Pediatric Sarcoma Program
Our Expertise
The Children's Hospital at Montefiore (CHAM) has assembled an expert team of specialists devoted to the medical and surgical treatment of all types of childhood sarcomas.
Sarcomas are cancers that can arise anywhere there is bone, muscle, or connective tissue. They account for about 10-15% of all newly diagnosed cancers in children under the age of 20 in the United States. Although rhabdomyosarcoma (a tumor arising from muscle), Ewing sarcoma (a tumor that typically arises from the bone), and osteosarcoma (a tumor that arises from bone) are the most common sarcomas diagnosed in children and young adults, other rarer forms of sarcomas can also be seen. Patients with certain genetic disorders such as Li-Fraumeni syndrome can be predisposed to developing these types of cancers. However, in most of our patients, there are no predisposing factors.
For every child who comes to CHAM for the diagnosis and/or treatment of a sarcoma, a multidisciplinary team including pediatric oncologists, surgical oncologists, radiation oncologists, diagnostic radiologists, pathologists, psychiatrists/psychologists, physical therapists/occupational therapists, child life specialists and other cancer specialists, will be involved in your child’s care. Appropriate imaging tests (plain X-rays, CT scans, MRI scans, bone scans, PET scans) are performed to determine the extent of disease involvement. In addition, a piece of the tumor is removed by our surgeons to be examined by CHAM pathologists who specialize in the diagnosis of sarcomas. Within days, the diagnosis of sarcoma (include type and the extent of disease involvement) is confirmed, and treatment is begun rapidly.
How CHAM treats sarcomas
To cure sarcomas in children, treatment is individualized and targeted based on the type of cancer diagnosed. In the broadest sense, treatment for these types of cancers involves systemic therapy, and local therapy. Systemic therapy refers to the use of medications that not only shrink the tumor but also prevent new tumors from forming. These medications are called generally called chemotherapy. Treatment for sarcomas typically employs more than one chemotherapy medication. Newer medications such as immunotherapy are beginning to be used in children with sarcomas.
“Local” therapy focuses on removing all detectable areas of tumor involvement. Depending on the type of sarcoma treated, this can mean surgery, radiation therapy, or a combination of the two. Our surgeons at CHAM are leading experts in surgical techniques that not only completely remove the tumors but also preserve the optimal function of the affected limb. For tumors that can be treated using radiation, our experts formulate a radiation treatment program designed to specifically target tumors so efficiently that it leaves healthy tissue unharmed while eradicating the cancer.
Types of Childhood Sarcomas
Osteosarcoma
Osteosarcoma is a tumor that arises from bone. Although any of the body’s 206 bones can be affected, most cases of osteosarcoma occur around the bones of the knee. Approximately 400 new cases are diagnosed in the United States annually. Pain and swelling are the most common presenting complaints for patients with osteosarcoma. When osteosarcoma is suspected, patients will undergo initial testing with plain X-rays, CT scans, and MRIs. Since osteosarcoma can spread widely, radiologic imaging studies with CT scans of the chest and bone scans or PET scans are done as part of the initial work-up to evaluate whether the tumor has spread to other parts of the body. In addition, a piece of the tumor is removed by our surgeons to be examined by CHAM pathologists who specialize in the diagnosis of bone tumors. After the diagnosis of osteosarcoma has been confirmed, patients will be treated with chemotherapy to shrink the tumor and to prevent new tumors from forming, as well as surgery to remove all areas of tumor involvement. Standard chemotherapy in osteosarcoma includes cisplatin, doxorubicin, and high-dose methotrexate. In our experience, most children with osteosarcoma can be cured with chemotherapy and surgery. However for the minority of patients whose tumors recur or whose tumors have spread to other areas of the body, other treatment strategies must be employed. Treatment for patients with relapsed or metastatic disease is individualized. Treatment options include surgery, radiation therapy, and chemotherapy agents that have not been used previously. Based on laboratory studies conducted here at CHAM, we offer a series of innovative, disease-specific clinical trials for this group of high-risk patients.
