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Geriatrics Expert Named
Cancer Care
| Physician-scientist Uses Novel Methods to Treat Bone Cancer Patients Orthopedic oncologist Francis Lee saves children from multiple operations, restores limb function |
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Last year, Clare became one of only 400 children in the United States to be diagnosed with osteosarcoma, a type of bone cancer. Her parents turned to Francis Lee, M.D., associate professor of orthopedic surgery in P&S and the Herbert Irving Comprehensive Cancer Center, one of only a handful of orthopedic oncologists in the New York City area skilled enough not only to remove the cancer from Clare’s leg but also to reconstruct her limb.
“A lot of people think that bone cancer always leads to amputation, but the techniques we have now have revolutionized patient care,” Dr. Lee says. “I always emphasize to my patients that, first and foremost, I must remove the tumor to save the life of the patient, even if that involves amputation. But most patients can keep their limbs, and they will look and function almost exactly like they did before the cancer.”
Like many osteosarcomas, Clare’s tumor was huge. Originating in the thigh bone, it had spread so extensively that it formed a lump above her knee. The lump, and some pain, prompted her parents to consult their Mount Kisco pediatrician, Nick Germanakos, M.D., who referred them to Columbia. X-rays and MRI revealed a tumor about the size of a wine bottle.
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With Clare, Dr. Lee faced an additional challenge beyond just saving her leg. At age 10, she still has several more years of growth, but her extensive tumor required the removal of cells responsible for bone growth. Clare would have to endure repeated invasive operations to lengthen the implant if Dr. Lee used a traditional titanium prosthesis to replace her femur.
Instead, Dr. Lee selected a relatively new implant – approved by the FDA in 2002 – that can be easily lengthened in the doctor’s office. The device vaguely resembles an automotive shock absorber, with one end of the implant inserted into the other end. The two ends are normally locked in place, but can slide apart when a magnetic field outside the leg releases a mechanism inside the prosthesis. One application of the magnetic field can lengthen the implant up to one centimeter.
“After Clare’s biopsy, we were grieving about what our daughter was losing,” says Clare’s father. “On the day of the operation, Dr. Lee came out of surgery after six hours, and I asked him if everything went well. He’s usually very polite and understated, but he was ecstatic about the results. I came away feeling more assured.”
New surgical devices like Clare’s expandable prosthesis have made a huge impact on the quality of life for bone cancer survivors. But it has been the use of chemotherapy that has been responsible for the massive improvement in survival, says Clare’s medical oncologist Linda Granowetter, M.D., associate professor of clinical pediatrics.
Before the advent of chemotherapy for bone cancer in the 1970s, only 20 percent of patients survived for two years after surgery. Survival now approaches 80 percent, because the drugs kill invisible micro-metastases every patient probably harbors.
Two months of chemotherapy before surgery also allows doctors to assess each patient’s response to the drugs’ toxic effects. “What’s gratifying about Clare’s case is that 100 percent of her tumor was necrotic when it was removed,” Dr. Granowetter says. “Our goal is to see as much tumor necrosis as possible after two months of chemotherapy. Total necrosis is not common, but it is a great outcome.”
Last month Clare went through another round of post-operative chemotherapy and just started at-home physical therapy to build on improvements she has made in the hospital in moving her legs.
“We are confident that Clare’s determination and spirit will help her overcome all obstacles so that she may live a normal, active life,” says Clare’s father.
—Susan Conova
| Dr. Lee’s Search for Bone Cancer Therapies For some bone cancer patients, the prognosis is less reassuring than Clare’s, and it is these patients that motivate Dr. Lee to go to his lab, even after a day spent in the operating room. The fact that Dr. Lee is also a researcher places him into a select, and dwindling, group of orthopedic surgeon-scientists. Of the nearly 16,000 members of the American Academy of Orthopedic Surgeons, less than two dozen – a group that includes Dr. Lee – have investigator-initiated RO1 grants from the NIH. His research is also supported by several foundations, including the Orthopaedic Research and Education Foundation, and a supportive environment for physician-scientists set up by Louis Bigliani, M.D., chairman of the Department of Orthopedic Surgery. In the lab, Dr. Lee tests new ways to kill osteosarcoma cells, especially those that resist current treatments. Dr. Lee’s initial in vitro results with a new type of drug, called interfering RNAs, are promising. The small RNAs shut down genes that allow resistant sarcoma cells to survive, converting them into cells that can be killed with radiation or chemotherapy. There are still many years of testing and development before the potential treatment is ever used in patients, Dr. Lee says. “Seeing Clare’s success just makes me even more motivated to stay in the lab so I can find ways to give other osteosarcoma patients the same hope for the future.” |
