Contact Information

Musculoskeletal Oncology Fellowship

Email: MGHmskoncfellowship@mgh.harvard.edu

Santiago Lozano Calderon, MD, PhD
Director, Musculoskeletal Oncology Fellowship

Kevin Raskin, MD
Director, Musculoskeletal Oncology Fellowship

55 Fruit Street
Yawkey Building, Suite 3B
Boston, MA 02114

617-726-0604
Fellowship Coordinator: Gina Delgado

Explore the 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 diversity 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 a list of our 2023 publications
    • Tobert DG, Kelly SP, Xiong GX, Chen YL, MacDonald SM, Bongers ME, Lozano-Calderon SA, Newman ET, Raskin KA, Schwab JH. The impact of radiotherapy on survival after surgical resection of chordoma with minimum five-year follow-up. Spine J. 2023 Jan;23(1):34-41. doi: 10.1016/j.spinee.2022.04.009. Epub ahead of print. PMID: 35470086.
    • Lozano-Calderón SA, Albergo JI, Groot OQ, Merchan NA, El Abiad JM, Salinas V, Gomez Mier LC, Montoya CS, Ferrone ML, Ready JE, Linares FJ, Levin AS, Peleteiro Pensado M, Pozo Kreilinger JJ, Ruiz IB, Ortiz-Cruz EJ, Gebhardt MC, Cote GM, Choy E, Spentzos D, Hung YP, Deshpande V, Chebib IA, McCulloch RA, Farfalli G, Aponte Tinao L, Morris CD, Petur Nielsen G, Anderson ME, Jeys LM. Complete tumor necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing sarcoma. Cancer. 2023 Jan 1;129(1):60-70. doi: 10.1002/cncr.34506. Epub ahead of print. PMID: 36305090.
    • Cahalane AM, Habib U, Balza R, Husseini JS, Simeone FJ, Lozano-Calderon S, Chang CY. A novel core biopsy needle with shorter dead space for percutaneous image-guided musculoskeletal biopsies - how does it compare with an established core biopsy needle? Skeletal Radiol. 2023 Jan;52(1):99-109. doi: 10.1007/s00256-022-04130-5. Epub ahead of print. PMID: 35876864.
    • Kamalapathy PN, Kline A, Hollow H, Raskin K, Schwab JH, Lozano-Calderón S. Predictors of Symptomatic Venous Thromboembolism in Patients with Soft Tissue Sarcoma in the Lower Extremity. Cancers (Basel). 2023 Jan 3;15(1):315. doi: 10.3390/cancers15010315. PMID: 36612310; PMCID: PMC9818863.
    • Kamalapathy PN, Raso J, Rahman R, Harihar S, Lozano-Calderon S, Hassanzadeh H. Orthopedic Surgery Fellowship Directors: Trends in Demographics, Education, Employment, and Institutional Familiarity. HSS J. 2023 Feb;19(1):113-119. doi: 10.1177/15563316221091798. Epub ahead of print. PMID: 36776521; PMCID: PMC9837408.
    • Crandell D, Lozano-Calderon S, Mayerson J. Editorial: Advances in rehabilitation intervention after limb amputation. Front Rehabil Sci. 2023 Feb 16;4:1149001. doi: 10.3389/fresc.2023.1149001. PMID: 36873819; PMCID: PMC9978791.
    • Hung YP, Chebib I, Bredella MA, Berner EA, Taylor-Black Q, Choy E, Cote GM, Chen YL, MacDonald SM, Schwab JH, Raskin KA, Newman ET, Selig MK, Deshpande V, Hornick JL, Lozano-Calderón SA, Nielsen GP. Prognostic Significance of Percentage and Size of Dedifferentiation in Dedifferentiated Chondrosarcoma. Mod Pathol. 2023 Mar;36(3):100069. doi: 10.1016/j.modpat.2022.100069. Epub ahead of print. PMID: 36788104.
