Brigham Offers High-Volume, Comprehensive Care for Rare Sarcomas

Chan Raut, MD in operating room

With about 12,000 to 13,000 cases diagnosed in the United States each year, sarcomas are among medicine’s rarest cancers. Since many oncologists may only see one or two cases during their career, patients often struggle to find experienced providers.

Sarcomas are also complex. There are more than 50 subtypes, they can occur anywhere in the body, and they exhibit vastly different behaviors.

“Sarcoma is not a single disease,” says Chandrajit P. Raut, MD, MS, chief of Surgical Oncology at Brigham and Women’s Hospital and Surgery director in the Center for Sarcoma and Bone Oncology at Dana-Farber Brigham Cancer Center. “The variability among sarcomas is striking.”

Managing Complex Sarcoma Cases a Team Effort

The high-volume Center for Sarcoma and Bone Oncology treats approximately 1,000 new patients every year. Its expanding group has three surgical oncologists, nine medical oncologists, two radiation oncologists, and two orthopedic oncologists dedicated exclusively to providing sarcoma care and working together to manage complex cases in a coordinated manner.

“Our surgical oncologists are supported on the frontline by a highly experienced team of anesthesiologists, plastic/reconstructive surgeons and other subspecialty surgeons, and OR and floor nurses who see and care for sarcoma patients every day,” Dr. Raut says. “Behind the scenes, we have a dedicated team of world-renowned sarcoma pathologists who are setting standards for sarcoma type identification and helping to define the field.”

Correctly diagnosing a patient’s sarcoma is crucial to proper treatment, and Dana-Farber Brigham’s sarcoma pathologists are integral to the Center for Sarcoma and Bone Oncology. They work in tandem with the surgical, medical, and radiation oncology teams daily to optimize care. They also are tasked with reviewing tissue samples obtained from biopsies or operations conducted at other hospitals. In about 25 percent of those assessments, the pathology team’s deep understanding of sarcoma types and their ability to identify subtle differences among them leads to patients receiving a different diagnosis. This, in turn, affects recommended chemotherapy, radiation, and surgery strategies.

Robust Tumor Bank Is a Foundation for Sarcoma Research

Because Dana-Farber Brigham sees a high volume of sarcoma patients every year, it has developed a large and robust sarcoma tumor bank. As a result, Dana-Farber Brigham physician-scientists are able to lead numerous clinical trials and other research projects focused on identifying and developing cutting-edge treatment strategies for individual sarcomas. In many trials, Dana-Farber Brigham collaborates with leading institutions worldwide, giving its researchers access to an even broader range of sarcoma tissue samples and sarcoma expertise.

The Dana-Farber Brigham sarcoma team was instrumental in a recent multinational phase 3 study to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma. The study was the first large, international, randomized trial in primary, localized retroperitoneal sarcoma to be successfully completed. With 43 months of follow-up, the trial was negative, showing similar abdominal recurrence-free survival in patients receiving surgery alone and in those receiving preoperative radiotherapy plus surgery. Similar overall survival was also observed in the two groups.

“We knew going into the study that radiation therapy reduces the risk of local recurrence in extremity soft tissue sarcomas, but we didn’t have evidence of efficacy for retroperitoneal sarcoma and therefore would have to extrapolate to justify its use,” Dr. Raut says. “We now suspect that due in part to the need to adjust and reduce doses of radiation around delicate abdominal organs, radiation it is not as effective as it is in extremity sarcomas, except perhaps in a small subset of patients.”

Active in Early-Phase Research as Well

In addition to leading clinical trials, Dr. Raut has a full slate of early-stage laboratory research focused on novel therapies to reduce the risk of local sarcoma recurrence.

In one proof-of-principle study, he and his colleagues synthesized and optimized a novel electrospun poly(caprolactone) surgical mesh coated with layers of a hydrophobic polymer to deliver the chemotherapy drug doxorubicin directly to the operative bed following sarcoma resection. The study demonstrated the approach to be therapeutically feasible in preventing postsurgical tumor recurrence and minimizing cardiotoxicity.

