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aforementioned procedures except for rotationplasty will require further surgeries as the child grows� Rotationplasties, first performed by Borggreve and then polarized by Van Ness, are an excellent option for children and young adults with bone tumors� Originally proposed for children age 8-10, the procedure is now performed in children and young adults� A rotationplasty can be thought of as a variation of an amputation� During surgery, in the area of the tumor and the knee, only the major artery, vein and nerve heading to the foot are saved� All other soft tissue and bone are resected, hence an effective amputation� After resection, the lower extremity is rotated counter clockwise and the femur and tibia are secured together� In pre-operative planning, the physician will take into account the age of the child and their growth potential� The surgeon will incorporate this into the surgery, and as the child grows and the unaffected limb 32 MD Anderson Cancer Center grows, the knee centers equalize. At skeletal maturity, when the child stops growing, the knee centers will be equal. This offers a great option for patients who wish to return to high impact activities. Patients with rotationplasties are free to pursue all activities that they wish Patients rejoice in the fact that they have no restrictions on their activities. More and more children and young adults are requesting the procedure. Tumors of the pelvic bone are some of the most challenging to treat. Hemipelvectomy, which involves surgically removing part of the pelvis, with or without removal of the corresponding leg, is among the department’s specialties. The extent of this surgery varies depending on the location and size of the tumor. Lewis established a multidisciplinary pelvic sarcoma team to provide unparalleled care to patients with these challenging tumors. The team is composed of physicians and providers who work with the patients from diagnosis to the operating room through recovery. While surgeons focus on removing the tumor and saving as much of the normal tissue as possible, the job doesn’t end in the operating room. “We have developed an outcomes program to not only help sarcoma patients return to normal activities, but to help them appropriately set expectations and gauge their progress,” Lewis says. After a tumor is removed, several reconstructive options are available. “Our program also helps patients decide on the best reconstructive option for them and their lifestyle,” Lewis says. Through prospective studies the pelvic team has rigorously evaluated the various pelvic reconstructive options and their associated functional outcomes. Patients, with the help of visual analytics, can now choose the functional outcome that best suits their expectations and lifestyle. The patients are also able to see their progress in recovery compared to others with similar disease and treatment. This dedicated multidisciplinary team has improved both the functional and oncologic outcomes of patients with pelvic sarcomas. Illuminating molecular pathways through research The Orthopaedic Oncology department includes a robust research program that spans basic science to clinical and translational research. Its basic science research program focuses on mouse models, targeted therapy and molecular mechanisms for the spread of bone cancer. Lewis’ research interest is in the treatment of osteosarcomas. Lewis’ laboratory is focused on illuminating the molecular pathways that osteosarcoma cells use to grow and spread. By investigating the molecular pathways, Lewis is working to develop site-specific therapy for osteosarcoma that is directed to the tumor while sparing normal organs. Discovery of functional ligand-receptor systems is the critical first step. The search for answers has led her to study histone methyltransferases. These molecules modify the structural proteins that bind to DNA and give chromosomes their coiled shape inside the cell. But when they malfunction, histone methyltransferases can turn off the activity of protective genes that suppress tumor formation. She recently focused on a specific type of histone methyltransferase called EZH2. Earlier research has implicated EZH2 in several types of cancer, and Lewis showed that the molecule also plays a critical role in the development of metastatic disease. With philanthropic support, her laboratory is ready to take the next step and begin research to evaluate whether inhibiting EZH2 activity in osteosarcoma cells can prevent the development of metastatic disease. Robert Satcher, M.D., Ph.D., associate professor of Orthopaedic Oncology, is studying how cancer progresses by spreading to the skeleton, with an emphasis on understanding destructive (osteolytic) bone metastasis formation. Bone metastasis in most cancers can cause pathologic fractures, and herald a poorer patient prognosis. Current treatment options are limited, and palliative surgery or radiation is often needed. Satcher hopes to identify the important steps in bone disease development, and in doing so, develop new treatment strategies for preventing or reversing this lethal process. Specifically, Satcher has developed a 3D co-culture model that mimics the bone environment. The model captures key cell-cell and cell-matrix interactions that promote tumor cell invasion and growth for the purpose of bone
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