    • Depauw N, Pursley J, Lozano-Calderon SA, Patel CG. Evaluation of Carbon Fiber and Titanium Surgical Implants for Proton and Photon Therapy. Pract Radiat Oncol. 2023 May-Jun;13(3):256-262. doi: 10.1016/j.prro.2023.01.009. Epub ahead of print. PMID: 36738918.
    • Merkely G, Leite CBG, Newman ET, Raskin K, Lozano Calderón SA. Venous Thromboembolic Event Following Soft Tissue Sarcoma Diagnosis is Associated with the Development of Pulmonary Metastasis. Ann Surg Oncol. 2023 Jun;30(6):3692-3699. doi: 10.1245/s10434-023-13276-y. Epub ahead of print. PMID: 36847960.
    • Ramsey DC, Fourman MS, Berner EA, Werenski J, Sodhi A, Heng M, Newman ET, Raskin KA, Valerio I, Eberlin KR, Lozano-Calderon S. What Are the Functional and Surgical Outcomes of Tibial Turnup-plasty for Salvage in Patients With Chronic Lower Extremity Infection? Clin Orthop Relat Res. 2023 Jun 1;481(6):1196-1205. doi: 10.1097/CORR.0000000000002536. Epub ahead of print. PMID: 36716090; PMCID: PMC10194532.
    • Merkely G, Leite CBG, Newman ET, Raskin K, Lozano Calderón SA. ASO Visual Abstract: Venous Thromboembolic Event Following Soft Tissue Sarcoma Diagnosis is Associated with the Development of Pulmonary Metastasis. Ann Surg Oncol. 2023 Jun;30(6):3700. doi: 10.1245/s10434-023-13329-2. PMID: 36907965.
    • Melnic CM, Salimy MS, Hosseinzadeh S, Moverman MA, Bedair HS, Lozano-Calderón SA, Raskin KA. Trabecular metal augments in severe malignancy-associated acetabular bone loss. Hip Int. 2023 Jul;33(4):678-684. doi: 10.1177/11207000221110787. Epub 2022 Jul 10. PMID: 35815407.
    • Ray GS, Werth P, Alexander JH, Eward WC, Bernthal NM, Jeys LM, Funovics P, Windhager R, Temple HT, Lozano-Calderon S, Avedian RS, Jutte PC, Ghert M, Ruggieri P, Henderson ER; PARITY Investigators. Surgical Site Infection in Patients Managed with an Endoprosthesis for the Treatment of Cancer: Evaluation of Patient, Disease, and Index Surgical Factors. J Bone Joint Surg Am. 2023 Jul 19;105(Suppl 1):87-96. doi: 10.2106/JBJS.22.01376. Epub ahead of print. PMID: 37466585.
    • Sangadala S, Shore EM, Xu M, Bergwitz C, Lozano-Calderon SA, Lin AE, Boden SD, Kaplan FS. Multifocal heterotopic ossification in a man with germline variants of LIM Mineralization Protein-1 (LMP-1). Am J Med Genet A. 2023 Aug;191(8):2164-2174. doi: 10.1002/ajmg.a.63304. Epub ahead of print. PMID: 37218523.
    • Gonzalez MR, Karczewski D, Bedi ADS, Denwood H, Lozano-Calderon SA. Risk factors for 30-day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study. J Surg Oncol. 2023 Aug;128(2):367-374. doi: 10.1002/jso.27290. Epub ahead of print. PMID: 37079428.
    • Gonzalez MR, Clunk MJ, Bedi ADS, Werenski JO, Lang JH, Karczewski D, Sodhi A, Lozano-Calderon SA. Prognostic and predictive factors in undifferentiated pleomorphic sarcoma: A long-term study from a large tertiary care urban center. J Surg Oncol. 2023 Aug;128(2):322-331. doi: 10.1002/jso.27279. Epub ahead of print. PMID: 37042427.
    • Hoftiezer YAJ, Posada Alvarez C, Werenski JO, Schreuder HWB, Eberlin KR, Lee SG, Lozano-Calderón SA. Salvage of a Fractured Proximal Ulnar Osteoarticular Allograft Using a Medial Femoral Condyle Free Flap: A Case Report. JBJS Case Connect. 2023 Aug 2;13(3). doi: 10.2106/JBJS.CC.22.00796. PMID: 37531445.
