Mission:
To provide the state-of-the-art quality care to patients with musculoskeletal tumors
The treatment of patients with malignant neoplasm of the musculoskeletal system has changed
drastically over the past years. This reflects in many ways of changes in the entire field of
oncology. In the early 70’s the standard treatment for high grade bone and soft tissue sarcomas
involved amputation at or above the joint involved. Advances in chemotherapy, reconstructive
surgery, bioengineering and prosthetics have enabled the surgeon in recent times to successfully
excise the tumor and reconstruct the extremity. The era of Limb Preservation was ushered in by
the late 80's and we in Hong Kong followed.
  
Musculoskeletal Tumors at the Prince of Wales Hospital
Though primary bone neoplasms are rare, representing about 1% of the overall incidence of
malignant conditions, bone and soft tissue neoplasms account for 10% of the malignant lesions
reported in children. Over the years, our department at the Prince of Wales Hospital, has
developed considerable expertise in the management of musculoskeletal neoplasms. Since 1984,
we have treated over 300 cases of musculoskeletal neoplasms of which 104 are malignant or
locally aggressive.
This institution is an acknowledged referral center to take care of patients with musculoskeletal
bone and soft tissue malignancies coming from the entire New Territories with a population of three
million. The institution has a dedicated team in radiology, pathologist and orthopaedic oncology
surgeons who are experienced in the initial diagnostic workup and with the surgical expertise
for oncological resection, microvascular reconstruction and megaprosthetic reconstruction. Our
surgical efforts are complemented by an excellent oncology department which enables us to
provide pre-operative adjuvant therapy for malignant neoplasms. Indeed, interhospital referrals
account for 1/3 to 1/2 of our cases. The multidisciplinary facilities available within the department
and the hospital have been appreciated by general practitioners and surgical specialists from
the region and we are able to catch patients with neoplasms even in the very early stages. Our
pioneering efforts at limb preservation surgery have been acknowledged all over the territory, and
our department is at the forefront in providing such a service to Hong Kong.
Limb Preservation Surgery
With advances in chemotherapy and with the use of newer agents such as the adriamycin, ifosphamide and cis –platinium, complete necrosis of the tumor may be achieved pre-operatively. This complements the effect of surgical excision. Local tumor control may thus be effectively achieved without the need for a mutilating amputation. Large bone and soft tissue defects may be suitably replaced and useful limb function thereby salvaged. This is rewarding for the patient who are largely children or young adults.
Almost all our primary bone tumors are seen at Stage II and we are able to perform successful Limb Salvage for 90% of patients.
 (A) Modular (B) Custom tumor prostheses
Limb Reconstructive Surgery
In our unit, more than 200 allografts have been used for massive bone defect reconstruction
after tumor resection in limb salvage surgery in the past 20 years. Although 20% of patients can
achieve good to excellent functional outcome in 10 years, there are up to 30-40% of complications
following allograft reconstruction. The complications include infection, fracture, nonunion, chronic
rejection, unstable joint. The source of the allograft is also limited as there are few bone donors
every year in Hong Kong.
With the financial support from Children Cancer Foundation and Samaritan Fund, our unit has
introduced metal tumor prosthesis for reconstruction in limb salvage surgery since 2003. The latest
design of tumor prosthesis is more durable and can achieve excellent functional result. The short
term complications are minimal and the rapid functional recovery can facilitate the postoperative
chemotherapy regime. The prosthesis can also be custom made to fit individual need and have the
ability to be extended to correct leg length inequality, which is common in paediatric bone tumor
following limb salvage surgery.
Achievements
| 1986 |
First allograft reconstruction
|
| 1992 |
Bone bank was established
|
| 1995 |
Basic research on Giant cell tumor of bone was started
|
| 2003 |
First tumor prosthetic reconstruction for patients with osteosarcoma in PWH
|
| 2004 |
Perform the 1st computer aided design (CAD) custom pelvic prosthesis in Hong Kong and Asia;
Perform the 1st
minimally invasive extendible custom tumor prosthesis in Hong Kong
|
| 2005 |
Set up the 1st multidisciplinary team on managing pelvic tumors in NTEC and Hong Kong
|
| 2006 |
Perform the 1st noninvasive extendible (magnet-driven) custom tumor prosthesis in Hong Kong and Asia
|
| 2008 - present |
Our work on “Bone tumor surgery with computer navigation” was chosen as one of the two leaders (the other is liver
transplants from HKU) in medical science and a pioneering member of international medical fraternity in applied
research and practice in Hong Kong in 2008. It is published by Information Services Department – Hong Kong
Special Administrative Region (HKSAR) Government.
