Musculoskeletal Oncology Fellowship

Orthopaedic Oncology at Mass General: A Spirit of Collaboration

Overview

The Orthopaedic Oncology Service was founded in 1972 by Dr. Henry Mankin. The scope of the service covers the comprehensive care of musculoskeletal oncology patients at the Massachusetts General Hospital, Beth Israel Deaconess Medical Center (BIDMC), and Boston Children’s Hospital. The service is fast-paced and requires excellent organizational and communicative skills. The diagnosis, treatment, and overall management of the orthopaedic oncology patient are complex. It requires coordination with our colleagues in Radiology, Pathology, Radiation Oncology, Pediatric and Adult Hematology Oncology, and other surgeons in the Thoracic, General Adult, Pediatric, Vascular, Plastic, Urology, Spine, Arthroplasty, and Hand Services.

We diagnose benign and malignant bone and soft tissue tumors in patients that are primarily referred to us for evaluation of difficult problems. Our population consists of children, adolescents, adults, and the elderly. We see more than 1,000 new patients each year, and this figure is growing. More soft tissue tumors are seen as compared to newly diagnosed bone tumors, which reflects the overall incidence of the soft tissue tumors relative to bone tumors. Patients with metastatic cancer are seen by our group, and we have especially focused on those with isolated metastatic disease.

We care for the orthopaedic oncology patient through all phases of their cancer experience. The phases include: physical exam, blood work, extensive radiographic imaging staging studies and biopsies to determine diagnosis, adjuvant treatment (chemotherapy and radiation), surgery, post-operation/rehabilitative care, routine oncology follow-up for up to 10 years or more, recurrences/metastases, and terminal or end-of-life care. The magnitude of their physical, emotional, and social needs creates quite a challenge, but we excel in meeting those needs.

The fellowship is an accredited ACGME and MSTS program of a one-year duration. It takes place between three institutions: Mass General, BIDMC and Children’s Hospital. The fellowship trainees rotated through these institutions in three-month blocks. We accept two trainees per year. While one trainee rotates through the Mass General, the other ones splits their time with between BIDMC and the Childrens’ Hospital. During each of these rotations the fellow trainees work in conjunction with orthopaedic surgery residents in different settings such as outpatient clinic, inpatient care (primary and consult patients), and in the operating room, assisting in procedures in the ambulatory and inpatient settings. The fellowship trainees participate actively and regularly in different teaching and academic sessions that take place on a weekly or monthly basis.

Training

Training guidelines

The format for training follows the ACGME guidelines in terms of the time and working hours limitation. The fellow is expected to participate actively in residency education. The fellowship uses the ACGME and MSTS guidelines for clinical volume and easily surpasses the requirements in terms of clinical volume. Training involves outpatient clinic, in patient and emergency room consultations and inpatient care. Surgical training takes place in the operating room.

Training Approach

The fellowship trainee has the opportunity to observe and assist in surgery with all faculty members. The variety and number in faculty members gives the opportunity to approach and treat the same problems/conditions in different manners. The training process follows the apprenticeship model in which the fellow sees and execute different portions of the surgery, with the expectation of becoming progressively more independent and capable to perform a surgical intervention or treatment to the point of absolute independence at the completion of the fellowship. With the same model, the fellowship trainee develops the proficiency and independence in the process of diagnosis, multidisciplinary care, surgical and medical care of patients with musculoskeletal oncology problems and conditions.

Rotations

A total of four rotations take place in blocks of 3 months in an alternating pattern. It is expected that in the second rotation at each of the sites, the fellowship trainee is expected to be more independent and self-sufficient in the described clinical settings and scenarios.

