Daniel Lerman, MD
Presbyterian/ St. Luke's Medical Center
From surgical techniques and infection control to implant technology and quality of life, bone sarcoma treatment has come a long way in the past few decades.
Daniel Lerman, MD, an orthopedic oncologist with the Institute for Limb Preservation at Presbyterian/St. Luke's Medical Center, a part of Sarah Cannon Cancer Institute and HCA Healthcare, shares promising new advances in bone sarcoma treatment.
Improvements in surgical techniques
“With bone sarcomas, we resect the bone, typically in an area we can reconstruct, such as the distal femur, proximal tibia, and proximal femur,” says Dr. Lerman. “If bone sarcoma is located in those areas, we can do a wide resection to remove all of the tumor and some surrounding normal tissue. Then we reconstruct with an implant.”
Significant advancements in implant technology and surgical techniques have improved outcomes for patients.
“We have more techniques to minimize implant failure and infection, which is important for patients going through chemotherapy and radiation,” he says. “Infection is a major way that implants fail and why patients may require amputation.”
Orthopedic oncologists work closely with plastic surgery colleagues to reduce the risk of infection.
“We use a multidisciplinary surgical approach and work together to optimize function,” he says. “The more we understand about function and limb salvage, the more it’s clear that it’s not only about putting implants in the right place, but also having optimal soft tissue envelopes to allow for a safe healing environment.”
Another area of progress is implant longevity.
“Young people who get limb implants tended to wear them out and need revision procedures, so we’re working to minimize that moving forward,” he says. “Our hope is that the longevity of the new implants will be comparable to that of hip and knee replacement implants.”
Improvements in quality of life
Another major advance is the focus on quality of life.
“A trend throughout oncology has been an awareness of and sensitivity to the whole patient, including their mental health, not just the oncologic problem we need to treat,” says Dr. Lerman. “This holistic perspective has improved outcomes. The more we know about surgery and recovery, the more it’s clear that patients who have focused, committed recoveries fare much better.”
This includes connecting patients with:
- Mental health providers who help with trauma and post-traumatic stress disorder.
- Rehabilitation resources, such as physical therapy, to improve limb function and assist with activities of daily living.
“Since its beginning, cancer care has been about balancing treating the tumor while minimizing effects on other areas of the body,” he says. “As we evolve in our thinking, we’ve added a focus on keeping the patient as close to the person they know themselves to be. No one who goes through cancer treatment is exactly the same on the other side of it, but our goal is to help them maintain their identity.”
Improvements in radiation therapy
Radiation therapy has also improved over the past few decades.
“Radiation oncologists are able to target higher doses within a more concentrated field, which is the holy grail of radiation therapy,” says Dr. Lerman. “We want to get as much radiation therapy to the tumor while minimizing exposure to other areas of the body.”
Systemic therapy research
Currently, surgery and radiation therapy are the most effective treatments for many forms of bone sarcoma, but Dr. Lerman says there is promising research in the field of systemic therapy.
“There are advancements in targeted therapy and immunotherapy to fight cancer,” he says. “These medications attack cancer cells more specifically than general cytotoxic chemotherapy.”
Sarah Cannon offers Phase I and Phase II clinical trials for both soft tissue and bone sarcomas.
The importance of seeing a bone sarcoma specialist
Finally, seeing an orthopedic oncologist who specializes in bone sarcoma treatment is crucial for better outcomes.
“The most critical thing is to seek care from an orthopedic oncologist in a sarcoma center,” says Dr. Lerman. “It’s a rare disease process—it accounts for less than 1% of cancers in adults and 15% in children—so you want to see a provider who specializes in sarcoma.”