Tumor Information

Treatments for Specific Tumors

Giant-cell tumor of bone

 

 

 

 

 

 

 

 

 

 

 

 

 

Benign Aggressive Tumors

Giant-cell tumors are benign but considered "aggressive" because of their capacity to rapidly destroy bone. They are most common in young adults and usually seen around the knee. Simple "curettage" (i.e. only mechanical removal) is associated with frequent tumor recurrence.

For many years, we have treated these tumors with a combination of curettage, cryosurgery (the use of liquid nitrogen to freeze tumor cells) and reconstruction with metal rods, cement and bone graft. Using this protocol, we have achieved a recurrence rate of less than 5% with a low complication rate. Other benign but aggressive bone tumors such as aneurysmal bone cysts and low-grade bone malignancies such as low-grade chondrosarcomas are treated similarly.

Osteoid osteoma

Osteoid osteoma is a small but typically very painful bone tumor found in children and young adults. It is always benign and most common in the lower extremities. Depending on the location, this tumor can be "killed" using a special probe that delivers radio-frequency waves directly onto the bone ("Radiofrequency Ablation"), without surgery.

In other cases, the tumor is localized using a CT scan and surgically removed by using a high-speed drill to carefully burr the bone surface where the tumor is located.

Pigmented Villonodular Synovitis (PVNS)

PVNS is a benign soft-tissue tumor of the joint lining, most common in the knee. It is considered "aggressive" because it has the capacity to slowly destroy the joint. Many patients have had more than one previous unsuccessful surgery before being referred to us. Arthroscopic removal rarely succeeds in completely removing PVNS.

For many years, we have used a protocol of sequential surgical resections in order to completely remove the tumor followed by radiation therapy to kill any remaining tumor cells.

With this regimen, our patients have had almost no recurrences and have maintained excellent function of their joints.

Metastatic Tumors

The large majority of skeletal tumors actually arise from non-skeletal locations; that is, they are "metastatic". The most common origins are breast, lung, thyroid and renal cancers. These metastatic lesions are usually painful and sometimes cause the bone to break ("pathological fracture").

Our familiarity with skeletal reconstruction after large bone resections allows us to achieve reliable results with even large metastatic lesions. In addition, our experience with cryosurgery often offers additional surgical options in removing the tumor.

We also have extensive experience with the use of pre-operative embolization (selective blockage of arteries that feed a tumor) to make surgery safer, or even feasible, in situations where the tumor has an extensive blood supply, such as with metastatic kidney tumors.

Osteosarcoma

Osteosarcoma is the most common malignant tumor of bone. It usually occurs in late adolescent children, most commonly about the knee.

Twenty years ago, there were few, if any, survivors of this disease. Now, with modern chemotherapy, the majority of children are completely cured. Therefore, it is critical that the most reliable and functional limb-sparing surgical resection be performed as these children will have many active years of disease-free life.

Because of our close working relationships with many of the pediatric oncologists in the region and the large number of previous patients, we are able to offer both advanced surgical techniques and a supportive environment where new and old patients help each other.

We have treated over 200 patients with osteosarcoma, from all over the region as well as nationally. We are considered one of the leading national centers for the treatment of sarcomas.

Chondrosarcoma

Chondrosarcoma is a malignant bone tumor that arises from cartilage cells and is most common about the hip, pelvis and shoulder. It is typically resistant to chemotherapy and radiotherapy.

Since the main hope for cure is an exact surgical resection, our extensive experience in pelvic and shoulder surgery is very useful in assuring that these tumors do not recur at their original location.

If the tumor is "low-grade", it can be successfully removed using curettage and cryosurgery, without removing the segment of bone.

Ewing's Sarcoma

Ewing's sarcoma is the second most common tumor of bone in children. Its histology is unique in that "round" cells are seen instead of the "spindle" cells seen with most other sarcomas.

As with osteosarcoma, twenty years ago there were few, if any, survivors of Ewing's sarcoma. Since then, tremendous advances have been made in chemotherapy for Ewing's sarcoma and now many children are cured from this disease.

Depending on the location of the tumor, we will use radiation or surgery to remove the tumor at its original location, in addition to chemotherapy.

Soft Tissue Sarcoma

Click here for the soft-tissue sarcoma page
Soft-tissue sarcomas are malignant tumors that arise from connective tissues, fat, muscles, nerves or vascular structures. They are more common that bone sarcomas.

If the tumor is small, it can usually be safely removed in its entirety. However, surgery alone for large, high-grade tumors can result in tumor recurrence.

Therefore, for many years, our treatment protocol for large tumors has been to give chemotherapy before performing surgery, some of it directly into the extremity ("Neoadjuvant" chemotherapy). On average, the percentage of tumor found dead at the time of surgery ("tumor necrosis") is about 90%.

This allows for much safer surgery with a very low risk of tumor recurrence and also allows us to to avoid post-operative radiation therapy in nearly half of our patients. Even with large tumors, 95% of our patients have been able to avoid amputation.



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7830 Old Georgetown Rd
Bethesda, MD 20814


email:
martin.malawer at gmail.com    

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301-215-7940

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