Aggressive tumors require aggressive treatment

by: Andrew Ragsdale

For patients with extremely aggressive tumors, the best option for improving outcomes is a multi-modality treatment involving surgery, chemotherapy, radiation and bone marrow transplant, or some combination of the four, according to Steven Hochwald, MD, University of Florida College of Medicine associate professor of surgery and chief of surgical oncology and endocrine surgery.

With Florida ranking second in the nation for the number of cancer cases reported and treated, it is no surprise that UF surgical oncologists at the UF Shands Cancer Center in Gainesville are treating more and more patients with rare and extremely aggressive tumors.

“Patients with unusual tumors, such as soft-tissue sarcomas, need to be referred to sarcoma experts,” Hochwald said. “Since sarcomas are often difficult to treat, it is imperative patients receive treatment at high-volume cancer centers with experience treating these types of tumors and by surgeons who understand the unique nuances between the histiological subtypes of various sarcomas.

“Each histiological subtype responds differently to different treatments, and it is critical to understand whether they are more responsive to chemotherapy, radiotherapy, or both, and whether these treatments should be delivered prior to or after surgery.”

Hochwald and Stephen Grobmyer, MD, UF College of Medicine assistant professor of surgery, recently treated a patient in his early 20s with an aggressive desmoplastic, small, round-cell sarcoma that had metastasized throughout his abdominal cavity. The patient received a vigorous neo-adjuvant treatment regimen with several cycles of chemotherapy, followed by radical surgery to remove the tumor. The patient will go on to receive additional chemotherapy and radiation therapy as well as a possible bone marrow transplant.

“It is this forceful, multi-modality approach that most impacts the survival of patients with aggressive tumors and sarcomas,” Grobmyer said. “In order to successfully manage these types of tumors, an experienced, multidisciplinary team is essential.”

Though few surgeons specialize in sarcomas, UF has a group of surgical oncologists who are trained and have a special interest in the management of soft-tissue sarcomas and other solid tumors. Additionally, Shands at UF is one of Florida’s highest-volume medical centers for cancer services , and is the state’s leading tertiary referral center.

Physician education is a priority for the UF surgical oncology group. UF hosts numerous educational events on sarcomas throughout the state to educate primary care providers on recognizing and initiating evaluation of lumps that may be soft tissue sarcomas.

The UF teams also focuses on research to develop new treatments. Hochwald currently is investigating new, targeted drugs that he hopes will obviate the need for surgery on patients with sarcomas.

The UF Shands Cancer Center is a regional resource research and clinical trials, and is a participant in the Sarcoma Allied Research Consortium.

“Our research, training and expertise rivals that of excellent academic institutions across the nation. With the opening of the new UF Cancer and Genetics Research Complex and the Shands at UF Cancer Hospital that is under construction, Shands at UF is well positioned to make advances in the treatment of these types of tumors and to handle the increased volume of patients with sarcomas,” Hochwald said.

For more information about the surgical oncology program at Shands at UF, call 352-392-0169.

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