Pediatric oncologist Leonard Wexler with nurse practitioner Joanna Moulton.
At Memorial Sloan-Kettering Cancer Center, our team of medical professionals has extensive experience with pediatric sarcomas, seeing about 140 children each year with this disease. The treatment needed to cure sarcomas differs depending on the cancer detected. In the broadest sense, treatment for these types of cancers may include therapies that affect the whole body (systemic therapy) and the removal of cancer from a specific area of the body (local control). Systemic therapy involves the use of medications that not only shrink the tumor but also prevent new tumors from forming. These medications are called chemotherapy. Treatment for sarcomas typically employs more than one medication.
For every patient who comes to Memorial Sloan-Kettering for the diagnosis and/or treatment of sarcoma, a multidisciplinary team of medical professionals, including pediatric oncologists, surgical oncologists, radiation oncologists, diagnostic radiologists, pathologists, integrative medicine specialists, nurses, psychiatrists, physical therapists, and other cancer specialists collaborate in your child's care.
Pioneering Treatments & Leadership
Since the 1970s, physician-scientists at Memorial Sloan-Kettering have pioneered the use of combination chemotherapy, which is now an essential part of sarcoma treatment. Treatment regimens developed here serve as models for the treatment protocols used worldwide [PubMed Abstract]. Local control of the disease is directed at removing all detectable areas of tumor. Depending on the type of sarcoma, this can mean surgery, radiation therapy, or a combination of the two.
Our surgeons are leaders in surgical techniques that not only completely remove tumors but also preserve the maximal function possible of the affected limb. For the treatment of tumors that are amenable to radiation, our radiologists pioneered the use of intensity-modulated radiation therapy (IMRT), a technique that targets tumors so efficiently that it leaves surrounding healthy tissue unharmed even when the cancer is wrapped around a vital organ.
Physicians on Memorial Sloan-Kettering's pediatric sarcoma team continue to lead many of the national clinical trials to improve treatment outcomes for these diseases. Our physicians have chaired the Bone Tumor Strategy Group of the Children's Oncology Group, a national cooperative group for centers specializing in pediatric cancers. Members of our staff have leadership roles in the recently established Pediatric Oncology Experimental Therapeutic Consortium (POETIC). And our specialists continue to head efforts, both at Memorial Sloan-Kettering as well as in the national cooperative groups, to improve cure rates in pediatric sarcomas.
Memorial Sloan-Kettering staff have led the national cooperative groups' laboratory research efforts and have identified crucial prognostic factors in osteosarcoma; explained some of the mechanisms by which osteosarcoma tumor cells develop resistance to chemotherapy; and developed novel therapies to overcome this resistance. Our physicians are also actively involved in developing new therapeutic strategies for soft tissue sarcomas.
Our investigators are leading national efforts to evaluate new treatments for bone sarcomas. We are leading a clinical trial to assess the use of a drug known as bisphosphonate pamidronate as both a tumor-inhibiting and bone-protective agent. A large cooperative study involving Memorial Sloan-Kettering investigators showed an interaction between the biologic agent muramyl tripeptide and ifosfamide for the treatment of osteogenic sarcoma. The two agents appeared most effective in combination, but the interaction needs further study. The intensive P6 chemotherapy protocol resulted in a high survival rate (82 percent at four years) for patients diagnosed with large primary tumors and with disease limited to the area in which it originated [PubMed Abstract].
Our current institutional approach to Ewing's sarcoma evaluates the addition of the drug rapamycin (sirolimus) both as adjuvant maintenance therapy following the P6 chemotherapy regimen for patients with localized disease, and also as part of our allogeneic bone marrow transplantation regimen for patients at high risk of recurrence.
Patient-Tailored Therapies
Going forward, our researchers continue to develop new medical therapies and surgical techniques. The new therapies being developed for pediatric sarcomas focus on delivering effective tumor-killing agents while reducing the side effects associated with therapy. These innovations are designed to tailor cancer therapies specific to each individual patient's metabolism and the extent of his or her disease.
For example, after promising laboratory studies that demonstrated the importance of certain cell surface proteins in the development of sarcomas, doctors at Memorial Sloan-Kettering have begun important clinical trials using targeted agents such as monoclonal antibodies in the treatment of various sarcomas. In addition, doctors at Memorial Sloan-Kettering remain very active in designing clinical trials using the latest agents for the treatments of sarcomas. Patients at Memorial Sloan-Kettering are assured the most comprehensive access to the most-up-to-date agents available.
Immune System Stimulation & High-Dose Chemotherapy
For patients with Ewing's sarcoma, we are testing to see if stimulation of the immune system in addition to chemotherapy will help achieve a cure. In an effort to improve outcomes in certain high-risk sarcomas, we are evaluating the effectiveness of high-dose chemotherapy followed by allogeneic bone marrow transplantation — in which bone marrow from a patient's own family is given to the patient after a high-dose chemotherapy regimen — in patients with high-risk sarcomas.
Nursing Care
Our dedicated team of nurses cares for your child during outpatient visits and inpatient hospital stays. Nurse practitioners work in collaboration with the primary physicians on your child's team to oversee care. This allows our nurses to assess your child's needs, triage symptoms, and if necessary, make referrals to other departments within Memorial Sloan-Kettering. Nurse practitioners and registered nurses can also help your child and family understand the details of the treatment plan and what to expect throughout the course of treatment.
As part of the multidisciplinary team caring for sarcoma patients, the integrative medicine specialists at Memorial Sloan-Kettering complement the traditional therapies given for pediatric sarcomas by offering ways to enhance the quality of life for patients undergoing intensive treatment.
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