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Sarcomas are a special type of malignant tumors, of exceptional frequency, being diagnosed between four and five cases per 100,000 inhabitants per year. It can be said that the incidence of soft tissue sarcomas is 4-5 cases new for every 100,000 inhabitants per year, and that of the bone 3-4 times lower.
It affects both bones and soft tissues, including muscles, nerves, tendons, vessels, skin, throughout the musculoskeletal system, from head to toe. They usually manifest as a lump or mass, initially painless, that grows progressively until it causes constant pain. Its wide diversity in terms of its presentation implies that each case must be addressed individually and necessarily through a specialized multidisciplinary approach.
In this regard, the Hospital Ruber Internacional has strengthened its Sarcoma Unit made up of different specialties, both surgical and radiation oncology, medical oncology, pathological anatomy, radiodiagnosis or interventional radiology, and is equipped with the latest technologies for both the diagnosis and treatment of this neoplasm. Its doctors have extensive experience in this pathology and have more than 15 years of practice in sarcomas.
according to the doctor Javier RomanIOB Medical Director Institute of Oncology Madrid Hospital Ruber Internacional, at the present time it is not reasonable to treat these tumors outside a Sarcoma Unit made up of highly specialized professionals closely coordinated to obtain the best results. “This is the contribution we make to national and international patients who trust our unit,” he points out.
“We are a unit involved not only in assistance, but also in teaching and research aspects. We actively participate as speakers and professors in various refresher courses and continuous training at a national and international level”, highlights the expert in Oncological Orthopedic SurgeryDr. Eduardo Ortiz, responsible for the resection of the tumor.
According to this specialist, the first objective we focus on is oncology and then on the best functional result, trying to minimize the chances of amputation of the affected limb. “It is diagnosis decisive tumor, the smaller the lump, the easier the intervention, it has also been seen that sizes less than 5 centimeters are a probable factor of better prognosis, although the prognostic assessment is multifactorial, “says Dr. Ortiz.
When the lesions are larger, or involve relevant vascular or nerve structures, the collaboration of other surgical specialists is required. As explained by the doctor paul roosterhead of the Angiology and Vascular Surgery Unit of the International Ruber Hospital, «the sarcoma sometimes it is in intimate contact with the blood vessels and then we must remove the tumor without injuring them or, on occasion, replace the vascular bundle with a by-pass of a vein, artery or both, which performs the function of the vessel that has been removed”. Dr. Gallo points out that the Ruber Internacional Hospital has a hybrid operating room, useful for carrying out tests in the operating room itself on these tumors.
The reconstruction of anatomical structures, avoiding limb amputation, is possible thanks to the role of Plastic, Aesthetic and Reconstructive Surgery Unit. Dr. César Casado, head of the team, affirms that “when removing a tumor of this type, it is not enough to remove the affected tissue, given that the aggressive behavior of the sarcoma requires the removal of healthy surrounding tissue, which serves as anatomical barriers.” ».
The reconstruction of anatomical structures, avoiding limb amputation, is possible thanks to the role of the UDepartment of Plastic, Aesthetic and Reconstructive Surgery. Dr. César Casado, head of the team, affirms that “when removing a tumor of this type, it is not enough to remove the affected tissue, given that the aggressive behavior of the sarcoma requires the removal of healthy surrounding tissue, which serves as anatomical barriers.” ».
In the operating room, these tissues are reconstructed in the same intervention, whether tendons, muscles or even bone, through microvascularized tissue, minimizing sequelae and allowing early recovery. “In addition to his correct reconstructionIt depends on whether patients can undergo radiotherapy in an adequate time”, points out Dr. Casado.
For Dr. María Purificación Domínguez Franjo, head of Pathological Anatomy Department of Hospital Ruber Internacional, the complicity between pathologists and surgeons is essential to know the exact location of the tumor and to be able to assess the surgical margins in the intraoperative biopsy and thus help the surgeon to achieve tumor-free margins. “Furthermore, pathologists interpret histological findings based on clinical data, so it is essential to know the history and whether there has been prior chemotherapy or radiotherapy treatment,” he stresses.
Radiotherapy is another procedure fundamental in treatment of most sarcomas, with the expertise of the radiation oncologist being of particular importance.
It is the case of the doctor Belen Belinchon, one of the most outstanding specialists in Spain in radiotherapy for sarcomas from the team of the Radiotherapy Oncology Unit of Hospital Ruber Internacional. The hospital center has the most advanced techniques for the radiotherapy treatment of sarcomas.
“Depending on its location, radiotherapy with intensity modulated techniques, guided image and movement control, is administered before or after surgery or, in certain cases, exclusively. In those patients in whom the disease recurs and it is necessary to consider re-irradiation or when there is a limited number of metastases, robotic radiosurgery with CyberKnife It allows treating these injuries in a safe, exact and precise way in a few days”, says Dr. Belinchón.
From the point of view of current diagnostic imaging methods, the specialist in Radiodiagnosis at Hospital Ruber Internacional, Dr. Fernando Herraiz del Olmo, affirms that the available techniques such as plain radiography, gammagraphy, ultrasound, computed tomography, magnetic resonance or positron emission tomography, provide us with fundamental data for choosing treatment and subsequent follow-up of patients. “As experts, we try to identify and qualify the lesion for possible further evaluation and/or, in some cases, image-guided tissue sampling and clinical-radiological correlation of pathology,” he stresses.
One of the last patients operated on at Hospital Ruber Internacional was PF, who developed a soft tissue sarcoma in his left tibia. His tumor debuted in 2013, although it did not begin to increase in size until the last two years. “I called, they gave me an appointment and they attended to me right away. Now, after surgery and two weeks in a wheelchair, I have started to walk and I have to receive radiotherapy”, explains the patient. According to the surgeons, “although they are very spectacular surgeries, we try to do them in an agile way, prioritizing healing and minimizing sequelae, obtaining very high satisfaction rates.”
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