Duke Sarcoma Center Leadership: David Kirsch, MD, PhD, Co-Leader; Brian Brigman, MD, PhD, Director; Richard Riedel, MD, Associate Director of Clinical Research. (photo by Brian Strickland)
New Duke Sarcoma Center Announced
Brian Brigman, MD, PhD, Director, Duke Sarcoma Center, presents a case at the tumor board, with (pictured at left) Nicole Larrier, MD, and Pam Pennigar, FNP, MSN, and Associate Director of Clinical Research at the Center, Richard Riedel, MD, and Center Co-leader David Kirsch, MD, PhD. (photo by Brian Strickland)
The Duke Cancer Institute is excited to announce the establishment of the Duke Sarcoma Center, a center of excellence for sarcoma treatment and research.
Spearheaded by orthopedic surgical oncologist and professor of Orthopedic Surgery and Pediatrics, Brian E. Brigman, MD, PhD, the Center is the natural outgrowth of DCI’s Sarcoma Disease Group — a program recognized for innovative personalized treatment grounded in state-of-the-art clinical and basic-science research and committed to training the next generation of sarcoma clinicians and scientists.
“Care for sarcoma patients has gone on for decades at Duke, but over the last 15 years or so, our specialized team has really grown into a national leader in this area. The Duke Sarcoma Center is a recognition of this accomplishment and a new beginning of even better care, research, and training at Duke,” says Brigman.
(at right) Director of the Duke Sarcoma Center Brian Brigman, MD, PhD (Orthopaedic Surgery) discusses a case with Center co-leader David Kirsch, MD, PhD (Radiation Oncology). (photo by Brian Strickland)
The multidisciplinary team is comprised of 35 specialists — physicians, physician assistants, nurses, and researchers across the disciplines of orthopedic surgery, surgical oncology, medical oncology, pediatric oncology, radiation oncology, radiology, neurosurgery, and pathology.
“We see more than 900 new patients in the Duke Cancer Institute’s Sarcoma Clinic per year across all specialties and are actively caring for more than 2000 patients. The majority are in active treatment or long-term-follow up or survivorship,” notes Brigman. “Sarcomas may be rare cancers, but they’re not rare for us. With our experience comes greater expertise.”
EXPERTISE IN MOTION AT DUKE & IN THE COMMUNITY Duke Sarcoma Center Co-Leader David Kirsch, MD, PhD, consults with Nicole Larrier, MD, MS, an associate professor of Radiation Oncology. Kirsch and Larrier are the only DCI radiation oncologists affiliated with the Center. Both work out of the Duke Cancer Center Sarcoma Clinic. Larrier also sees patients at the Maria Parham Cancer Center in Henderson, NC, which is part of the Duke Cancer Network. (photo by Brian Strickland)
Sarcomas are cancers that affect the supporting tissue of the body. They can occur in bone, muscle, fat, or other tissues.
According to the American Cancer Society, about 3,910 new cases of cancer in the bones and joints and an estimated 13,190 new cases of soft tissue sarcomawill be diagnosed in adults and children this year. An estimated 2,100 people are expected to die from bone and joint sarcoma and 5,130 from soft tissue sarcoma.
That’s about 17,000-plus diagnoses and 7,000-plus deaths too many.
“Because they occur anywhere in the body, can affect people of any age, and have more than 100 different subtypes, they are very challenging to diagnose and cure,” Brigman explains. “This work requires a true team approach. There’s ample evidence to suggest that patient outcomes are better when they’re treated by an integrated subspecialized sarcoma team.”
Notably, in addition to adults, the Center treats a significant number of pediatric sarcoma patients. All five pediatric sarcoma specialists affiliated with the Center (Lars Wagner, MD, Corinne Linardic, MD, PhD, David Van Mater, MD, PhD, Michael Deel, MD and Susan Kreissman, MD) have clinics at Duke Children’s Health Center in Durham.
