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Soft Tissue and Bone Cancer

NewYork-Presbyterian Cancer Centers are at the forefront of the diagnosis and treatment of adult sarcomas of soft tissue, which may arise from any supporting or connective tissue of the body such as bone, muscle, joint linings, or fatty or fibrous structures. For tumors of the extremities, such as osteosarcoma, Ewing's sarcoma, and rhabdomyosarcoma, that arise in bone, connective tissue, and muscle, respectively, our programs provide expert treatment at every level – surgical tumor eradication, physical rehabilitation, and pain management. For sarcomas that arise in or spread to internal organs, we provide the latest in multidisciplinary diagnosis, staging, and continuing management. In addition to the newest experimental therapies, our patients have access to innovative clinical trials in immunotherapy unique to this institution. With expertise in medical, surgical, and orthopedic oncology, and specialized services in radiology and pathology, NewYork-Presbyterian Hospital's experienced staff calls on state-of-the-art technology to provide children and adults with primary and metastatic soft tissue and bone tumors the most advanced, individualized, and considerate care available. The programs also conduct important research that offers the hope of improving the lives and survival of patients who have these cancers.

Diagnostic Innovations

Diagnosis of bone cancer often is very difficult because bone marrow can make the pattern of disease unclear. The pathologists of the Cancer Centers have developed techniques for diagnosing sarcomas on very minor biopsies with a high degree of certainty, thus eliminating the need for multiple biopsies.

Tissues from patients with advanced or metastatic soft tissue tumors are being assessed by the latest molecular biological techniques to determine the likelihood of sensitivity or resistance to chemotherapy drugs being considered for treatment, and to determine whether the tumor type is eligible to be treated effectively with tumor vaccines.

Therapeutic Excellence

In sarcoma of the bone and extremities, our center continues its tradition of excellence in bone tumor surgery, particularly limb salvage surgery, prosthetic reconstruction, and individualized postoperative rehabilitation programs.

In addition, physicians here have pioneered a new technique for treating pathological crush fractures of the vertebral body in patients with round cell malignancies, most notably lymphomas and myelomas, as well as those who have osteoporosis secondary to steroids or chemotherapy. This minimally invasive procedure involves inserting a balloon after biopsy that reduces the fracture, thus providing significant pain relief while straightening out deformities. The results have been outstanding.

The Cancer Centers' radiation oncologists are among the leaders in developing limb-preserving techniques using brachytherapy in the treatment of soft tissue sarcomas of the extremities. Our physicians also have extensive experience with cryosurgery to extend margins without sacrificing tissue, such as bone, adjacent to soft tissue sarcoma.

Our physicians also are looking into preventing phantom pain in patients whose cancers require amputation. It is crucial to manage phantom pain as soon as possible after surgery; otherwise the pain can overwhelm the patient and make recovery much more difficult. This pain can be managed with the use of a catheter inserted directly in the area of the nerve that has been cut. The catheter technique permits the patient to move his or her limb right after the procedure, enhancing the rehabilitation process.

In advanced, unresectable, or metastatic sarcomas, our medical oncologists are principal investigators of national and institutional clinical trials of the latest chemotherapy agents, many of which are not available elsewhere. Our clinical trials are conducted with the help of dedicated and highly specialized research nurses and data management staff. NewYork-Presbyterian Hospital/Columbia University Medical Center was among the first to use the new agent Gleevec for gastrointestinal stromal sarcoma, and we have pioneered the use of temozolomide for leiomyosarcomas. At any one time at least two promising new agents are under investigation, both in the clinic and in the laboratory.

Our physicians have developed a strong relationship with the worldwide Ludwig Institute for Cancer Research, with two ongoing Phase I protocols for immunization with tumor-related peptide antigens detected in our patient material. These translational studies are at the very forefront of antigen discovery using "Serex" and other techniques, and are helping to define the appropriate techniques and pitfalls for optimization of the response. A new series of experiments has already shown that many useful peptide antigens are detectable on a variety of mesenchymal sarcomas that can be used to fabricate a tumor vaccine for these patients and hold great promise for the possibility of longer-term tumor control.

Whether the most up-to-date conventional or experimental plan of care is chosen, the goal of treatment is always the expeditious improvement of patient survival, symptoms, and quality of life.