肉瘤的治疗方案

面试官: 肉瘤有哪些治疗选择? 大发娱乐将在接下来的《大发体育官网》中讨论这个问题."

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面试官: Dr. 卤兰德尔 is the director of the Sarcoma 服务 at Huntsman Cancer Institute. For somebody who's received the diagnosis of sarcoma and they're looking at what are some of their treatment options, 让大发娱乐来分析一下你会和潜在病人讨论什么. 让大发娱乐从治疗选择开始?

Dr. 兰德尔: 这取决于病人的年龄和期望. 手术是治疗大多数肉瘤的主要方法. Some of these patients will also undergo chemotherapy and radiation therapy either before or after, 取决于大发娱乐所说的肿瘤的阶段. But how we develop a personalized plan really does depend upon age and expectation.

面试官: 好吧. So, just like many things, there's a lot of different variables that go in there. 给大发娱乐举个比较常见的例子吧. 也许你会崩溃 . . . I know sarcomas affect a lot of younger people, children, and also somewhat older adults. Why don't we take a look at some of the common things that you might have a discussion. Dr. 兰德尔：让大发娱乐来扮演一个不幸的10岁女孩 . . . 或者让大发娱乐生个男孩，因为他们发育得有点慢. A 10-year-old boy with a distal femur, meaning lower thigh, just above the knee, osteosarcoma. This patient has a very good chance of beating this cancer after a year of treatment. 通常会先进行大发娱乐所说的新辅助化疗. 然后大发娱乐将观察肿瘤的反应. 然后，大发娱乐会进去切除肿瘤. Usually, this is a lot of real estate that we're moving and we have to reconstruct it. 大发娱乐用什么来重建它?

对于久坐不动的人来说, 有人可能会使用一种叫做内假体的东西, 哪一个是大的美化的膝关节置换术. 在一个向往运动的人身上, we would do something called a rotationplasty where we actually use the joint below, 在这种情况下, 脚踝, 把它向上旋转，然后倒着戴上, 如果你愿意, 让它成为一个功能齐全的膝盖. And these kids can play competitive sports, contact sports like football and lacrosse. 他们会游泳. 他们可以做所有耐用的东西.

Now, for some people, that is an esthetically, very unattractive option. 他们更注重自己的身体习惯和外表, 所以他们可能会使用内假体. 但对于一个还有这么多成长空间的人来说, 再一次。, 10岁以下的人, they have a real chance of needing multiple revision surgeries down the road with an endoprosthesis. So we really will push, out of compassion, the use of the rotationplasty.

面试官: 如果是老年病人呢? 给大发娱乐另一个场景.

Dr. 兰德尔: 是的. 在一个年长的病人身上, 说, they have a chondrosarcoma this time in the upper femur or around the pelvic bone, 大发娱乐通常不会进行化疗. 大发娱乐通常会用手术切除肿瘤. 很多病人在手术和癌症中幸存了下来, but they are left with some functional considerations that are sometimes a challenge. 替换股骨上部相对容易. Sometimes when it's on the what we call the socket side or around the joint on the pelvis, the reconstructions are much more challenging and can be much more hard to recover from. But we are actually learning now that sometimes these simply options are better than the complicated hemi-pelvic replacement surgeries that we have done over decades.

面试官: 然后, 你自己也做过一些, a handful of some different types of procedures some might call innovative procedures. 解释这些.

Dr. 兰德尔: Well, one that we advocate for here in Utah is something called the clavicula pro humero procedure. This is a procedure where we actually have to remove the upper arm bone in a child. So, 因为骨肉瘤, Ewing's sarcoma of the upper humerus bone which is about the shoulder joint, 大发娱乐将替换它. 然后, 大发娱乐将把锁骨或锁骨向下移动, 在铰链上旋转它, 如果你愿意, 肩胛骨上, 然后把肱骨的下半部分连接到锁骨上.

我想说的是，我第一次看到它的实际应用, 如果你愿意, 当时我在南非做海外客座教授, 在一个叫林波波的地方, 我去了哪里, 不幸的是, many of these children were abandoned by their families once they had the diagnosis. 所以, there's these wards of surviving children from osteosarcoma out there playing soccer, out there playing basketball with the shortened limbs because the collar bone is shorter than the humerus bone that we removed, 而是他们想做什么就做什么. And I asked them what the procedure was, and they said, "It's this CPH or clavicula pro humero. 这是大发娱乐唯一拥有的东西. We don't have access to the technologies that you do in the West and this is what we do."

And what I saw before me were beautiful, happy children playing in a gregarious way with one surgery. As I was supposed to go over there and tell them about the wonders of the West, 我把它买回家，然后我 . . . 再说一次，我不应该 . . . 有人在大发娱乐做这件事. 我并不是说我就是那个做这件事的人. But I fell in love with this procedure because I knew what it offered children in their ability to live out their lives completely.

面试官: 在锁骨手术中，你爱上了它. 这是为什么？? Was is because it was so elegant and simple and restored function in such just a great way?

Dr. 兰德尔: 没错，优雅而简单. It used nature's parts to give a sound, durable, stable reconstruction. The only thing that is foreign in that child is the plate that we use to attach the collar bone to the remaining arm bone. 他们做得非常好. 我不应该说他们没有危险. 他们有并发症的风险. 有一些担忧. 但总的来说，这些病人做得非常好.

面试官: 还有其他可能的治疗方案吗?

Dr. 兰德尔: 外科创新一直在不断出现. As a surgeon, I work with surgeons around the country to push the envelope. We have new ways of attaching metal bones to femurs, things of that sort. But the real excitement is in the researches being done at major sarcoma centers like Huntsman Cancer Institute where we're looking at the molecular targets and doing sort of the personalized medicine already in that these signatures, 这些易位大发娱乐在过去讨论过, 实际上 . . . we can actually develop therapeutic targets to knock those out or their downstream events. 生物学, the molecular targets that are being done at these cancer institutes like Huntsman is really the future. And, 你知道, I'd rather be flipping burgers than cutting tumors out of kids.

面试官: 是的. 我正想问你呢, 那会让你失业的, 正确的, 因为手术就没必要了?

Dr. 兰德尔: 没关系.

面试官: 是的. 我以前听你说过，研究等于希望.

Dr. 兰德尔: 正确的. 这就是大发娱乐在国会讨论的问题. It's all about the care today, but the future tomorrow for cure is for the research. 这就是亨茨曼的任务.

面试官: 这听起来像是一个病人的肉瘤诊断, 你知道, 就像很多癌症诊断一样, 不是什么了不起的事, 但它是可以治疗的，也很容易存活, 你可以继续你的生活.

Dr. 兰德尔: 是的. 这是一个范围. 我是说，就像任何癌症一样，有好有坏. But there's plenty of hope for the patient of today and there's even more hope for the patient of tomorrow.

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