDT approach in management of sarcomas. The developing countries too need to follow a similar model in the interests of the sarcoma patients. It is still not very uncommon in a country like India, which dreams of a digital revolution, to see examples of late diagnosis, improper biopsies, incorrect interventions and non-evidence based management. We believe that there is a need to prepare our own guidelines, modified according to suit the geography, disease prevalence and health care and infrastructural capabilities and to promote the concept of MDT in the care of sarcomas.

Yogesh Panchwagh & Ashok Shyam

References

1. National Institute for Health and Clinical Excellence, 2006. Improving outcomes for people with sarcoma. NICE guidance on cancer services.
2. Robert Grimer Nick Athanasou, Craig Gerrand, Ian Judson, Ian Lewis, Bruce Morland, David Peake, Beatrice Seddon, and Jeremy Whelan.  UK Guidelines for the Management of Bone Sarcomas.  Sarcoma. 2010; 2010: 317462.
3. Why Multi disciplinary care is important in sarcomas. www.australiansarcomagroup.org/multi-disciplinary-care.html
4. The ESMO / European Sarcoma Network Working Group. Bone Sarcomas: ESMO Clinical Practice Guidelines. Ann Oncol (2014) 25 (suppl 3): iii113-iii123.

How to Cite this article: Panchwagh Y, Shyam AK. M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must ! Journal of Bone and Soft Tissue Tumors Sept-Dec 2015; 1(2):1-2.

(Abstract) (Full Text HTML) (Download PDF)

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Paediatric Bone Tumours

Like this:

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

Like this:

Paediatric Bone Tumours

Like this:

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

Like this:

Full Sized Blog Element (Big Preview Pic)

Paediatric Bone Tumours

Author: Dr Subin Sugath [1].

Paediatric Bone Tumours

Like this:

M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

Author: Dr. Yogesh Panchwagh [1], Dr. Ashok Shyam [2,3].

Editorial: M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

References

Like this:

Like this:

Journal of Bone and Soft Tissue Tumors (JBST) Editorial Office

Important Information

Journal of Bone and Soft Tissue Tumors (JBST) License

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Like this:

Like this:

Like this:

Like this:

Full Sized Blog Element (Big Preview Pic)

Author: Dr Subin Sugath [1].

Paediatric Bone Tumours

Like this:

Author: Dr. Yogesh Panchwagh [1], Dr. Ashok Shyam [2,3].

Editorial: M.D.T. (Multi Disciplinary Team) For Sarcomas: A Must !

References

Like this:

Share this:

Like this:

Journal of Bone and Soft Tissue Tumors (JBST) Editorial Office

Important Information

Journal of Bone and Soft Tissue Tumors (JBST) License