Tammy Nickle and Mark Stewart feel fortunate for the outstanding care they receive from Dr. Jay Wunder, Surgeon-in- Chief and Orthopaedic Surgeon with Mount Sinai’s Sarcoma Program at the Christopher Sharp Centre for Surgery & Oncology.
|Drs. Rebecca Gladdy and Jay Wunder
“Dr. Wunder has given me the best care I’ve ever had in my life,” says Nickle, who was diagnosed with Ewing sarcoma in 2007. Dr. Wunder removed the tumour from her leg, fitting her for an implant that spared her limb and allows her to bend her knee to 90 degrees and walk without a limp. “I wouldn’t trust anyone else with my leg.”
Similarly, Mark Stewart, who was diagnosedwith osteosarcoma in the 1990s (the same kind of tumour that afflicted Terry Fox), is impressed with Dr. Wunder’s patient care. “His unbelievable care and friendly nature are unsurpassed. I see Dr. Wunder once a year for a check up. He is always interested in me not only as a patient, but what I’m doing in my life.”
Sarcomas are cancers of the connective tissue, such as that of the bone, cartilage or fat. There are two main types: those that arise from bone and cartilage, of which osteosarcoma, chondrosarcoma and Ewing sarcoma are the most common; and soft-tissue sarcoma, which develops from tissues such as fat, muscles, tendons, blood vessels and nerves. Dr. Wunder specializes in bone and soft-tissue sarcoma in the extremities (arms and legs).
Dr. Wunder, Leadership Sinai Chair in Surgery and Rubinoff/Gross Chair in Orthopaedic Oncology and an Associate Member of the Samuel Lunenfeld Research Institute, and his colleagues have built a world-renowned sarcoma program. The largest of its kind in Canada, with the highest patient volume and most complex cases, the program also performs clinical research that has resulted in significant advances in sarcoma care.
Dr. Wunder’s team has made discoveries that have changed patient care dramatically. Previously, patients with soft-tissue sarcoma received radiation post-surgery. With limb-preserving surgery now at almost 95 per cent, long-term functional outcomes have become more important. Research, numerous studies and a randomized clinical trial conclude that patients do better long term when treated with radiation pre-surgery. This is now the standard of care for soft-tissue sarcomas throughout Ontario, and is gaining acceptance worldwide.
“Clinical practice changes like this one are discovered at Mount Sinai because of our rich source of patient data,” says Dr. Wunder. “Our patients are extremely willing to share their medical information and tumour samples for research. We started a patient database in 1989 and we’ve had almost 100 per cent voluntary participation. Because of our patients, we have an invaluable tool to measure quality of life post-surgery.”
Dr. Wunder and the joint Mount Sinai Hospital-Princess Margaret Hospital sarcoma team are also studying Intensity-Modulated Radiation Therapy (IMRT ), a new three-dimensional radiation approach. Previously, patients with soft-tissue sarcomas in extremities needed radiation, commonly leading to skin-healing complications requiring additional surgeries, prolonged dressing changes that sometimes led to infection, bone fractures, and amputation. Dr. Wunder observed that the IMRT technique results in radiation being given with more precise localization, minimizing the risk of wound complications.
Research That Enhances Treatment
While Dr. Wunder focuses on cancers in the extremities, Dr. Rebecca Gladdy, a Surgical Oncologist and Associate Member of the Lunenfeld, specializes in soft-tissue sarcomas in areas other than the extremities. Dr. Gladdy’s clinical practice and research focuses on softtissue sarcomas in the abdomen. Dr. Gladdy, the team’s newest member, was recruited to Mount Sinai from Memorial Sloan-Kettering Cancer Center in New York City in 2008.
“A big reason I decided to come to Mount Sinai is the amazing research support at this Hospital and the emphasis on translational research,” explains Dr. Gladdy, who dedicates 80 per cent of her time to research.
Treatment for soft-tissue sarcomas involves radiation followed by surgery to remove the tumour. Unfortunately, these tumours are likely to recur in the same area. Dr. Gladdy and her colleagues focus on educating other doctors in Canada on how to improve their ability to diagnose soft-tissue sarcomas.
“Research needs to enhance treatment further,” says Dr. Gladdy. “The goal is to stop tumours from growing so that recurrence is less common, provide patients with non-surgical options and to be more sophisticated in how we treat each subtype of soft-tissue sarcoma.
Dr. Gladdy’s lab at the Samuel Lunenfeld Research Institute has created cell lines that will be used to examine and screen molecular changes in soft-tissue tumours. The goal is to discover subtype-specific, molecularly targeted therapeutics that can provide new treatment options unique to each type of soft-tissue sarcoma.
“Almost 50 per cent of those with the disease do not survive,” says Dr. Gladdy. “There is an urgent need for more specific treatments that limit toxicity and morbidity.”
Similarly, the direction of Dr. Wunder’s translational research is focused on discovering molecular changes to better predict patient outcomes, identify targeted drugs to help stop metastasis, and develop more specific treatments for different sarcoma types.
The research progress Drs. Wunder and Gladdy and their team have made supports their commitment to exceptional patient care. “I have an open invitation to call Dr. Wunder with any concerns at any time,” says patient Mark Stewart. “He’s the best doctor.”