|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 184-185
OrthOncoCon-2014: Continuing education in musculoskeletal oncology
A Gulia, C Wilding, MB Suman, A Puri
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||5-Feb-2016|
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gulia A, Wilding C, Suman M B, Puri A. OrthOncoCon-2014: Continuing education in musculoskeletal oncology. Indian J Cancer 2015;52:184-5
Musculoskeletal oncology is a subspecialty that deals with education, research and management of musculoskeletal tumors. We need a continuous effort to raise the standards of orthopedic oncology awareness in our country and education of young orthopedic surgeons is one of the major areas that would address this issue.
The orthopedic oncology services of Tata Memorial Hospital organized a 1-day conference, OrthOncoCon-2014, to create awareness about the principles of management of musculoskeletal tumors. This event was conducted under the aegis of the Indian Musculoskeletal Oncology Society. The well-structured educational extravaganza bought together 119 residents and 17 renowned faculties from all across India interacting with the gathered delegates.
The day started off with a didactic lecture on radiology. Plain radiographs remain the first radiographic modality and are of vital importance to differentiate an aggressive/malignant bone tumor from a benign one. The paramount importance of salient radiological features such as type of lesion, location, skeletal maturity, tumor matrix, zone of transition and periosteal reaction, which are used to differentiate benign and aggressive tumors, were explained with radiological examples.
The next didactic lecture focused on “The approach to the patient with a suspected primary bone malignancy.” The main aim of the lecture was to outline an algorithm to reach a correct diagnosis. This necessitates a systematic approach comprising of clinical evaluation, radiological assessment and confirming the clinicoradiological diagnosis histopathologically by doing a biopsy. The lecture discussed the importance of symptoms and features of the history, which would help with differentiating the lesion. In particular, age was the most useful differentiating factor between the three most common primary bone malignancies with Ewing's sarcoma a disease mostly of childhood and adolescence, chondrosarcoma peaking from the fifth decade whilst osteosarcoma has a dual-peak incidence effecting patients during the adolescent years and then from the fifth decade also.
The final lecture of the morning session was on the important topic of “biopsy.” The importance of this topic was highlighted with discussion of the Mankin paper demonstrating the consequences of technically poor bone biopsy. The lecture also highlighted the advantages and pitfalls of needle biopsy technique vis a vis open biopsy. The lecture laid emphasis on undertaking the biopsy only after careful consideration to the final operative plan. An improper biopsy can result in disastrous patient outcomes associated with contaminating healthy skin leading to unnecessary amputations or excessive skin loss necessitating skin flap coverage. The importance of doing the appropriate imaging prior to biopsy in order to maximize the chances of sampling representative tissue were also addressed.
The morning lectures were followed by an interactive session with a panel of multi-disciplinary experts to discuss clinical cases enforcing the salient teaching points from the morning lectures regarding assessment and diagnosis of bone tumors. The open discussion format allowed delegates to raise questions. Through the discussion, a systematic approach was taught to help clinicians arrive at a correct diagnosis.
The next lecture discussed the concepts behind the treatment of the three most common primary bone cancers, osteosarcoma, chondrosarcoma and Ewing's sarcoma. The speaker gave a succinct account of the main treatment strategies for each of these tumors. The lecture reinforced the point that oncological clearance is the main goal of any oncosurgery. Limb salvage should be deferred if there is any doubt to achieve clear tumor margins. The role of multi-disciplinary management was the highlight of this talk. The indications of adjuvant treatment such as chemotherapy and radiotherapy were well-discussed. The lecture gave the delegates the important theories and steps in the planning and management of patient treatment and gave them the knowledge needed to adopt these concepts into their own practice.
The next lecture addressed chemotherapy. The lecture aimed at giving a brief overview of the strategies adopted by the medical oncologists in the medical treatment of bone cancer patients. Osteosarcoma is treated with a three-drug combination after studies demonstrated an improved outcome relative to two drugs but no difference when a fourth drug is added. The chemotherapeutic management of Ewing's involves a four-drug therapy; vincristine, doxorubicin, cyclophosphamide or ifosfamide with the addition of etoposide are used. The lecture helped clarify the role of chemotherapy in the treatment of patients with bone cancers as well as giving a brief overview of the regimes and potential side effects faced.
The next lecture focused on the role of radiotherapy in the management of benign and malignant bone tumors. With the surgical background of the delegates in mind, the lecture focused on the fundamental aspects of radiotherapy. With Ewing's being the most radiosensitive, the focus centered upon radiotherapy's role in Ewing's sarcoma. Delegates were made aware of the main indications and contraindications for the use of radiotherapy in these patients. Radiotherapy is also considered postoperatively in those patients with tumors with a poor response to preoperative chemotherapy evidenced by the percentage of tumor necrosis upon histopathological examination.
The final lecture of the day focused on the methods of rehabilitation to achieve optimal functional outcomes for patients. The lecture had well-illustrated pictures and videos showing the methodology of treatment and expected functional outcome.
The last session of the day was another open floor interactive session, which summarized all the key concepts of the afternoon sessions by revisiting the same cases initially discussed in the interactive diagnostic session. With senior panelists on hand to lend their expertise to the queries raised, the delegates were able to clear any doubts they had regarding treatment strategies and management options. The crucial concepts of the diagnosis and treatment of bone tumors were addressed in each major area allowing the delegates to confidently face bone tumors in their own practice with more skill and expertise. The use of didactic lectures initially allowed delegates to receive information and learn the theory behind the practice of orthopedic oncology with the interactive expert panel sessions ensuring delegates were able to apply these theories to realistic cases as well as identify any areas of confusion.
| » The Future!!!|| |
The subspecialty, orthopedic oncology/musculoskeletal oncology, is a challenging field of medicine and requires intense teaching and education. The management of musculoskeletal tumors requires seamless interaction between various specialties such as orthopedics, medical oncology, radiation oncology, pathology, radiology and rehabilitation medicine. An integrated approach is necessary to get all specialties together on a common platform and propagate the need for multi-disciplinary evidence-based medicine for the management of these tumors. The above day school on musculoskeletal oncology is a perfect example of such a platform and should be frequently repeated at various levels across the nation. The “Indian Musculoskeletal Oncology Society” has provided an umbrella under which a multi-disciplinary management program can grow and help in raising the standards of musculoskeletal oncology in the country.