Treatment of bone and soft tissue sarcomas at the Ichilov (Sourasky) clinic, Tel Aviv

Sarcomas are a rare and aggressive group of tumors (~1% of all malignant neoplasms), where the concentration of experience is critically important. Individual surgeons worldwide perform only 10–15 such operations per year, while the Ichilov (Sourasky) Oncology Orthopedics Department is one of the few centers in the region where the number of sarcoma interventions exceeds 100 per year. A multidisciplinary team is involved in the work: an oncology orthopedist, a pediatric oncologist (for osteosarcoma and Ewing's sarcoma in adolescents), a radiotherapist, a reconstructive surgeon, a pathomorphologist, and a geneticist.

The hub contains materials on the main histological types: osteosarcoma (the most common bone tumor in adolescents), Ewing's sarcoma, chondrosarcoma, rhabdomyosarcoma, leiomyosarcoma, GIST (gastrointestinal stromal tumors), Kaposi's sarcoma, reticulosarcoma, soft tissue liposarcomas, and angiosarcomas. All of them require different protocols but are united by a common approach: precise staging → neoadjuvant chemotherapy → organ-preserving surgery with wide margins → adjuvant therapy and rehabilitation.

Diagnosis at the clinic includes MRI with contrast, PET-CT, core needle biopsy with immunohistochemistry and molecular analysis (EWSR1 for Ewing's sarcoma, MDM2/CDK4 for liposarcomas, KIT/PDGFRA for GIST). Surgery is organ-preserving in 85–90% of cases: endoprosthetics of large joints (including growing prostheses for children), microsurgical reconstruction with vascular flaps, computer navigation for pelvic and spinal tumors. Chemotherapy follows international protocols EURAMOS-1, EURO-EWING, for GIST — targeted therapy with imatinib/sunitinib/regorafenib, and for rhabdomyosarcoma in children — COG/EpSSG protocols.

A separate rehabilitation and recovery program is conducted after prosthetics, as well as clinical trials of new drugs (pazopanib, eribulin, temozolomide+irinotecan). Below are articles, programs, and specialized doctors from Sourasky.