Multidisciplinary approach to MSK cancer treatment needs “gaps” filling

Dimitrios Filippiadis (image credit: CIRSE on demand)

Dimitrios Filippiadis (National and Kapodistrian University of Athens [ATTIKON], Athens, Greece) was the final speaker to take to the podium at the European Conference on Interventional Oncology’s (ECIO; 16–19 April, Stockholm, Sweden) advanced musculoskeletal (MSK) session. His presentation drew on the subtopics within MSK oncology addressed by previous speakers to underline the importance of multidisciplinary collaboration to treat a range of MSK tumours or metastatic disease. Echoing the takeaways of preceding sessions, Filippiadis underlined that, despite the good work already being done to prove the value of a multidisciplinary approach to treating patients with MSK tumours or metastatic disease, gaps in the data persist from a clinical evidence point of view.

“Stating the obvious,” Filippiadis began, he advocated for cancer patients being managed at multidisciplinary tumour board meetings, “ideally with orthopaedic and neurosurgeons, medical and radiation oncologists, and, of course, interventional radiologists”.

The speaker then homed in on the value of shared terminology, and mutual understanding of what keywords mean—in the National Comprehensive Cancer Network (NCCN) 2023 guidelines, in relation to management of pain in adult cancer patients, ‘interdisciplinary’ was replaced by ‘multidisciplinary’, Filippiadis detailed. “We need to have both—to be able to offer a patient-tailored, or, even better, a lesion- or tumour-tailored approach.” The presenter elaborated how “everything in theory seems to work if you can have a multidisciplinary approach, but there are theoretical and practical gaps that we need to fill in”.

Moving on to focus on a location-specific example of where multidisciplinary treatment has worked well, Filippiadis suggested that “we can all agree that [Wallace et al’s paper in The Oncologist on treating metastatic spine disease in a multidisciplinary manner] was a success”. The essence of this, the speaker summarised, is having “therapies proposed from different disciplines”, adding that it “goes without saying that interventional radiology [IR] was at the core of these multidisciplinary approaches”. Filippiadis listed the advantages of IR treatments which render it so well suited to featuring in the multidisciplinary approach—“it is minimally invasive; well tolerated even in patients with comorbidities or extensive disease; the overall morbidity of the procedures is low; and there is impressive and reliable pain relief in the vast majority of cases”.

Furthermore, Filippiadis mentioned, among other examples of specific treatments for specific tumour types, systemic therapies to treat desmoid tumours or sarcoma metastatic disease—it is a “good example of how you can combine with local treatments”.

However, the speaker made sure to note “clear gaps” in knowledge surrounding a multidisciplinary approach to treating MSK tumours or metastatic disease. Yet Filippiadis outlined how data on the immuno-oncological effect of ablation on a tumour, including when combined with immunotherapy, plus the interplay and timing between systemic therapy and MSK oncology interventions and techniques” is coming to “[fill] these gaps”.

Filippiadis then took the opportunity to recommend distinct approaches depending on “whether the goal of your therapy is local tumour control or pain palliation”—the time interval between treatments can be adjusted accordingly. A pain palliation specific knowledge gap, the speaker supplemented, is around “the effect of ablation combined with radiation therapy for pain palliation”. A phase I or II trial for painful skeletal metastases could be a first step, he suggested.

To conclude, Filippiadis reiterated that IR treatments for MSK tumours have a “significant role to play because they are simple and effective [and afford great benefits to practitioners, to the cancer patients and to the wider field of oncology, including the healthcare system and its economics.” As the presenter sees it, he conveyed to delegates, “high-quality data [can] fill in these gaps, [but] the prerequisite for this is that people from different specialties are speaking the same language”.


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