 |
|
|
|
|
|
|
 |
|
| The
Peter Mac Sarcoma Service provides evaluation and treatment
for all types and stages of soft tissue and bone sarcomas.
|
| |
| A
weekly multi-disciplinary clinic is attended by: |
| |
 |
musculoskeletal
tumour surgeons |
| |
|
radiation
and medical oncologists |
| |
| With
specialist expertise in the management of: |
| |
|
Bone
and Soft Tissue Sarcoma |
| |
|
Bone
Metastasis |
| |
| A
weekly tumour Conference provides a forum for multidisciplinary
review of information, from Clinic and Consultation cases. |
|
|
 |
|
|
All
varieties of benign and malignant soft tissue and bone tumours |
|
|
Multi-disciplinary
clinic with specialised radiation oncologists, musculoskeletal
tumour surgeons and medical oncologists |
|
|
Combined
therapy with emphasis on functional outcome as well as tumour
control in management of soft tissue and bone tumours |
|
|
Expertise
in functional imaging, with Position Emission Tomography and
thallium scans used for diagnosis and monitoring of therapeutic
response, correlated with structural imaging (Computerised Tomography,
Magnetic Resonance Imaging) and pathology |
|
|
Preoperative
radiotherapy and limb sparing surgery for soft tissue sarcoma |
|
|
Translational
research including: |
|
|
 |
investigation
of the mechanism of metastasis and local spread in bone
sarcoma via antisense technology |
|
|
investigation of the regulation of angiogenesis in the
growth and progression of osteosarcoma |
|
|
evaluation
of the role of bisphosphonates in bone sarcoma |
|
|
assessment
of the role of functional imaging in soft tissue sarcoma
management |
|
|
|
 |
|
|
Largest
paediatric radiotherapy centre in Australia |
| |
|
Multi
disciplinary consultation and management |
| |
|
Integrated
patient care and clinical translational research programs in
association with The Royal Children's Hospital |
| |
|
Participation
in National and International cooperative paediatric clinical
trial groups allowing access to latest protocols and advances
|
| |
|
Access
to and experience with innovative and novel therapeutic options,
such as three?dimension conformal radiation planning, intense
modulated radio therapy and stereotactic radiation therapy |
| |
|
Access
to specialised paediatric anaesthesia and sedation where required.
|
|
|
 |
|
|
| Chair
of Sarcoma Service |
|
|
Prof
Peter Choong |
MB
BS MD FRACS FAOrthA |
Page
through Peter Mac switchboard |
|
| Medical
Oncology |
|
Assoc
Prof Guy Toner |
MB
BS MD FRACP |
Ph:
9656 1804 |
|
Dr
David Thomas |
MB
BS MD FRACP |
Ph:
9656 3563 |
|
| Palliative
Care |
|
|
Dr
Odette Spruyt |
MBChB
DipObst FRACP FAChPM |
Ph:
9656 1109 |
|
|
Dr
Simon Wein |
MB
BS FRACP FAChPM |
Ph:
9656 1919 |
|
| Radiation
Oncology |
|
|
Dr
Sam Ngan |
MB
BS FRANZCR |
Ph: 9656 1059 |
|
|
Dr
Mike Fay |
MB
BS FRANZCR |
Ph:
9656 1696 |
|
| Surgical
Oncology |
|
|
Prof
Peter Choong |
MB
BS MD FRACS FAOrthA |
Page
through Peter Mac switchboard |
|
|
Mr
Gerard Powell |
MB
BS FRACS(Orth) FAOrthA MRACMA |
Page
through Peter Mac switchboard |
|
| Nurse
Co-ordinator |
|
|
Ms
Marianne Griffin |
RN
Div 1, B.Arts |
Contact
Pager 7323 |
|
|
|
 |
|
| Specialised
Diagnostics |
|
|
Magnetic
Resonance Imaging |
|
|
High
speed helical CT |
|
|
Positron
Emission Tomography (PET) |
|
|
Functional
Nuclear Scanning |
|
|
Molecular
pathology |
|
| Specialised
Treatments |
|
|
Preoperative
Radiotherapy |
|
|
Limb
Sparing Surgery |
|
|
Pelvic
Surgery |
|
|
Radiofrequency
ablation |
|
 |
|
| Malignant
bone and soft tissue tumours (sarcomas) are rare. The care of these
tumours is best treated by an expert group, who have a specialised
interest in these types of tumours. The cause of primary bone or soft
tissue cancers is unclear but abnormalities in their ability to respond
to the normal signals from the body is thought to be the major reason
for their growth. These tumours can spread to nearby areas as well
as other parts of the body, particularly the lungs. Spread to the
lungs may happen in up to 30% of cases.
