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induce tumor cell death. Heimberger is the PI of WP1066’s first-in-human clinical trial, which is Division of Surgery | Surgical Outcomes FY18 29 2015 2018 0 2014 2015 2016 2017 2018 20 40 60 80 100 Case volumes Awake craniotomy procedures BrainSuite procedures Other (1) LITT Biopsy-stereotactic Resection 47 104 5 2017 2018 Primary spine procedures 0 20 40 60 80 100 8171666367 812014 2015 2016 Endoscopic skull base tumors 9794957591 0 10 20 30 40 50 60 52 817166 81 2014 2016 2017 Complex benign and malignant skull base tumors FY14-FY18 924 Pituitary tumors 466 FY14-FY18 Metastatic spine tumors 531 FY14-FY18 Spine LITT procedures 109 FY14-FY18 Total neurosurgery cases : 9,298 Other, including pain and peripheral nerve cases Skull base Spine Brain 929 6,722 1,411 236 currently open to patients with recurrent malignant gliomas or melanoma brain metastases. Ganesh Rao, M.D., professor of Neurosurgery, is the site PI for a Phase I clinical trial of Ad-RTS-hIL-12 and veledimex for recurrent or progressive glioblastoma or grade III malignant glioma. The multicenter study opened to patient enrollment at MD Anderson in 2018. “Our neurosurgeon-led clinical trials demonstrate the department’s commitment to innovative and impactful translational research,” Lang says. “Ultimately, we hope these efforts will help revolutionize patient care for those affected by central nervous system tumors.” FY14-FY18 FY18 30 MD Anderson Cancer Center ORTHOPAEDIC ONCOLOGY F, Carter Smith Valerae Lewis, M.D. Department chair Division of Surgery | Surgical Outcomes FY18 31 For the love of the game By Sarah Zizinia As a former college volleyball player, Jillian Williams wanted a surgery that would help her beat Ewing’s sarcoma and afford her with the best functional outcome. After completing preoperative chemotherapy following her diagnosis in 2016, she met with Orthopaedic Oncology chair Valerae O. Lewis, M.D. to discuss surgical treatment options. Jillian was given the option of an above-theknee amputation, a rotationplasty or limb-salvage surgery. Being able to stay active was important to Jillian, so she chose to have a rotationplasty. During the operation, Lewis removed the tumor located in Jillian’s left tibia along with the knee joint, and then rotated the lower portion of her leg 180 degrees before attaching it to the femur. The rotation of the limb now allowed Jillian’s ankle to act as a knee. This surgery afforded Jillian excellent function, and allowed her to join the US National Sitting Volleyball Team in 2017, which won a silver medal in the 2018 World Championships. “Something that really sticks with me all the time is don’t let the fear of amputation stop you from tying something new. I’m more willing to try new things now that I have one leg instead of two legs,” says Jillian. A longer version of this story originally appeared on MD Anderson’s Cancerwise blog. Overview Most cancers of the bone and soft tissue require extensive surgery by specialized orthopaedic surgeons, who can resect the tumor and then perform reconstruction to give the patient the best possible functional outcome. Orthopaedic Oncology at MD Anderson provides specialized care to adults and children with benign and malignant tumors of the bone and soft tissue. These include, but are not limited to: • Soft tissue sarcomas • Osteosarcoma • Ewing’s sarcoma • Chondrosarcoma • Chordoma • Spine tumors • Metastatic bone disease • Giant cell tumors • Aggressive bone cysts The department also treats general orthopaedic issues as they relate to MD Anderson patients, including: • Pathologic fractures • Avascular necrosis • Degenerative joint disease • Muscle and tendon dysfunction • Compartment syndrome and infections “Our goal is not just to remove the cancer, but to protect and restore the patient’s limb and maximize their function,” says Valerae O. Lewis, M.D., chair of Orthopaedic Oncology, whose team of six surgeons uses the most advanced surgical and reconstructive techniques. Orthopaedic oncology surgeons also use state-of-theart real-time imaging in the operating room. By using tools and equipment that can visualize the patient’s anatomy in real time, they can precisely remove the tumor and spare as much normal anatomy as possible� To complement real-time imaging, the orthopaedic oncologists often employ surgical navigation� The use of this technology has enabled more complex and detailed surgery to be performed� Navigation can be beneficial in complex spinal, pelvic or periarticular resections� While improving the operative experience it has also had the potential to improve clinical outcomes� Treating bone sarcomas in children Bone sarcomas in children present a unique dilemma for the orthopaedic oncologist� Limb-salvage procedures that rely on endoprostheses or allografts are difficult because of the small size of the pediatric skeleton, the growth potential of the patient, the proposed final length of the unaffected limb, the significant ensuing limb-length discrepancy and the need for durable reconstruction� There are several limb salvage options for the pediatric patient with tumors of the long bones�These include: expandable prostheses, distraction osteogenesis, intercalary allografts and intercalary autografts and rotationplasty� All of the
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