Advances in the Treatment of Osteosarcoma

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There are about 2,500 new cases of osteosarcoma diagnosed each year in the U. S., making primary bone cancer relatively rare. Though osteosarcoma is the most common bone sarcoma, it's still quite uncommon. There are only 900 - 1,000 cases a year in the entire United States. Dr. Christopher Cannon joins Andrew on this episode of Patient Power sponsored by The University of Texas M. D. Anderson Cancer Center to discuss the latest advances in osteosarcoma treatment and research. Dr. Cannon is Assistant Professor of Surgery in the Department of Orthopaedic Oncology at M. D. Anderson.

Also joining the program is Michelle from Louisville, Kentucky. Michelle was diagnosed with osteosarcoma after worsening back pain followed her pregnancy. Because her type of cancer is so rare, she chose to seek treatment at M. D. Anderson, as their Sarcoma Center sees more sarcoma than any hospital in the country. You’ll hear about Michelle’s surgery, treatment and how she’s doing now.

Dr. Cannon helps us to understand exactly what osteosarcoma is and how this type of cancer is diagnosed. Surgery is often a necessity, and Dr. Cannon explains surgery, reconstruction and the advances being made in limb-sparing surgery. He goes on to explain the treatments for osteosarcoma, the need to seek care at a specialized center and why the latest research at M. D. Anderson is making an impact in the sarcoma community. Dr. Cannon closes the program with a look at the future and how researchers “continue to push the envelope and advance the field. And there will be newer and better therapies coming down the line.” If you or someone you know has been affected by osteosarcoma, this program will provide you with great information.

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Transcript

Andrew Schorr:

Hello and welcome once again to Patient Power. I'm Andrew Schorr. And each session of Patient Power, every two weeks on the M. D. Anderson website, we talk about critically important cancer topics. It's time to talk about osteosarcoma. We're going to learn a lot more about it, but osteosarcoma is a bone tumor that consists of malignant cells that produce immature bone, the most common type of bone cancer in children and adolescents, affects more males than females, a lot more statistics about it. It's not a common cancer, but if you are diagnosed with it it is so important to see people who specialize in it. M. D. Anderson has a sarcoma center. We previously talked about soft tissue sarcomas. Today we're going to talk about these osteosarcomas, bone cancers.

I want you to meet someone who has lived through all this, and that is Michelle. She's 29 years old now. She has a little boy, two years old, Florian. She joins us from Louisville, Kentucky, if I get that right.

How did I do on my pronunciations, Michelle?

Michelle:

You did pretty well. You did pretty well.

Andrew Schorr:

All right. So let's go back a couple of years. September 11, 2006, I guess it was, you were living in Albuquerque, New Mexico, and you had had the baby and you're getting past the pregnancy, but throughout the pregnancy and continuing you had back pain, and it was getting worse, not better. You end up going to a chiropractor to see what was going on, and when you talked about numbness and other pain he said you better get x rays. That was an important recommendation, wasn't it?

Michelle:

Yes, definitely. I consider it lifesaving.

Andrew Schorr:

So you get the x rays, you go to the doctor. The doctor says, No, I'd rather do an MRI. And the MRI showed something unusual. And unfortunately often when it shows something unusual maybe it isn't a big deal, but in this case it turned out to be a sarcoma. When you were told that, this word "sarcoma," had you ever heard it before?

Michelle:

No, I had never heard the word before.

Andrew Schorr:

So what did you do? The oncologist says, Well, I know the word sarcoma, but I haven't seen it much. What was the recommendation on what to do then to try to get treatment for it?

Michelle:

Well, when he met with the oncologist in New Mexico he was very forthcoming with us right off the bat and said, you know, very frankly, I will treat you if you choose to stay here. However, it's not my recommendation that you get treatment here because we just don't see this cancer often enough. So he recommended that I go somewhere that would be the best because it is such an aggressive cancer. So we needed to see people that knew what they were doing with it.

Andrew Schorr:

And you found that at M. D. Anderson?

Michelle:

Exactly.

Andrew Schorr:

Well, you got to know M. D. Anderson very well because my understanding is you arranged to have a consultation there, and they said, well, maybe you'll be here for a month. With all the treatment you had, and we'll help people understand the happy result, but how long were you in Houston?

Michelle:

We ended up staying nine months.

Andrew Schorr:

Wow. And that was your husband, Erik, who took a leave of absence from his job. And then you had in laws and your mom there and of course Florian. You had a family support structure. Well, your treatment was combination chemotherapy for many months, maybe five months?

Michelle:

Yep, five months.

Andrew Schorr:

And then major surgery because the bone cancer was in your pelvis. So you had major surgery. How long was that surgery to try and cut the cancer out after those courses of chemotherapy?

Michelle:

Dr. Cannon can correct me if I'm wrong, but I recall the resection I think was 13 hours, and then the reconstruction was 17 hours of surgery.

Andrew Schorr:

Well, you're right. We have your doctor with us, and he can chime in. We're going to spend a lot more time with him, and that's Dr. Christopher Cannon, who is assistant professor of surgery in the department of orthopaedic oncology at M. D. Anderson and the surgeon with his whole team and made a big difference for you.

Dr. Cannon, so just to pick up the story on Michelle there, she went through that combination chemotherapy for a number of months but then had this surgery to cut the cancer out first. How long a surgery was that, do you recall?

Dr. Cannon:

I think Michelle is about right. I think the first day was slightly shorter, but it was on the order of 12 or 13 hours, a fairly long day for all concerned. We had planned this ahead of time knowing it was going to be a long day, so to give everybody a chance to recover, I think the first surgery was on a Wednesday, and then Thursday was just a recovery day for all concerned, and then we did the reconstruction, put everything back together on the following day on Friday.

Andrew Schorr:

And so reconstruction of her pelvis. Now, there's you as an orthopaedic surgeon. What other M. D. Anderson surgeons, what types of surgeons did you need to do this?

Dr. Cannon:

Michelle's osteosarcoma was in a little bit of an unusual place in that it was in the pelvis, which is unusual in and of itself, but also it was kind of at the base of her spine. So we had one of our neurosurgeons who specializes in spine surgery, Dr. Larry Rhines, assist both in the resection of the tumor as well as the reconstruction. So we both had to again work on the spine and the pelvis.

And also as part of the reconstruction, we had a big gap between where the portion of the pelvis had been taken out, and one of our plastic surgeons participated in that and basically harvested Michelle's fibula, which is the smaller bone in your lower leg, which they can take with its blood supply and then plug it into the blood supply in the pelvis and basically grow between the two to fill in the missing segment of bone basically in the pelvis.

Andrew Schorr:

Wow. Wow. So these were two major surgeries and bringing sort of cross functional teams together.

Dr. Cannon:

Correct.

Andrew Schorr:

And this is in addition to Michelle already going through part one of her medical oncology story, having combination drugs fighting the cancer. And then, Michelle, afterwards you had sort of a mop up chemotherapy for a little bit, first in Houston and then back where you had chosen to move now with your in laws, back to Louisville, right?

Michelle:

Right. Yeah, I continued chemo after surgery for a year.

Andrew Schorr:

Wow. So you're off chemo. How are you doing? Are there signs of the cancer?

Michelle:

No, I'm cancer free. As far as I'm concerned I've been cancer free since the surgery. But, yeah, all my scans are clean and just loving life, you know. I'm back to normal.

Andrew Schorr:

Loving Erik and Florian.

Michelle:

Yeah. Yeah. That's my number one job now. I'm a stay at home mom and living every day with my little boy.

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