Taking the Tumor, Not the Leg

ot long ago, a leg amputation would have been the only cure for a large malignant tumor like the one doctors found in the thigh of 63-year-old Keith Moore of Martinsburg, W. Va. So circuitous was the cancer, it had infiltrated the muscles and tendons. Attempting to remove only the malignancy would have risked cutting into the tumor, increasing the chance that the cancer would spread to other organs.

Today, adept surgeons have learned not only how to cut out such malignancies but also how to take precautions to kill any cancer cells left behind. Orthopedic surgeon Frank Frassica, a specialist in the removal of these soft-tissue sarcomas, says the key is knowing how to meticulously dissect away from major arteries and nerves to create a sufficient margin around the tumor bed.

“When a tumor is near a nerve, you depend on an MRI to show how close it comes,” explains orthopedic oncology surgeon Steven Lietman, M.D. “We want to know if there’s a plane of normal tissue between the tumor and the nerve. If there is, then we take advantage of it to peel the nerve off the tumor.” (To get even clearer, “real-time” pictures of the tumor and its surroundings, radiologists here are developing an MRI probe that will be able to be placed in the tumor bed during the actual surgery.)

Once the tumor is removed from an arm or leg, plastic surgeon Gene Duene, fills in the cavity with a muscle flap to give contour to the limb and restore blood circulation. In Moore’s case, a piece of muscle from his back was reattached in his thigh and the new blood vessels hooked up. In other patients, the vessel hook-up isn’t necessary since surgeons can often pivot a nearby muscle into the cavity.

Finally, “brachytherapy” tubes are sewn into the wound to provide direct delivery of radiation treatments (after surgery and before the formation of scar tissue) to get rid of any stray cancer cells.

Summing up these new approaches, Frassica says, “The patients’ first fear is the cancer, but closely following is their fear of losing their limb. We haven’t lost a limb yet, and with both arm and leg tumors, there’s been almost no recurrence of the cancer.”

—- GL