Bone Cancer: Our Approach & Expertise

Pictured: John Healey & Jody Roth with a patient Surgeon John Healey, Chief of the Orthopaedic Service, and nurse Jody Roth examine a patient. Memorial Sloan Kettering cares for some 175 individuals with bone cancer every year.

Memorial Sloan Kettering Cancer Center has extensive experience in treating patients with bone cancer. Each patient's care is delivered in a way that ensures optimal quality of life, preserving form and function whenever possible.

Our doctors have a long history of treating the disease, creating the first detailed descriptions of both osteosarcoma and Ewing sarcoma. In fact, Dr. James Ewing, who first described the disease, was the original leader of Memorial Hospital and the scientific founder of Memorial Sloan Kettering Cancer Center. Today, Memorial Sloan Kettering's doctors are helping their patients with bone cancer live longer and better with treatments and surgical techniques that have been pioneered here. Among our accomplishments, we have been at the forefront of developing limb-sparing surgery for patients with high-grade bone sarcomas. We also have led studies to create longer-lasting and more functional prostheses, including bone and joint replacements for children that grow as the child grows. Induction chemotherapy given before surgery was pioneered by our researchers, and our team is also investigating novel antineoplastic, antiangiogenic, metabolic, and radiation therapies.

Team Approach to Care

The number of patients with primary bone cancer seen at Memorial Sloan Kettering — about 175 a year — gives our physicians the expertise to recognize and treat rare forms of the disease and the ability to quickly identify, manage, and avoid treatment complications. Our doctors also see more than 500 patients a year with metastatic cancers to bone (cancers that have spread to the bone from other sites).

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As with all types of cancer, Memorial Sloan Kettering takes a multidisciplinary approach to bone cancer. Our Primary Bone Cancer Disease Management Team of 14 physicians — including surgeons, medical oncologists, radiologists, radiation oncologists, and pathologists — meets weekly and works closely together to create treatment regimens, monitor patients' progress, and select and modify therapies. Our team also includes pediatric oncologists with special expertise in bone tumors and sarcomas of childhood.

Our experience extends to patients who develop Paget's disease, fibrous dysplasia, and osteochondromatosis, or who develop sarcomas in difficult-to-treat locations such as the pelvis. We also offer a combined neurosurgery-orthopaedic team specializing in spinal bone cancers and expertise in sarcoma of the hand.

Focus on the Patient

Communication with patients and caregivers is an important priority at Memorial Sloan Kettering. We believe that treating the whole person, not just the disease, is the best for patients and family members. At Memorial Sloan Kettering, we offer a broad range of emotional support programs designed to help patients and family members cope with the range of issues related to life during and after cancer treatment.

Our Surgical Expertise

Surgeons at Memorial Sloan Kettering are able to save the affected limb (arm or leg) in most bone cancer surgeries and have developed replacements that are more durable and functional than standard replacements. Our surgeons were the first to perform successful limb-salvage surgery for patients with high-grade bone sarcomas.

For cases in which the entire limb cannot be saved, surgeons make an effort to preserve as much as possible during reconstructive surgery in order to optimize functionality. For example, in a procedure called Van Nes rotationplasty, the surgeon is able to recreate a functioning knee that can withstand vigorous athletic activity. Memorial Sloan Kettering physicians led studies to create longer-lasting prostheses, such as the ComPreSs implant — a novel method to secure a knee replacement to the thighbone. For children, we are using specially designed expandable prostheses that “grow” as the child grows, so that a second surgery can usually be avoided later in life.

Cryosurgery (the freezing and killing of cancer cells) is sometimes used in addition to surgery for some bone cancer patients. Memorial Sloan Kettering surgeons were the first to use cryosurgery in bone tumors, perfecting its use to reduce tumor recurrence while preserving limb and joint function, as well as decreasing the need for amputation. After a bone tumor is removed, liquid nitrogen is used to freeze the tumor cavity to subzero temperatures, killing microscopic tumor cells.