|
| 2008 - present |
The founder and world opinion leader in Computer Assisted Tumor Surgery (CATS) and have collaborated with
commercial company (Stryker Navigation) to develop an Orthopaedic Tumor Navigation System (OrthoMap 3D). It is
the first of its kind in the World and has been launched internationally since 1 Jan, 2009
|
| 2008 - 2011 |
The only team in the world that can organize and conduct 1st to 3rd international workshop on Computer Assisted
Tumor Surgery
|
| 2009 |
|
| 2010 |
Published the book “A Practical Guide for Computer Assisted Tumor Surgery (CATS)”, the first and the only one of its
kind in the world describing this advanced technology in orthopaedic oncology
|
| 2012 |
Developed and published the world 1st tumor Patient Specific Instrument (Tumor- PSI) in bone tumor resection and
custom prosthetic reconstruction |
Computer Assisted Tumor Surgery (CATS)
Research
Giant Cell Tumor of Bone (GCTB)
| • |
GCTB is the most commonly reported nonmalignant, primary bone tumor in Chinese population, which contributes about 20% of all skeletal neoplasms. |
| • |
It is typically found at the epiphyseal ends of long bones & its prime radiological characteristic is the presence of large expansile osteolytic lesions. |
| • |
GCTB is well known for its potential to recur following treatment, local recurrence rates of 18% to 50% have been reported. |
Basic Sciences
Tumorigenesis
| • |
We have always endeavored to identify key molecular mechanisms underlying tumorigenesis in GCTB and what drives the neoplastic stromal cells to proliferate extensively and pause at an early differentiation stage of pre-osteoblast lineage. |
| • |
We also recently found that p63 regulates GCT stromal cells proliferation by binding to the CDC2 and CDC25C p53-REs, which may inhibit the p53 tumor suppressor activity and contribute to the GCT tumorigenesis. |
 p63 regulates cell proliferation and cell cycle progression‑associated genes in stromal cells of giant cell tumor of the bone. Lau CP, Ng PK, Li MS, Tsui SK, Huang L, Kumta SM. Int J Oncol. 2013 Feb;42(2):437-43.
Histology & biological behaviour
| • |
GCTB exhibits three histological different cell types: the multinucleated osteoclast-like giant cells, the spindle-shaped stromal-like cells, and the round-shaped macrophage-like cells. |
| • |
GCT stromal cells (GCTSC) are the primary neoplastic cells of this tumor and are the only proliferating cell component in long-term culture, which recruit osteoclast-like giant cells that eventually mediate the bone destruction. |
| • |
GCTSC are able to proliferate unlimitedly in cell culture and express early osteoblastic differentiation markers such as collagen type I, bone sialoprotein and osteonectin protein. |
Cytokines & Chemokines
| • |
We have also discovered the neoplastic stromal cells express pre-osteoblastic markers and secrete several important cytokines, especially the osteoclastogenesis-inducing factor, receptor activator of nuclear factor kappa-B ligand (RANKL). |
| • |
GCT stromal cells over-express RANKL, which drives the macrophage-like cells (which express RANK, the receptor of RANKL) to undergo fusion to form multinucleated osteoclast-like giant cells. |
| • |
We have investigated the transcriptional regulation of RANKL promoter, and found that CCAAT/enhancer binding protein beta is up-regulated and regulates RANKL expression in the neoplastic stromal cells. |
Adjuvant Therapy
| • |
Our research team is keenly studying molecular mechanisms for a variety of adjuvants which are currently or potentially useful for GCTB treatments, such as nitrogen-containing bisphosphonates (N-Bps), denosumab and prenyl transferase inhibitors. |
Comparison of the anti-tumor effects of denosumab and zoledronic acid on the neoplastic stromal cells of giant cell tumor of bone. Lau CP, Huang L, Wong KC, Kumta SM. Connect Tissue Res. 2013;54(6):439-49.
Representative Publications on GCTB (Basic Science)
| 1. |
Giant cell tumor of bone. Yip KM, Leung PC, Kumta SM. Clin Orthop Relat Res. 1996 Feb;(323):60-4. |
| 2. |
Gene expression of glucocorticoid receptor alpha and beta in giant cell tumour of bone: evidence of glucocorticoid-stimulated osteoclastogenesis by stromal-like tumour cells. Huang L, Xu J, Kumta SM, Zheng MH. Mol Cell Endocrinol. 2001 Jul 5;181(1-2):199-206. |
| 3. |
Tumour cells produce receptor activator of NF-kappaB ligand (RANKL) in skeletal metastases. Huang L, Cheng YY, Chow LT, Zheng MH, Kumta SM. J Clin Pathol. 2002 Nov;55(11):877-8. |
| 4. |
Expression of VEGF and MMP-9 in giant cell tumor of bone and other osteolytic lesions. Kumta SM, Huang L, Cheng YY, Chow LT, Lee KM, Zheng MH. Life Sci. 2003 Aug 1;73(11):1427-36. |
| 5. |
Expression of preosteoblast markers and Cbfa-1 and Osterix gene transcripts in stromal tumour cells of giant cell tumour of bone. Huang L, Teng XY, Cheng YY, Lee KM, Kumta SM. Bone. 2004 Mar;34(3):393-401. |
| 6. |
Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM. Calcif Tissue Int. 2004 Jul;75(1):71-7. |
| 7. |
CCAAT/enhancer binding protein beta is up-regulated in giant cell tumor of bone and regulates RANKL expression. Ng PK, Tsui SK, Lau CP, Wong CH, Wong WH, Huang L, Kumta SM. J Cell Biochem. 2010 May 15;110(2):438-46. |
| 8. |
Pamidronate, farnesyl transferase, and geranylgeranyl transferase-I inhibitors affects cell proliferation, apoptosis, and OPG/RANKL mRNA expression in stromal cells of giant cell tumor of bone. Lau CP, Huang L, Tsui SK, Ng PK, Leung PY, Kumta SM. J Orthop Res. 2011 Mar;29(3):403-13. |
| 9. |
p63 regulates cell proliferation and cell cycle progression‑associated genes in stromal cells of giant cell tumor of the bone. Lau CP, Ng PK, Li MS, Tsui SK, Huang L, Kumta SM. Int J Oncol. 2013 Feb;42(2):437-43. |
| 10. |
Comparison of the anti-tumor effects of denosumab and zoledronic acid on the neoplastic stromal cells of giant cell tumor of bone. Lau CP, Huang L, Wong KC, Kumta SM. Connect Tissue Res. 2013;54(6):439-49. |
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