Chapter 23: Limb Salvage; an Informal Connection with an Italian Institute

Title

Chapter 23: Limb Salvage; an Informal Connection with an Italian Institute

Files

Loading...

Media is loading
 

Description

In this chapter, Dr. Benjamin gives an overview of his work with limb salvage treatments, based on the osteosarcoma model. This work was greatly facilitated by advances in prosthetics, he observes. He notes that in 1974, MD Anderson was just beginning to do limb salvage work in connection with radiation therapy. He then explains how limb salvage works with chemotherapy. He cites an important study of limb salvage conducted at the Instituto Ortopedico Rizzoli in Bologna, Italy. He explains that faculty from the Instituto learned chemotherapy from MD Anderson in the 1980. He explains some of the good results they achieved using MD Anderson techniques. Next, Dr. Benjamin talks about the national and international community of individuals who focus on sarcoma.

Identifier

BenjaminR_02_20150116_C23

Publication Date

1-16-2015

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Researcher; The Researcher; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Overview; Definitions, Explanations, Translations; Discovery and Success; Beyond the Institution

Transcript

Tacey Ann Rosolowski, PhD:

That’s interesting. I’m looking at the work that you’ve done with the limb-salvage regimens and also with prostheses, and I’m wondering how that work evolved from the work that you’ve described so far.

Robert Benjamin, MD:

So that’s this osteosarcoma model where you say let’s optimize the chemotherapy treatment for the osteosarcoma, and if we can get enough of an effect on the tumor that the tumor can be removed in an oncologically sound surgical fashion without requiring taking the entire leg off—

Tacey Ann Rosolowski, PhD:

Mm-hmm, or the pelvis.

Robert Benjamin, MD:

Or pelvis.

Tacey Ann Rosolowski, PhD:

Yeah. (laughs)

Robert Benjamin, MD:

—then that’s the model for doing some sort of limb salvage. I mean, the work with the prostheses is the work of the orthopedic surgeons, not mine, but we can help facilitate that.When I came here, they were just beginning to do limb-salvage surgery for soft-tissue sarcomas, and there the effective additional treatment that was required was radiation, but we can do that with chemotherapy as well, and/or in addition to radiation. As I said, the primary target organ of the chemotherapy is really the pulmonary metastases that we don’t see, but if in helping to destroy those pulmonary metastases we can also destroy or eliminate most of the primary tumor, then the surgeon can get away with less extensive surgery.And for osteosarcoma, the group at the Rizzoli Institute in Bologna has done the best study and the best analysis of that, the effects of the results of the chemotherapy on the ability to do limb salvage in terms of what kind of margin of resection do you need, and I like the Rizzoli group particularly. Number one, they have tremendous experience. They see essentially all of the osteosarcomas in all of Italy in one institution. Second of all, they learned how to do the chemotherapy from us, because they spent a few months here visiting, and they’ve gone way beyond what we had done what we taught them, but they basically followed some of the same principles.

Tacey Ann Rosolowski, PhD:

When was this relationship established?

Robert Benjamin, MD:

Oh, probably early eighties.

Tacey Ann Rosolowski, PhD:

How did you make contact with them? How was that established?

Robert Benjamin, MD:

I made contact with them by their showing up here on my doorstep. I think the arrangements were all made through Dr. Wallace in Interventional Radiology, actually. They came to visit him to see how we did the intra-arterial chemotherapy. But we have continued just sort of interchange with them over the years.They did a really nice study where they showed that if you had a good, effective chemotherapy, defined as 90 percent tumor necrosis or better in osteosarcoma, then you could get away with a marginal resection. So the surgeon didn’t have to take as much normal tissue around the tumor because most of the tumor was dead, and it was less likely to occur, whereas if you had a bad response to the chemotherapy, if you didn’t take a radical margin, the incidence of local recurrence was very high. So it’s a nice example of the fact that the local effect actually does make a difference in terms of what needs to be done surgically. If you can get away with a wide resection regardless of the response, then it doesn’t matter, but if you can’t get a wide resection and you know the response to chemotherapy is not very good, then you’re probably better off doing the amputation, because local recurrence causes more problems than just initial amputation.

Tacey Ann Rosolowski, PhD:

Have there been ways—I mean, as the relationship with the Rizzoli group has continued, because that’s a long time, you know, it’s a twenty-year relationship, but what has that brought to MD Anderson?

Robert Benjamin, MD:

Oh, it’s not a continued interaction. I mean, we haven’t been collaborating on projects over a twenty-year period. We just set them off in a direction they did things similar to what we were doing, so each of our studies sort of complemented each other.But the sarcoma community—sarcomas are rare tumors. Sarcoma community in the world is very small, so we all know each other, and at one point we formed a society called the Connective Tissue Oncology Society, which is sort of a platform for continued global interaction among all of the people interested in sarcomas.

Tacey Ann Rosolowski, PhD:

When you say “we,” were you one of the people that helped plan that?

Robert Benjamin, MD:

I was one of the people that helped. It wasn’t my idea. The person who came up with the idea was Herman Suit, who was a radiation oncologist who was here initially and then went to Harvard, and most of his career was spent at Harvard, and he’s been considered one of the pioneers in sarcoma radiation and new developments in radiation. But he’s the person who basically initiated the programs allowing for limb-salvage surgery here, working with Dr. Martin [phonetic] in Surgery.

Tacey Ann Rosolowski, PhD:

I’m sorry, his last name is Suit?

Robert Benjamin, MD:

Suit, S-u-i-t.

Tacey Ann Rosolowski, PhD:

Okay. Thank you. So your research in the limb-salvage area was pretty much it’s worked with the chemotherapy dimension and then collaborating with surgeons to kind of see how that would support their decisions on exactly what to amputate.

Robert Benjamin, MD:

Correct. Yeah. And to amputate less and less.

Tacey Ann Rosolowski, PhD:

Yeah. (laughs)

Robert Benjamin, MD:

Surgeons don’t like to do amputations.

Tacey Ann Rosolowski, PhD:

Yeah, I can’t imagine.

Robert Benjamin, MD:

They pretty much prefer to be able to get away with limb salvage if they can. So it’s an easy decision to make.

Conditions Governing Access

Open

Chapter 23: Limb Salvage; an Informal Connection with an Italian Institute

Share

COinS