The Multidisciplinary Team
The primary goal of the Musculoskeletal Tumor Center at Cincinnati Children's Hospital Medical Center is to provide state-of-the-art multidisciplinary care for every patient, which can only be achieved through the team approach.
Our orthopaedic oncology specialists evaluate many different types of disorders, including:
- Benign tumors
- Malignant tumors
- Bone tumors
- Soft tissue tumors
- Metastatic lesions
We manage orthopaedic problems in oncologic patients who may require specialized, multidisciplinary care in a comprehensive cancer center. Such problems include:
- Fractures
- Avascular necrosis
- Osteoporosis
- Infections
One of the main objectives of the orthopaedic oncology team is to provide state-of-the-art treatment for primary, malignant tumors. Osteosarcoma, Ewing's sarcoma, rhabdomyosarcomas, chordoma and soft tissue sarcomas are some of the diseases that we treat most often. The goal is to maximize the function of each patient with advanced surgical and reconstructive techniques.
Limb-Sparing Surgery
Orthopaedic surgeons are able to save the affected limb in most bone cancer surgeries and have utilized replacements that are more durable and functional. The goal of limb-sparing surgery is the safe and complete removal of the tumor with preservation of limb function. The use of a metal endoprosthesis or allografts to reconstruct bone and joint after the removal of a tumor affords the surgeon
and patient the best combination of operative flexibility and durability.
Prosthetic Replacement Techniques
Pediatric bone tumors present a specific challenge when the growth plate cannot be spared. In these cases, the orthopaedic surgeons have successfully utilized the most advanced and expandable prosthesis that is made to grow with the child in a non-invasive way. This represents remarkable progress in the management of these patients whom in the past have needed multiple surgeries.
The Cancer Center at Cincinnati Children's is nationally recognized for leading-edge pediatric cancer care and research. Within the Division of Hematology / Oncology, 17 faculty participate in clinical care and / or research and approximately 250 other health care and other professionals support the program.
Oncologists work closely with the Musculoskeletal Tumor Center's orthopaedic surgeons to develop a total treatment plan. They also meet weekly with the entire multidisciplinary team to discuss the coordinated clinical care of each patient.
The center's oncologists are advancing knowledge and care through research — a vital aspect of the center. Only through innovative, interconnected laboratory and clinical research will advancements be realized so that future patients do even better.
Radiation Oncology
For many types of musculoskeletal cancers, radiation is a critical aspect of treatment regimens.
The Division of Radiation Oncology is an integral part of the Musculoskeletal Tumor Center. In partnership with the University of Cincinnati Radiation Oncology Department, a full range of radiotherapy technologies are available, including facilities for:
- 3D conformal radiotherapy
- Intensity modulated radiotherapy (IMRT)
- Extracranial stereotactic radiosurgery
- Brachytherapy
The radiation oncologists use these state-of-the-art technologies to facilitate effective treatment of tumors while minimizing risks and side effects of the therapy.
Clinicians in the Division of Radiation Oncology include internationally recognized experts in the treatment of musculoskeletal tumors. Division members also have extensive experience in the design, conduct and analysis of clinical trials for these tumors. This allows them to incorporate the latest advances into treatment programs.
Pediatric radiologists are critical members of the care team. Our radiologists specialize in musculoskeletal imaging and have some of the most extensive experience nationwide in the diagnosis and follow-up imaging of children.
The Department of Radiology at Cincinnati Children's evaluates and treats children with tumors of the musculoskeletal system using state-of-the-art equipment such as:
- Conventional radiography
- Multidetector computer tomography (CT)
- High-field magnetic resonance imaging (MRI) using both 1.5 and 3 Tesla systems
- Nuclear scintigraphy
- Single photon tomography (SPECT)
- Positron emission tomography (PET) with CT
- Ultrasonography
Interventional radiologists specialty trained for musculoskeletal procedures in children are also integral members of the team. They offer diagnostic percutaneous tissue sampling using cutting-edge imaging technology. The modalities available to guide biopsies and other therapeutic interventions include a pediatric hospital first-in-the-nation, three-dimensional fluoroscopic unit, ultrasonography, multidetector CT and intraoperative MRI.
Correct diagnosis of musculoskeletal tumors in children requires a high degree of specialized expertise.
The Division of Pathology and Laboratory Medicine at Cincinnati Children's examines more than 11,000 surgical specimens and performs more than 1 million laboratory tests each year. The staff of board-certified pediatric pathologists has extensive experience examining tumor tissue samples — including tumor aspirates, biopsies and resections — and diagnosing these tumors in children. In addition to diagnosing tumors, Cincinnati Children's pathologists:
- Provide critical information about prognosis and appropriate treatment for some tumors through close collaboration with other team members
- Perform ancillary studies of pediatric tumor samples when necessary to ensure correct diagnosis, and / or to provide information about prognosis
- Provide state-of-the-art support, including immunohistochemistry, in situ hybridization, electron microscopy and RT-PCR
- Routinely analyze tumor samples of patients cytogenetically, which may provide diagnostic information
- Perform tests that are critical to monitor the effect of therapy such as chemotherapy, radiation therapy and bone marrow transplant
The Division of Pediatric Rehabilitation at Cincinnati Children's includes five physicians trained in both pediatrics and physical medicine and rehabilitation.
A pediatric physiatrist, a specialist in evaluating and treating deficits with mobility or fine motor skills, participates in our outpatient clinics and multidisciplinary conferences and also is involved with patients who are admitted to the hospital for surgical care and recovery. The physiatrist will assist in assessment and referral for physical and occupational therapies as well as evaluate the need for any assistive devices or equipment that may enhance the patient's level of independence. Involvement with the physiatrist throughout the course of treatment will help identify any concerns that the patient or parents may have regarding physical impairments or disabilities.
