When an entire leg cannot be saved, surgeons keep as much as possible so that they can reconstruct the most functional limb possible. An example is a procedure called van Nes rotationplasty that recreates 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 thigh bone. We are also using specially designed expandable prostheses in children that "grow" as a child grows, so that a second surgery can usually be avoided later in life.
Cryosurgery (freezing and killing of cancer cells) is sometimes used in addition to surgery in certain patients with bone cancer. Memorial Sloan-Kettering surgeons were the first to use cryosurgery, perfecting its use to reduce tumor recurrence while preserving limb and joint function. After a bone tumor is removed, liquid nitrogen is used to freeze the tumor cavity to subzero temperatures, killing microscopic tumor cells. Cryosurgery decreases the chance of tumor recurrence and may also lessen the need for amputation.
Advanced Imaging Technology
An important part of the diagnosis and follow-up screening of bone cancer is imaging. During the diagnosis phase, our radiologists will usually start by ordering imaging tests such as an x-ray, 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 CT (computed tomography) or MRI (magnetic resonance imaging) scan is often ordered to show the exact size and shape of the suspected bone tumor, and to determine if it has invaded surrounding tissue or the bone marrow space. A PET (positron emission tomography) scan is also used to diagnose bone cancer and is especially useful when 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.
Innovations in Adjuvant Care
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 developed standard strategies for chemotherapy for this kind of 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.
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 treat tumors that cannot be surgically removed.
Research is also under way at Memorial Sloan-Kettering to evaluate the application of radiation directly to the bone during surgery (intraoperative radiation therapy). We are also evaluating new ways to apply radiation therapy directly to bone cancers. This novel form of radiation therapy -- called intensity-modulated radiation therapy (IMRT) -- targets tumors so efficiently that it leaves healthy tissue unharmed.
Applying Scientific Discoveries to Medical Practice
Memorial Sloan-Kettering investigators are scrutinizing the genetic changes that cause and define bone cancer, and determining 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 a patient.
