Treatment
Treatment Team
Paul Kent, MD, Pediatric Hematology/Oncology
Steven Gitelis, MD, Orthopaedic/Oncology/Joint Reconstruction
Rush University Medical Center
Chicago, IL
Some Sarcoma Basics
Oncologists consider Casey as an adolescent or young adult (AYA). This group of cancer patients is stuck between pediatrics and adult care and require a specialized treatment protocol. The AYA group has not seen an increase in cancer survival rates since 1975. Those patients considered adults—not AYAs—have a worse prognosis.
Pediatric survival rates for soft tissue sarcomas are as much as 40% greater than survival rates for adults with the same disease, and better than for the AYA group. For this reason, Casey has sought the care of Dr. Paul Kent, a pediatrics oncologist at Rush University Medical Center and the founder of the Rush Sarcoma Conference. Every 2 weeks, specialists from Rush and surrounding hospitals get together to review sarcoma cancer cases. Because sarcomas make up less than 1% of all cancers, it is crucial that diagnosis and treatment happens at a sarcoma cancer center. Specialists at Rush see more sarcoma cases in a month than most oncologists will see in their entire careers.
Casey’s Treatment Plan
1. Shrink the primary tumor to make the surgery more practical, reduce the chance of recurrences and protect the body from spreading or kill the disease that has already spread to other parts of the body. This is pre-adjuvant chemotherapy (before surgery).
2. Use wide excision (surgery) to remove the primary tumor once the tumor is as small as possible. This saves more bone and tissue.
3. Post-surgical chemotherapy is critical to kill any additional disease in the body. Soft-tissue cancers like the kind Casey has tend to recur. A several months-long chemo regime after surgery (if chemo is effective against the tumor) provides the best chance to a cancer-free life later.
Radiation is also being considered as another treatment option. The location of the primary tumor makes it an excellent candidate for radiation treatment.
Chemotherapy
Gemcitabine - chemotherapy drug; cost is $4,000 per round
Taxotere - chemotherapy drug; cost is $5,000 per round
Avastin - chemotherapy drug; cost is $8,000 per round
A full round of chemo for Casey is 3 weeks of chemotherapy. The Children’s Oncology Group (COG) clinical trial for more common sarcomas like osteosarcoma (the most common type of bone cancer), prescribes 4 rounds of pre-adjuvant (before surgery) chemotherapy, and around 10-15 rounds of chemo are given after surgery. With a soft tissue sarcoma like leiomyosarcoma, the chemotherapy may extend far beyond what is typical for osteosarcoma—if the cancer responds to chemo.