Bone and joint cancers account for a fraction of cancer cases in the U.S., and their rarity and a paucity of treatment options underscore the need for experienced, multidisciplinary care and novel solutions. Nicklaus Children's Hospital's Sarcoma and Solid Tumor Program  delivers both options for children with these malignancies.

The Sarcoma and Solid Tumor Program is a collaboration between the Nicklaus Children's Cancer and Blood Disorders Institute and Orthopedic, Sports Medicine, and Spine Institute. The program attracts a high volume of pediatric bone and soft tissue cancer cases, serving patients from throughout South Florida, the Caribbean basin, Central and South America, and beyond.

Pediatric oncologists, orthopedic oncologic surgeons, radiation oncologists, and other specialists and sub-specialists partner to provide individualized care to every child.

“Using a team approach, we discuss all modalities of treatment, from first-line treatments for different tumor types to salvage therapy strategies and the development of novel investigational agents,” says Maggie Eidson Fader, MD, a pediatric hematologist/oncologist who sees patients at Nicklaus Children's Hospital and specializes in sarcoma. “Our oncologists offer patients options through clinical trials or the best standard of care available. The orthopedic surgeons we collaborate with also offer the most sophisticated technology and expertise available.”

Collaborative Care

A differentiating feature of the Sarcoma and Solid Tumor Program is the high level of coordination between team members, which allows for rapid patient evaluation and staging so treatment can begin as soon as possible.

“If I were to see a patient on, say, a Monday, I would perform a biopsy on them and receive the results within an hour, and then they would go through staging of the disease at Nicklaus Children's the same day,” says H. Thomas Temple, MD, pediatric orthopedic oncologic surgeon. “The patient could, potentially, start chemotherapy the following day. Nowhere else, in my experience, provides that level of service.”

The Sarcoma and Solid Tumor Program uses innovative diagnostic and tumor surveillance and targeting methods.

“Nicklaus Children's is also investigating sequencing the genome for many of these tumors to identify unique targeted therapies,” Dr. Temple said. “There is a tissue repository with nearly 100 sarcoma cultures for looking at novel ways of screening and surveilling these patients based on factors that tumor cells secrete. The team also employs novel techniques of diagnosing and surveilling patients with ultrasounds that not many other programs in the U.S. offer.”

The members of the Sarcoma and Solid Tumor Program meet in a weekly tumor conference to discuss every patient case and determine the most appropriate form of treatment.

“The oncology team at Nicklaus Children's provides not only standard chemotherapy options for bone cancers, but also several clinical trials with novel therapies and personalized medicine,” Dr. Fader says. “The orthopedic surgery team performs surgical resection of the tumor, striving to remove as much cancer as possible while preserving limb function and aesthetics whenever feasible.”

Leading-Edge Limb Salvage

The Sarcoma and Solid Tumor Program sees around 12 new limb salvage cases per year, and the team is able to avoid amputation in nearly every case, according to Dr. Fader. For children who have not reached skeletal maturity, preservation of the growth plate is the priority, preferably using a biologic reconstruction, Dr. Temple says. To accomplish this, orthopedic oncologic surgeons remove the tumor and place a structural allograft or perform a bone transport that uses an external frame or rod.

“When we have to remove the growth plate, we can place an implant and intermittently expand it through a small incision, or lengthen the extremity using a magnet,” Dr. Temple says. “Another option is to give the patient's family a magnet to take home. They can place it over a transducer beneath the skin and lengthen their child's extremity three-tenths of a millimeter per day. That's an exciting technology.”

Our team can provide custom, extendable prosthetic implants for skeletally immature patients. We work with bioengineers at various companies to tailor these implants to each patient's anatomy.

Supporting Patients and Shaping the Future of Bone Cancer Treatment

The Sarcoma and Solid Tumor Program's mission encompasses supportive care for patients and families.

“The team coordinates the delivery of physical therapy, occupational therapy, nutrition, behavioral medicine and social work,” Dr. Fader says. “This promotes improvements in patients' quality of life, better physical, social, and emotional outcomes, and improved patient satisfaction. Our cancer survivorship program, Survive & Thrive, provides monitoring and guidance for living with the long-term side effects of treatment.”

Pushing frontiers in search of new treatments is woven into the fabric of the Sarcoma and Solid Tumor Program. We participate in clinical trials through the Children's Oncology Group and with a variety of collaborators.

As bone cancer care continues to evolve, the Nicklaus Children's Cancer and Blood Disorders Institute is helping to drive its advancement.

For more information about the Nicklaus Children's Cancer and Blood Disorders Institute, email a member of the Nicklaus Children's physician liaison team.