Randall Details Inaugural Birmingham Orthopedic Oncology Meeting

R. Lor Randall, MD, FACS

During the 2024 Birmingham Orthopedic Oncology Meeting, the first event of its kind, investigators from around the world came together to share data and try to reach a consensus around some of the most difficult questions still facing clinicians in the field of orthopedic oncology, according to R. Lor Randall, MD, FACS.

“I was fortunate to attend the Birmingham Orthopedic Oncology Meeting which was an inaugural, global event of 300 recognized content experts in sarcoma from 53 countries,” Randall said. “It was powerful that we had representation from so many different countries with different socioeconomic considerations. Not only did we talk about the disease, but we talked about how people approach managing the disease surgically with varying amounts of resources. [For example, management in] Europe and the United States vs potentially Sub-Saharan Africa or some other areas where resources are very disparate had [some of] the same sets of problems.”

The Birmingham Orthopedic Oncology Meeting was a 2-day consensus meeting which took place on January 29 and 30, 2024, in the United Kingdom. The first day of the meeting was focused on chondrosarcoma and the second was dedicated to infected oncology reconstructions. Each day consisted of a brief overview of each topic, followed by voting on 10 consensus statements with a strict 5-minute presentation by the authors of the submitted evidence. Twenty minutes were set aside for debate and 5 minutes were dedicated to voting.

In an interview with OncLive®, Randall, the David Linn Endowed Chair for Orthopedic Surgery, the chair of the Department of Orthopedic Surgery, and a professor at UC Davis Comprehensive Cancer Center in Sacramento, discussed highlights from the meeting as well as future plans for it.

OncLive: How was the 2024 Birmingham Orthopedic Oncology Meeting structured?

Randall: The meeting was run by Lee Jays, MB ChB, MSc, FRCS, an internationally recognized thought leader who has a terrific world-famous group at the Birmingham Royal Hospital in the United Kingdom. He brought these doctors in, and they talked about 2 subjects. One was the management of chondrosarcoma, which is [one of] the most common forms of primary bone cancer, and the second subject was periprosthetic infections in tumor endoprosthetics.

What were your main takeaways from day 1 of the meeting?

There’s a wide array of philosophies and treatments around [managing] low-grade all the way through high-grade dedifferentiated chondrosarcoma, and it was eye opening to me talking to world experts from all sorts of backgrounds because there was a great deal of disagreement, as well as agreement, around best practices for managing these conditions. It solidifies some ways of thinking, but it also introduces questions about our own practices given that many people have different opinions.

For example, when we have these low-grade cartilage cancers in bone that are slowly growing, some people espouse going in and surgically removing them through a curettage—making a window into the bone, scraping out the tumor, using local adjuvant therapies that are usually some sort of thermal ablation, and then packing it with bone graft [and] sometimes putting it on hardware to stabilize it. The thought is you can go intralesional on these because you can adequately control it that way and the risk of metastasis is remotely small. Many people treat [low-grade cartilage cancers] that way.

Whereas others feel that if it’s a cancer at all, it requires en bloc resection. So, you take out the segment of the bone and replace that segment with a variety of different things. It could be a bone transplant or it could be a metal prosthesis, for example, but the idea is people feel you need to get a negative oncologic margin.

It’s very eye opening to me that people felt passionate about it and that’s an example of disparate thinking when we’re trying to build consensus. But there was also a great deal of consensus around other aspects of chondrosarcoma and there are several manuscripts coming out from this meeting which will highlight some of the challenges we face as a world community in chondrosarcoma, with the caveat being that sarcoma centers around the world have different access to resources to be able to treat these cancers.

What were some highlights from day 2 of the meeting?

The second day was [discussing] managing periprosthetic joint infections—these are cancer prostheses. When someone has either an aggressive chondrosarcoma, osteosarcoma, or Ewing sarcoma, we will do these wide resections where we remove a big piece of tissue in the form of bone and rebuild it with a metal prosthesis. Those metal prostheses are at a very high risk of getting infected. When they get infected, even if you’ve cured the cancer, you leave a patient with physical, mental, and emotional challenges.

If this big half of a bone is infected, you have to remove that and then you don’t have half of the bone. We talked about controversies about things such as serial washouts or silver-impregnated implants to decrease infection rates. It was wonderful to have all of those thought leaders in that room to talk about that and I would say there was much more consensus around that topic.

What does the future hold regarding this meeting?

Dr Jays and his team have already put [the idea of surveying the attendees on what topics are of the most interest for the agenda going] forward into motion. There’s a bunch of people that are putting forward ideas and this [meeting] was to get the get the ball rolling. Both of these subjects, [chondrosarcoma and periprosthetic joint infections], will be coming out with future publications. It’s the inaugural event and we will be having other meetings, not necessarily in the UK, but several centers around the country including in California have offered to host some of these meetings. But it was the first of its kind and it means that the surgical oncologists in sarcoma are coming together to get some consensus around how we manage these challenging situations.

As more of these meetings start to happen, do you imagine that there will be a virtual component?

I do—we’ve all learned from the pandemic that there is the convenience of virtual participation, but there’s also the desire of physical proximity so that people can connect at another level. It probably will be hybrid to some degree.

We want the level set where we have agreement and can highlight where we have disagreement, and therefore launch studies to be able to address that. This is just consensus, expert opinion. We bring data into the presentations about what we know—most of it is level 4 data— and with level 4 data, many people will potentially agree with it or not. That’s why we wanted to get consensus in the face, or lack thereof, of the available literature such that we can then prioritize saying that we need to do a prospective randomized clinical trial on low-grade chondrosarcoma, for example.

What is your take home message for your colleagues following this meeting?

We all are influenced by our local environments and what we have available to us— if you know that you can widely resect something because technology or resources afford you to do it, maybe you'll be biased that way or maybe not because you feel it’s too aggressive. There’s no doubt that local socio-economic environments influence how we treat these [diseases], and that’s the beauty of this meeting.

I’m excited for the non-sarcoma surgical community to be aware that we, as the surgeons on the teams that have taken care of patients with sarcoma, are looking very critically at our own biases, preferences, and listening to our peers. We look forward to hopefully defining some unanswered questions and moving forward in concert with our medical, radiation, and pediatric oncology partners.

Reference

Birmingham Orthopedic Oncology Meeting: The Consensus. Clockwork Medical. July 6, 2023. Accessed March 4, 2024. https://www.clockworkmedical.com/boom/