UP TO THE CHALLENGE DCI medical oncology nurse practitioner Jenny Phillips, FNP-C, sees patients with bone and soft tissue sarcomas — a rare and often challenging diagnosis.
Diagnostic testing offered at the Center includes the use of chest X-ray, cross-axial imaging with MRI or CT imaging, nuclear medicine imaging with bone scan or PET imaging, and ultrasound- or CT scan-guided needle biopsies.
Patient cases are discussed weekly at a multidisciplinary sarcoma tumor board (a meeting of sarcoma specialists) where imaging and pathology are reviewed, and consensus is built around building the best treatment for an individual patient.
The team offers the latest treatment options to preserve healthy tissue and bone, including comprehensive limb-sparing surgeries to avoid the need for amputation, and radiation therapy that reduces potential damage to surrounding tissue and organs by targeting the tumor directly or the tumor site (before or following surgical removal). Radiation therapy modalities include intensity- modulated radiation therapy, intraoperative radiotherapy, and brachytherapy. Chemotherapy may also be deployed depending on the patient’s specific diagnosis, anticipated risks versus benefits, and other factors.
Clinical trials are also often an option for pediatric and adult patients with sarcomas.
“We have a strong record of developing innovative clinical trials and research studies at Duke and are dedicated to accelerating, into the clinic, those research discoveries with translational potential,” says associate professor of Medicine and practicing medical oncologist Richard F. Riedel, MD, the Duke Sarcoma Center’s associate director of Clinical Research. “Our goal is to try and have a clinical trial option for every patient who walks through the door.”
OPTIONS: ONE SIZE DOES NOT FIT ALL (at right) DCI medical oncologist Richard Riedel, MD, reviews a case before the tumor board with Duke pathologist William Jeck, MD (back left) having queued up a slide. Riedel is an associate professor of Medicine, and Associate Director of Clinical Research at the Duke Sarcoma Center. “Our goal is to try and have a clinical trial option for every patient who walks through the door," he says.
David G. Kirsch, MD, PhD, the Barbara Levine University Distinguished Professor and vice chair for Basic & Translational Research in the Department of Radiation Oncology, is co-leader of the Duke Sarcoma Center. He sees patients as a radiation oncologist and also runs a research lab — the Kirsch Lab — focused on developing better treatments and understanding how sarcomas develop and spread.
Duke oncologist and veterinarian Will Eward, MD, DVM, (right) with N.C. State University veterinary oncologist Steven Suter and canine osteosarcoma patient "Deuce" in 2018.
“Although our current treatments cure some patients with sarcomas, these therapies fail in too many patients. At the Duke Sarcoma Center, we have a critical mass of investigators funded by the NIH and foundations who are focused on understanding the mechanisms of sarcoma development, metastasis, and developing novel treatments for sarcomas,” says Kirsch. “Our goal is to not only make impactful discoveries in the lab but translate them to new treatments for sarcoma patients in the clinic.”
Some of the clinician-scientists and researchers affiliated with the Duke Sarcoma Center also play an active role in the DCI Comparative Oncology program, which leverages research and resources across species to ensure the development of new diagnostics and therapies for naturally occurring cancers, including bone and soft-tissue sarcomas.
Led by orthopedic surgical oncologist William Eward, DVM, MD — an expert in treating pediatric, adult, canine, and other mammalian sarcomas — Comparative Oncology brings together researchers, medical doctors, and veterinarians at Duke, NC State University's College of Veterinary Medicine, and the Triangle Veterinary Referral Hospital to defeat the common enemy of cancer.
HAIR GOALS Richard Riedel, MD, and Brian Brigman, MD, PhD, show their team spirit with yellow ribbons & "hair."
Community engagement is an important pillar of the team’s mission.
This includes planned public symposia on sarcoma treatment and research and the traditional Strike Out for Sarcoma run/walk event, an annual event that brings together patients and families, friends and caregivers, survivors, providers, and the local community to raise awareness and research support for the program.