Advanced Imaging Technology

Important in the diagnosis of and follow-up screening for bone cancer is imaging. During diagnosis our radiologists will review imaging tests such as an x-rays which will allow the doctor to see any unusual bone growths. This may be followed by a bone scan, to see if there are other abnormal areas in the skeleton. A computed tomography (CT) or magnetic resonance imaging (MRI) scan is often ordered to show the exact size, shape, and extent of the suspected bone tumor, and to determine if it has invaded surrounding tissue. A positron emission tomography (PET) scan may be used to diagnose bone cancer and is especially useful for identifying metastasis. PET and CT scans can be used in combination to pinpoint the exact location of cancer.

Imaging technology is also used after the initial diagnosis and throughout the course of treatment to reevaluate the tumor size and identify possible metastases or recurrence.

Innovations in Chemotherapy and Radiation Treatments

Using a combination of chemotherapy and/or radiation before or after surgery is a common practice in the treatment of bone cancer. Our pediatric and medical oncologists have developed standard strategies for using chemotherapy to treat bone cancer. For example, a type of treatment called induction chemotherapy — often administered before surgery to reduce the size of the tumor to make surgery more effective — was pioneered at Memorial Sloan Kettering. [PubMed Abstract]

Radiation therapy is also often used in combination with surgery or chemotherapy to destroy tumors or to reduce the size of the tumor. Radiation therapy may also be used to kill remaining cancer cells after surgery, or to treat tumors that cannot be surgically removed.

Research is also underway at Memorial Sloan Kettering to evaluate intraoperative radiation therapy and brachytherapy, techniques that involve the direct application of radiation to the tumor bed during surgery. We are also evaluating a new method to apply radiation therapy directly to bone cancers. This novel form of radiation therapy — called image-guided radiation therapy (IGRT) — targets tumors efficiently, minimizing radiation exposure to surrounding healthy tissue.

Applying Scientific Discoveries to Medical Practice

Memorial Sloan Kettering investigators are scrutinizing the genetic changes that cause and define bone cancer. This process is helping them to understand why some bone cancers respond more readily to treatment than others. Such knowledge may give doctors the information they need to select the best course of treatment for patients on an individual basis.

Investigational Approaches

New approaches to treating bone cancer at Memorial Sloan Kettering are constantly being developed to give patients a broader range of treatment options. Research protocols involving the study of investigational approaches are sometimes offered to eligible patients through the clinical trial process. Clinical trials are designed to advance the current standards of care.

Our current clinical research is focused on identifying new agents to treat the most common bone tumors, specifically osteosarcoma, Ewing sarcoma, chondrosarcoma, and malignant fibrous histiocytoma of bone. We are also examining both standard chemotherapy agents as well as newer, less toxic substances, known as “targeted” agents.

For example, clinical trials are now underway to assess potentially more effective novel therapies for different kinds of bone cancer. One study will examine and evaluate the use of a new monoclonal antibody for the treatment of recurrent, or refractory, Ewing sarcoma, and osteosarcoma. Monoclonal antibodies are laboratory-produced substances that help direct the body's immune system to attack certain targeted cells, such as cancer cells.

Another study is examining the efficacy of a lung cancer drug in the treatment of bone cancer. The drug works by preventing cancer cells from using folate, a naturally occurring vitamin that the body uses to help normal cells keep growing.

A clinical study is now underway to evaluate the safety and effectiveness of a treatment regimen called myeloablative therapy for patients with Ewing sarcoma. The treatment includes a combination of several drugs followed by hematopoietic stem cell transplantation (transplanting blood stem cells derived from the bone marrow or the blood).

And a recent study evaluating the effectiveness of adding a chemotherapeutic agent known as L-MTP-PE to chemotherapy following surgery for patients with newly diagnosed nonmetastatic osteosarcoma demonstrated improved overall survival.

Access Information About Your Care

Memorial Sloan Kettering offers a secure Web site — called MYMSKCC — for patients to access personalized information about their care. If you enroll to use MYMSKCC, you can view, confirm, and keep track of appointments; access over 300 lab results; make changes to contact and insurance information; send and receive secure electronic messages to and from the healthcare team, as well as to billing, patient representatives, and clinical genetics; and view balances and pay hospital and physician bills.

To enroll in or learn more about MYMSKCC, please ask a session assistant in clinic or contact your physician's office.