Why Train at Mass General

The Orthopaedic Oncology Service at Mass General and the partnering institutions for the fellowship program are very busy clinical services that offer a very large volume of patients and conditions that is enriches substantially the experience of the fellows in the program. The high volume improves substantially the surgical training, practice and repetition of surgical techniques. The infrastructure as a tertiary referral cancer care center facilitates exposure to the different subspecialties involved in the multidisciplinary care and management required by the oncologic patient population. The frequent interaction with plastic surgery, vascular surgery, thoracic oncology surgery, urology and surgical oncology enriches the experience of our fellows and expands greatly their fund of knowledge and experience. The constant interaction with musculoskeletal radiologists, bone and soft tissue pathologists, sarcoma oncologist and radiation oncologists, enriches the academic conferences, clinical discussions and inherently the experience of our fellowship trainees. Compared to other centers and fellowships, our program has a very balanced combination of adult and pediatric patients in addition to significant exposure to pelvic and sacral surgery as well as spine oncology. Members of our faculty are pioneers in surgical technique development and innovations allowing the fellowship trainees to familiarize with new technologies such as carbon fiber implants, photodynamic nails, custom made implants for pelvic reconstruction, intraoperative ICG dye for sarcoma surgery amongst other. The number of faculty (six surgeons) offers variety in surgical technique and strategies for patient management.

The multiple academic conferences offer protected time for fellow trainee education which allows learning despite a busy clinical day to day.

For research, the fellowship program has a series of ongoing clinical research and basic science projects that provide opportunity to be involved in the design of studies and protocols, database management and data analysis, and finalization and writing of manuscripts. Fellows in our program are expected to complete one original article during the fellowship year.

Didactics

A series of conferences take place on a weekly and monthly basis. The weekly conferences include:

• Indications Conference: Preoperative review of the surgical cases of the week and the indications for each particular procedure
• Resident Teaching Conference: Resident-led presentation in a flexible format of musculoskeletal oncology topics relevant to orthopaedists as a whole
• Musculoskeletal Radiology Conference: Multidisciplinary conference where different cases from clinics are presented to discuss biopsy approaches, follow-up and additional work up strategies, rare conditions and classic clinical/radiologic scenarios with learning value
• Fellow Teaching Conference: One-hour long duration multidisciplinary conference in which a multidisciplinary presentation is given by faculty from different services focusing in benign and malignant musculoskeletal oncologic conditions are review along with their medical and surgical treatment

These conferences includes faculty from the bone and soft tissue pathology service, musculoskeletal radiology division, radiation oncology and medical oncology departments, and the orthopaedic oncology service). Lastly, a Sarcoma Tumor Board Meeting takes place in both rotations for the multidisciplinary discussion and management of sarcoma patients. In this conference adjuvant and neoadjuvant treatment plans are discussed and reviewed as well as surgical plans and final margin status.

Monthly conferences include Journal Club and the department Morbimortality meeting. The Journal Club is led by the fellowship trainees. Both fellows select topics and articles for discussion with the participating faculty in this meeting.

Special Programs

In addition to the musculoskeletal oncology service, our fellows can partipate in the ICAN Clinic (management of patients with amputations), the pediatric and adult oncology clinics, radiation oncology treatments and clinic including the proton radiation center and the musculoskeletal radiology service on days of procedures and biopsies.

Research

Research Overview

There are two independent research units in our program. One covers research that takes place at Children’s Hospital and BIDMC, with one research coordinator at each hospital, and one covers research at Mass General, which has three research coordinators. Most of the research is clinical in nature, focusing in clinical outcomes, surgical techniques, diagnostic tools, application of machine learning to prognosis calculators in musculoskeletal oncology and the use of new implants for surgical reconstruction. The use megaprosthetic, allograft reconstruction or a combination of the two (alloprosthesis), is one the biggest pillars of research at both sites focusing particularly in complications such as infection. There are few studies that are sponsored by companies with the majority of studies being investigator initiated. Both sites have infrastructure for biomechanical studies and at MGH, Dimitiris Spentzos, MD, leads research dedicated to micro-RNA extraction and analysis through bioinformatics.

Support Resources for Research

Support resources for research include research coordinators, biomechanical laboratories at both Mass General (with the Foot & Ankle Research and Innovation Lab (FARIL)) and BIDMC; basic science laboratiories in microRNA and bioinformatics; as well as other basic science laboratories at Mass General and the Martinos Research Institute; machine learning laboratory and initiative at Mass General; and Biostatistical support by the Harvard Catalyst Institute.

Recent Research Projects

See our active protocols (PDF) (updated August 2025)

See our presentations from 2021-2023 (PDF)