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Three orthopaedic surgeons at Vanderbilt now practice full-time orthopaedic oncology, and it is quickly becoming a major
center for sarcoma surgery.
“I know there’s a small group of people, probably only 50 people in the country who practice full-time orthopaedic oncology, and we have three of them at Vanderbilt,” Schwartz said. Last year, 250 sarcoma surgeries were performed, and that number grows annually.
But successful sarcoma treatment requires a team effort from oncologists, radiologists, pathologists, nurses, therapists and social workers, in addition to surgeons.
Scott Borinstein, M.D., Ph.D., assistant professor of Pediatrics and Pediatric Hematology-Oncology, is working to establish a sarcoma program that will provide comprehensive care to patients with bone tumors.
“The goal is to coordinate the treatment and management of these complex patients, so families and patients have a better feeling that we’re using a team approach,” he said. “Even though I’m fairly early in my career, I’ve found that a multidisciplinary approach is optimal for everyone involved. All understand the treatment plan, it goes smoothly, and the end result is better care for all.”
A team approach is also crucial in research. Because sarcoma is so rare, it can be difficult to recruit enough patients for a valid
clinical trial. Vicki Keedy, M.D., assistant professor of Hematology/ Oncology, said there can sometimes be as many as 50 to 60 centers involved just to complete one study.
“If you look at the basic science of the cancers, there’s some great research going on, but it may be in a very specific subtype of sarcoma, such as synovial cell sarcoma. It’s so hard to take that basic science research and put it into clinical trials because there are so few patients and so many different sarcomas. What we end up doing is getting a promising drug from synovial cell sarcoma research and testing that in all soft-tissue sarcomas. But that drug
is never going to bring the outcome we would expect because the tumors are not all the same,” Keedy said.
A resource that could speed advances is Vanderbilt’s tissue archives. Instead of waiting for new sarcomas cases to develop, researchers can delve into tissue archives dating back to the 1920s and a tumor registry that began in 1950.
Cheryl Coffin, M.D., Goodpasture Professor of Investigative Pathology, said Vanderbilt has just begun to revisit these archives to define what is there and how it can be used.
“Sarcomas are rare, so getting a sufficient number of either pathology samples or patients with sarcoma can be challenging. At Vanderbilt, we’re fortunate to have tissue archives,” Coffin said. “We may or may not be able to access medical records from decades ago. We may only have a name, birth date, a diagnosis and some slides, and we may not be able to even get that much. But even limited information combined with the tissue archives is a valuable resource for future clinical and translational research. Over time, we can determine what tests a sample is good for and what may not be feasible.”
Borinstein is using the tissue archive for his research in Ewing sarcoma, a bone and soft-tissue tumor that most often occurs in adolescents and young adults. He is interested in DNA methylation, an epigenetic mechanism (chemical modification to DNA that does not change the underlying sequence) that can control the way genes are expressed.
“Research has shown that DNA methylation can occur abnormally and lead to the silencing of signals that normally prevent cells from becoming cancers,” he said. “We have learned how to examine methylation patterns in old, archived tissue specimens, which is critical when investigating rare tumors such as Ewing sarcoma. We may identify methylation patterns to help us understand the cause of Ewing sarcoma, which may help us come up with better treatment strategies.”
It is research like this that leads Coffin to believe that sarcoma is on the threshold of really significant advances being made in the next few decades, and Vanderbilt is poised to lead the charge.
“At Vanderbilt, we’re really lucky because we have a very large group of people who can form a sarcoma team. The clinical care for sarcomas is great, and we can start to build a sarcoma program that is multi-disciplinary, that can have not only the clinical care, but also clinical and translational research and perhaps basic research. It’s a pretty exciting time to be at Vanderbilt,” she said.
It’s a pretty exciting time for Camille Fraser too. She made the first-team all-district in volleyball last year and is in the midst of her senior season. She still has a lot of pain in her leg and sometimes has to sit on the sidelines, but her love for the sport keeps her going and her coaches and teammates are understanding.
“I wear a brace, and players will come up and ask how I messed up my knee, thinking it will be an ACL or something,” she said with a laugh. “When I tell them, their eyes get really big and they say they’re so sorry, but I don’t mind talking about it.”
She wants to become a child life specialist to help reduce the stress and anxiety of other children facing similar experiences. Camille has already made two mission trips to Honduras and
definitely plans on returning next summer to continue her work.
“We build houses, deliver food packages, visit orphanages, just do what needs to be done. I would move there right now if she would let me,” she said, pointing to her mother. “As much as I have gotten, I have to give back.” 
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