Ewing sarcoma
Ewing sarcoma is a tumor that involves the bone as well as the soft tissue; it tends to appear in the middle of bones – most often in the hip, ribs, upper arm, and thigh. Annually, approximately 300-400 new cases are diagnosed in the United States. Pain and swelling are the most common presenting complaints for patients with Ewing sarcoma. When a child is suspected to have Ewing sarcoma, the diagnosis is confirmed using plain X-rays, CT scans, and MRIs. Since Ewing sarcoma can spread widely, examination of the bone marrow and radiologic imaging studies with CT scans of the chest and bone scans or PET scan are done as part of the initial work-up to evaluate whether the tumor has spread to other parts of the body. In addition, a piece of the tumor is removed by our surgeons to be examined by CHAM pathologists who specialize in the diagnosis of sarcomas. After the diagnosis of Ewing sarcoma has been confirmed, patients will be treated with chemotherapy to shrink the tumor and to prevent new tumors from forming, as well as surgery to remove all areas of tumor involvement. Depending on the site of tumor involvement, radiation therapy may also be used to treat Ewing sarcoma. Standard chemotherapy in Ewing sarcoma includes vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide. Treatment for patients with relapsed disease is individualized based on the therapy previously received. In the context of clinical trials, new agents with activity in Ewing sarcoma are employed in the relapse setting. Additional surgery and/or radiation are also possible approaches. Based on laboratory studies conducted here at CHAM, we offer a series of innovative, disease-specific clinical trials for this group of high-risk patients.
Rhabdomyosarcoma
Rhabdomyosarcoma are tumors that involve the muscles of the body. Any muscle in the body may be involved. Pain and swelling are the most common presenting complaints for patients with rhabdomyosarcoma. When a child is suspected to have rhabdomyosarcoma, the diagnosis is confirmed using CT scans, and MRIs. Since rhabdomyosarcoma can spread widely, examination of the bone marrow and radiologic imaging studies with CT scans of the chest, MRIs, PET scans, and bone scans are done as part of the initial work-up to evaluate whether the tumor has spread to other parts of the body. In addition, a piece of the tumor is removed by our surgeons to be examined by our pathologists who specialize in the diagnosis of sarcomas. These studies allow us to categorize patients with rhabdomyosarcoma into different “risk-groups” (low, intermediate, or high) based on the extent of tumor involvement. These “risk-groups” also allow us to tailor therapy based on the risk groups assigned. Treatment then consists of chemotherapy to shrink the tumor and to prevent new tumors from forming, as well as surgery to remove all areas of tumor involvement. Depending on the site of tumor involvement, radiation therapy can also be used as a way to shrink the tumor. Depending on risk-group assigned, patients will receive different therapies. In general, patients in the low-risk group will require less therapy than patients in the high-risk group in order to be cured of their sarcoma. For the minority of patients whose tumors recur or whose tumors have spread to other areas of the body, CHAM offers several innovative treatment strategies including novel combinations of chemotherapy agents, radiation therapy, and surgery. Based on laboratory studies conducted here at CHAM, we offer a series of disease-specific clinical trials for this group of high-risk patients.
Other types of childhood sarcomas
In general, the other types of sarcomas are extremely rare in children, and young adults. These include:
- alveolar soft part sarcoma (in sac-like cavities such as those in the lungs)
- fibrosarcoma and dermatofibroma (in fibrous tissues)
- infantile hemangiopericytoma (in connective tissue surrounding capillaries)
- leiomyosarcoma (in smooth muscles)
- liposarcoma (in cells that develop into fat tissue)
- synovial sarcoma (in fluid and tissues of the joint cavities, bursae, and tendons)
Treatment of these soft tissue sarcomas are individualized and can include a combination of systemic chemotherapy, surgery, and radiation therapy.
Innovative and Individualized Cancer Care
More than 80% of pediatric cancers can now be cured with chemotherapy, surgery and radiation. A major reason for this success is enrollment of patients onto clinical trials. Clinical trials in pediatric cancers are rationally designed to deliver the most effective therapy known in addition to testing new combinations or medications that can lead to an even better cure rate. Such innovation is vital not only to the sustained success of treating children with cancer but is also a major focus here at CHAM. A list of our clinical trials is found here[a1] .
Physicians on CHAM’s Pediatric Sarcoma Team continue to lead many of the national clinical trials to improve treatment and most importantly cure of these diseases across the country. Our pediatric sarcoma team members have led national cooperative group's laboratory research efforts and have identified crucial biologic insights into childhood sarcomas. Our physicians are also actively involved in developing new therapeutic strategies for childhood sarcomas both here at CHAM as well as in national cooperative groups.
Our researchers continue to develop new treatments and surgical techniques. The new therapies being developed for pediatric sarcomas focus on delivering effective tumor killing agents while reducing the side-effects associated with therapy, and tailoring cancer therapy specific to the patient’s metabolism and extent of the patient’s disease.
To contact our team
Patients can secure an appointment within 24 hours. For more information about The Pediatric Sarcoma Team at the CHAM, or to refer a patient, please call 718-741-2342.