In another study, Dr. Raut and research colleagues studied intraoperative implantation of paclitaxel (PTX)-eluting polymer films to deliver sustained, supratherapeutic PTX concentrations. The latter were found to markedly decrease sarcoma lethality in vivo, making the approach an alternative paradigm for recurrence prevention.

“Oncologic outcomes can be inferior for patients with locally recurrent disease, even after macroscopically complete surgical resection,” Dr. Raut says. “New and emerging treatment modalities like those we are developing may someday improve these outcomes.”


Gastroenterology Fellowship Leaders Perceive Multiple Benefits of GI Hospitalists

Doctor standing next to patient recovering in bed at hospital, inpatient

Clinicians in the Department of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital and colleagues explored the prevalence and perceptions of the GI hospitalist model in academic GI departments across the United States. They report GI hospitalists are relatively common and geographically diverse.


Systematic Review: Effectiveness of Remote Exercise Programs for Pain Reduction in Knee Osteoarthritis

Woman stretching on yoga mat at home in front of laptop, remote exercise concept

In-person exercise programs are well-established to effectively reduce pain in patients with knee osteoarthritis (OA). Elena Losina, PhD, and colleagues recently explored whether the same is true of remote exercise programs.


The Brigham Presents Updates in Hypertension Among Older Adults at Medical Grand Rounds Panel

Doctor monitoring blood pressure of older male patient, hypertension concept

In this Medical Grand Rounds presentation, Naomi D.L. Fisher, MD, of Brigham and Women’s Hospital, joined a panel of colleagues from the Boston area to discuss recent developments in the diagnosis and treatment of hypertension among older adults.


Remotely Delivered Hypertension and Lipid Program Effective at Scale for Diverse Populations

Telehealth concept, patient taking own blood pressure at home while on laptop video call with doctor

Mass General Brigham researchers have demonstrated an algorithm-based cardiovascular risk management program delivered remotely is scalable at a population level and can meet the needs of diverse patient populations.


Transcriptional Profile Overlaps in PPI-Responsive and -Nonresponsive Eosinophilic Esophagitis

Esophagram or Barium swallow front view showing esophagus for diagnosis

Researchers at Brigham and Women’s Hospital hypothesized that differences in mucosal gene transcript expression might explain the differences in PPI treatment response. Instead, they found the transcriptional profiles in patients with PPI-responsive and -nonresponsive eosinophilic esophagitis are remarkably similar.


Making Progress in Creating a New Standard of Care for Essential Tremor

Woman sitting on bed holding glass with shaking hand, suffering from essential tremor

Propranolol, the current standard of care for essential tremor (ET), has significant shortcomings in efficacy and safety. As medicinal chemist Kevin Hodgetts, PhD, explains, Brigham investigators are developing novel therapies for ET patients by applying innovative drug design concepts to validated disease targets.


Patient-reported HF Symptoms Not Associated With Objective Markers of Pulmonary Congestion

Older female patient filling out questionnaire on clipboard, seated across from doctor

Researchers wondered whether the Kansas City Cardiomyopathy Questionnaire (KCCQ), a health status questionnaire for patients with heart failure, could be useful to monitor worsening pulmonary congestion remotely. They found no significant associations between KCCQ total symptom score and objective congestion markers


Mineralocorticoid Receptor Antagonists Have No Meaningful Role in Treating Primary Hyperparathyroidism

Aldosterone scientific molecular model, 3D rendering

Colleagues from the Brigham’s Center for Adrenal Disorders assessed the efficacy of aldosterone antagonism with a mineralocorticoid receptor (MR) antagonist versus placebo in patients with primary hyperparathyroidism (P-HPT). They provide evidence that MR antagonists have no meaningful role in P‐HPT treatment.


MKRN3 Gene Linked to Delayed Puberty

3D rendering of colorful DNA sequences in and out of frame, gene concept

Based on findings from a novel mouse model, researchers at Brigham and Women’s Hospital led by Ursula B. Kaiser, MD, suggest that genetic variants resulting in increased MKRN3 expression may be a previously unrecognized cause of delayed puberty.