In this episode, host Jacob Fleming interviews interventional radiologist Tony Brown and orthopedic oncologist Daniel Lerman about their multidisciplinary IR/orthopedics practice and innovative techniques for pelvic fixation in metastatic cancer patients.

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SHOW NOTES

The guests recount their first case together, a “no option” patient in which they collaborated on a tripod fixation of an acetabulum, using a combination of screw placement and cementoplasty. They realized that they were both invested in improving minimally invasive fixation and helping patients with pain management and daily functioning. Their collaboration blossomed into a joint practice of MSK interventional oncology that offers biomechanics knowledge of orthopedic surgery and the precise image guidance of interventional radiology. With the rise of systemic cancer therapies, more patients are living with metastatic bone disease, and this new treatment paradigm could offer them a true joint reconstruction and stable fixation. Overtime, they have streamlined the technique to make their cases more efficient and precise.

Despite their advances, Dr. Brown notes that MSK interventional oncology still has a long way to go. In the community, pelvic fractures usually go untreated. He speaks about the importance of outreach to radiation oncologists and orthopedic surgeons and letting them know about new methods of pelvic fixation. Dr. Brown encourages IRs who are curious about MSK interventions to get in contact with colleagues who are already doing innovative techniques and device companies that offer classes. Additionally, there is a need for innovation in instrumentation. Most pelvic intervention tools have been adopted from spine tools; however pelvic anatomy and pelvic lesions are vastly different. Dr. Lerman highlights the uniqueness of each patient’s disease, tumor, and bone lysis. He believes that there is a need to elucidate why different patients respond to different types of constructs.

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RESOURCES

Institute for Limb Preservation:

https://www.limbpreservationcolorado.com/

Musculoskeletal Tumor Society (MSTS):

http://msts.org/