Musculoskeletal Oncology: Finding Its Place in the Sun!

The Congressman from California, Jeff Denham, while speaking on principles of immigration reforms said “I expect if you are going to come out of the shadows, then you’re going to want to have some type of hope in the future that you’re going to improve your life and yes, accomplish that American Dream.” This can easily be rephrased vis-a-vis musculoskeletal oncology to read as “I expect if you are going to come out of the shadows, then you’re going to want to have some type of hope in the future that you’re going to improve lives and yes, accomplish that dream.”

When I started practising musculoskeletal oncology almost two decades ago, it was a speciality that was largely in the shadows, especially in India, with limited awareness and very few practitioners. Today, it is starting to find its place in the sun, being recognized as a distinct orthopedic subspecialty with a society of its own (Indian MusculoSkeletal Oncology Society - IMSOS) and an oncology session in almost every regional and state conference.

This symposium volume bears testimony to the fact that today we have many more orthopedic surgeons practising the science and art of musculoskeletal oncology. We had more submissions than we could accommodate in this volume giving credence to the belief that, “Yes, we have come out of the shadows, there is hope in the future, we are improving lives and accomplishing that dream.”

In this volume, we have articles from various centers across India and the globe that cover a wide range of topics in musculoskeletal oncology–benign and malignant bone tumors, pelvic tumors, soft-tissue sarcomas, metastatic bone disease, newer tools such as navigation-assisted tumor surgery, surveillance strategies in sarcomas and the issues that confront long term pediatric sarcoma survivors.

This symposium includes articles that focus on reconstruction and function after surgery in specific anatomic areas such as the fibula, distal end of the radius, and the head of the femur. An interesting study by Sabrina et al.1 examines the significance of RANKL expression as a prognostic marker in predicting the risk of local recurrence in giant cell tumors while Kundu et al.2 explores the role of Zoledronic acid as an adjuvant in the management of giant cell tumor and its potential in reducing the risk of local recurrence.

Singh and colleagues34 demonstrate the effectiveness of distal femoral canal decompression in reducing the risk of cardiopulmonary events in patients with metastatic bone disease of the proximal femur when using long stem cemented hip replacement and use gait analysis techniques to objectively conclude that limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcomes.

The group from Tata Memorial Hospital sheds light on the role of postoperative radiotherapy on outcomes after adequate resection in Ewing's sarcoma of the pelvis5 while Sukumaran et al.6 share their experience in managing pediatric osteosarcoma patients from a center in south India.

“Whether less intensive surveillance protocols would affect sarcoma patient survival” was recently identified as the highest-ranking research priority in the field of orthopedic oncology by an international expert panel.7 The article by George et al.8 investigates the effectiveness of their followup imaging protocol to determine if earlier detection may have been possible had more intensive imaging been undertaken and its potential effect on outcomes.

The article by Weiss and Zimel9 focuses on the long term issues of pediatric sarcoma survivors and the effects of the therapy they received. What gives this article a unique perspective is that it is penned by two musculoskeletal oncologists who themselves are sarcoma survivors.

Review articles on soft-tissue sarcoma management and the applications of navigation surgery in musculoskeletal oncology will help the readers update their knowledge on the current practices prevalent in these areas.10

No man (or woman) is an island; effective musculoskeletal oncology cannot be practised by a surgeon in isolation. The need for multidisciplinary care and inputs from allied colleagues forms the cornerstone of providing the best possible results in this challenging speciality.11 Cancer care is the new buzz word in the field of medicine and we are seeing a transformational change as to how cancer is perceived and treated. The promise offered by progress made in unraveling the genetic predisposition of certain sarcomas, newer diagnostic modalities, and path-breaking novel treatment regimens offers renewed hope in what was earlier considered a relatively unattractive and not so gratifying career option.12 An effort to increase the access to affordable quality cancer care is evident with the government taking the initiative to set up oncology centers across the country.1314 Private philanthropic organizations are also contributing to this initiative.14 Sustaining this endeavor will necessitate many more appropriately trained oncologists with the potential for rewarding and gratifying career opportunities. This will need to be coupled with creating increased awareness about this field beginning with the undergraduate teaching curriculum to sustained attempts at reinforcing these principles among practicing colleagues.

Although musculoskeletal oncology is starting to enjoy its moment in the sun, to echo Robert Frost “we have promises to keep, and miles to go before we sleep”. This symposium volume will help in highlighting the strides that have been made in the last few decades and create awareness of the potential that exists in this subspeciality.