Modern
treatment of bone and soft tissue tumours consists of radiotherapy,
chemotherapy and surgery in different combinations. Before treatment
all patients are seen by the expert group and special investigations
are undertaken. The purpose of this is to find out as much as possible
of where the tumour is located, what important structures it is
next to, what it is doing and where it may have spread. A careful
needle biopsy performed under computer guidance is then performed
to harvest tissue to determine what the tumour is. When all this
information is available, the team of doctors then plan the correct
treatment for the tumour.
Patients
with soft tissue sarcoma are treated with radiotherapy then surgery.
Patients with bone sarcomas are treated with chemotherapy then surgery
followed afterwards by chemotherapy again. After all treatment is
completed, the team of doctors review the patients at regular intervals
to allow early detection of tumours should they return. Protocols
are available for the treatment of tumours if they recur.
|
|
 |
|
Primary
malignancies of bone and soft tissue are rare, occurring in approximately
2 per 100000 population and account for 1 in 1000 malignancies. Concentration
of these numbers in a specialized center allows the development of
expertise in management and improved patient outcomes. The multidisciplinary
management of bone and soft tissue sarcomas is delivered by a team
of musculoskeletal surgeons, radiation oncologists and medical oncologist,
together with pathologists, imaging specialists and cytogeneticists.
This team of specialists conducts a weekly Tumour Conference to review
and discuss patients recently diagnosed or undergoing treatment for
their tumours, as well as consultation cases referred to the group
for an opinion of a suspected tumour. The team also conducts a weekly
clinic to see and treat patients with tumours of bone and soft tissue.
Management protocols follow established guidelines for investigation,
biopsy, radiotherapy, chemotherapy and surgery. The majority of patients
with soft tissue sarcomas are treated with preoperative radiotherapy
followed by wide resectional surgery. The goal of surgery is to excise
the tumour with oncologic margins but to attempt limb sparing reconstructive
surgery which is possible in over 85% of cases. Chemotherapy is offered
to patients who present with bone sarcomas and fulfill inclusion criteria.
In certain circumstances, patients may be suitable candidates for
trials of novel therapy. With current treatment, the local control
rate for soft tissue and bone sarcomas is 95% or more. The rate of
metastasis is approximately 30-35%. Pulmonary metastasis can be treated
with pulmonary metastasectomy and an active programme exists to provide
pulmonary metastasectomy where indicated. |
|
 |
|
|
Choong
PF, Sim FH. Limb-sparing surgery for bone tumors: new developments.
Semin Surg Oncol 1997;13(1):64-9. |
|
|
Phillips
K, Toner G. Chemotherapy for soft tissue sarcomas. Indications
and advances.
Acta Orthop Scand Suppl. 1997 Feb;273:133-8
|
|
|
Ngan,
SY Radiotherapy in soft tissue sarcoma of the extremities.
Acta Orthop Scand Suppl. 1997 Feb;273:112-6.
|
|
|
Choong
P. Staging and surgical margins in musculoskeletal tumours.
In: Bulstrode C, Buckwalter J, Carr A, Marsh L, Fairbank J,
Wilson-Macdonald J, et al., editors. Oxford Textbook of Orthopedics
& Traumatology. Oxford: Oxford University Press; 2002.
p. 110-120.
|
|
|
Choong
P, Petersen I, Nascimento A, Sim FH. Is radiotherapy important
for low-grade soft tissue sarcoma of the extremity? Clin Orthop
2001;387:191-9.
|
|
|
Choong
PF, Pritchard DJ, Rock MG, Sim FH, Frassica FJ. Survival after
pulmonary metastasectomy in soft tissue sarcoma. Prognostic
factors in 214 patients. Acta Orthop Scand 1995;66(6):561-8.
|
|
|
Choong
P.F.M., Management of the patient with carcinoma of unknown
origin metastatic to bone, in Menendez L.R.(ed): Orthopaedic
Knowledge Update: Musculoskeletal Tumours. Rosemont, Il, American
Academy of Orthopaedic Surgeons,2002, pp323-329
|
|
|
Kunisada,
T, Ngan, SY, Powell, G, Choong PF. Wound complications following
pre-operative radiotherapy for soft tissue sarcoma.
Eur J Surg Oncol. 2002 Feb;28(1):75-9. |
|
|