This article was updated on April 26, 2022, to update the number of Center members -- from 25 to 35.
A special report by Duke Cancer Institute the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report
Back in person, the Duke Sarcoma Center's signature annual event raises nearly $30K for sarcoma research
The annualDuke Cancer Institute-hosted Strike Out Sarcoma 5K Run/Walk event— held in person (not virtual) for the first time since 2019 — raised nearly $30,000 for sarcoma research at Duke. About 180 runners and walkers, plus many more families, caregivers, and friends who hadn't pre-registered came out to Wake Med Soccer Park on October 23 to show their support.
Brian Brigman, MD, PhD, orthopedic surgical oncologist, and the director of the Duke Sarcoma Center at DCI, was the emcee.
He invited sarcoma survivor and mother Sharon Alstonto share her journey with the crowd, which she did, with wit, faith, and hope.
"Around January, I noticed my arm getting bigger. At my next PCP telehealth visit, my doctor suggested I come in person. We passed it off as a lipoma...She had me get an ultrasound, which basically told us that I had a mass, but not much more... What she said next was a game-changer and would change my LIFE forever," Alston shared. "Why, when someone tells you not to freak out, are you supposed to be calm? She states that she's going to do a referral, stat, to orthopedic oncology. I was referred and had an MRI. Meanwhile, I wait; looking like a deer caught in the headlights, trying not to think about it, keeping it cool, but wanting to lose it, researching, Googling.."
When the results of the MRI came in, Alston met with orthopedic surgical oncologist Will Eward, MD, DVM, who thoroughly explained what he saw and made sure she "had a full understanding of what it might be" — "maybe cancer, maybe not."
She proceeded to undergo a biopsy; receiving her diagnosis four days later — four days before her 50th birthday.
On May 17, 2022, Alston was diagnosed withhigh-grade undifferentiated pleomorphic sarcoma in her right upper arm. It's a rare type of cancer that begins mostly in the soft tissues of the body.
On June 1, Alstonhad her first of 25 radiation therapy treatments — under the care ofradiation oncologist Nicole Larrier, MD, MS.She underwent surgery in August, followed by physical therapy and take-home compressive cryotherapy, which combines the effects of cold therapy and compression to ease pain in recovery.
Alston, a Durham resident, is already back at work as an instructional technologist specialistand Blackboard System AdministratoratNorth Carolina Central University's Division of Extended Studies.
"Overall, most days I was a trooper. I realized it was all part of the process and I took it in stride," Alston reflected. "I pressed heavy in my faith and belief —to the point that I would have specific songs to remind me that all things work together for my good."
Alston also shared "lessons learned" and a "charge of action" with those gathered 'round to hear her speak.
(some excerpts)
"Be proactive with your health; it truly can save your life. Ask questions until you understand.
Take a TALL GLASS of SIT DOWN.
Make the most of your time and life, especially while you are still here.
Put your life affairs in order; DO IT NOW.
Check on your loved ones. Realize that family, friends, and caregivers have been through a lot. You ALL are healing and changing.
Remember to take a moment and BE.
Remember it's where you are going, NOT where you have been."
"Know that every step and stride of this run/walk today was for loved ones and yourself," Alston continued, beforeclosing her speech withplenty of thank-yous and love for her care team — Eward; Larrier; Nicole Mouser, RN, BSN; Colleen Forbes, RN, BSN, ONC; Mark Binion, MD; Kate Ericson, NP; and Pam Pennigar,FNP, MSN.
She also thanked "many others of the Duke Cancer Sarcoma Clinic family" — all the nurses, the valet staff, environmental services — as well as her local primary care physician, Althea Massenburg, MD, her mom Barbara Alston, and"my 'why' to press through this journey to live, my son Cason."
Afterward, the nervousness that she'd felt as she'd prepared to speak (when she almost lost her notes to the cold wind) had faded away. One by one, other survivors came up to her to sharetheir storiesand snap selfies.