    • Rijs Z, Weekhout A, Daniel S, Schoones JW, Groot OQ, Lozano-Calderon SA, van de Sande MAJ. Carbon-fibre plates for traumatic and (impending) pathological fracture fixation: Where do we stand? A systematic review. J Orthop Traumatol. 2023 Aug 11;24(1):42. doi: 10.1186/s10195-023-00724-4. PMID: 37566178; PMCID: PMC10421838.
    • Kelly SP, Ramkumar DB, Crawford B, Lozano-Calderon SA, Gebhardt MC, Anderson ME. Management of limb length discrepancy after bone sarcoma resection about the knee in the skeletally immature. J Pediatr Orthop B. 2023 Sep 11. doi: 10.1097/BPB.0000000000001124. Epub ahead of print. PMID: 37712771.
    • Clunk MJ, Gonzalez MR, Denwood HM, Werenski JO, Sodhi A, Hoffman BA, Merchan N, Lozano-Calderon SA. A PEEK into carbon fiber: A practical guide for high performance composite polymeric implants for orthopaedic oncology. J Orthop. 2023 Sep 29;45:13-18. doi: 10.1016/j.jor.2023.09.011. PMID: 37822644; PMCID: PMC10562613.
    • Karczewski D, Gonzalez MR, Bedi A, Ready JE, Anderson ME, Lozano-Calderon SA. Giant cell-rich osteosarcoma: A match pair analysis of 11 new cases and literature review of 56 patients. J Surg Oncol. 2023 Oct;128(5):877-890. doi: 10.1002/jso.27368. Epub ahead of print. PMID: 37292033.
    • Lozano-Calderon SA, Rijs Z, Groot OQ, Su MW, Werenski JO, Merchan N, Yeung CM, Sodhi A, Berner E, Oliveira V, Bianchi G, Staals E, Lana D, Donati D, Segal O, Marone S, Piana R, Meo S, Pellegrino P, Ratto N, Zoccali C, Scorianz M, Tomai C, Scoccianti G, Campanacci DA, Andreani L, Franco S, Boffano M, Pensado MP, Ruiz IB, Moreno EH, Ortiz-Cruz EJ, van de Sande M. Outcomes of Long Bones Treated With Carbon-Fiber Nails for Oncologic Indications: International Multi-institutional Study. J Am Acad Orthop Surg. 2023 Oct 31. doi: 10.5435/JAAOS-D-22-01159. Epub ahead of print. PMID: 37824083.
    • Salimy MS, Blackburn AZ, Alpaugh K, Lozano-Calderón SA, Bedair HS, Melnic CM. Postoperative Outcomes in Total Hip and Total Knee Arthroplasty for Patients Who Have Multiple Myeloma. J Arthroplasty. 2023 Nov;38(11):2269-2274. doi: 10.1016/j.arth.2023.05.019. Epub ahead of print. PMID: 37211290.
    • Bhashyam AR, Yeung C, Sodhi A, Xu RF, Groot OQ, Kelly S, Lozano-Calderon S. Titanium vs. carbon fiber-reinforced intramedullary nailing for humeral bone tumors. J Shoulder Elbow Surg. 2023 Nov;32(11):2286-2295. doi: 10.1016/j.jse.2023.04.023. Epub ahead of print. PMID: 37263478. Gonzalez MR, Bedi ADS, Karczewski D, Lozano-Calderon SA. Treatment and Outcomes of Fungal Prosthetic Joint Infections: A Systematic Review of 225 Cases. J Arthroplasty. 2023 Nov;38(11):2464-2471.e1. doi: 10.1016/j.arth.2023.05.003. Epub ahead of print. PMID: 37172795.
    • Kamalapathy PN, Gonzalez MR, de Groot TM, Ramkumar D, Raskin KA, Ashkani-Esfahani S, Lozano-Calderón SA. Prediction of 5-year survival in soft tissue leiomyosarcoma using a machine learning model algorithm. J Surg Oncol. 2023 Nov 16. doi: 10.1002/jso.27514. Epub ahead of print. PMID: 37974529.
    • Gonzalez MR, Clunk MJ, Acosta JI, Bedi ADS, Karczewski D, Lozano-Calderon SA. High Rates of Treatment Failure and Amputation in Modular Endoprosthesis Prosthetic Joint Infections Caused by Fungal Infections With Candida. Clin Orthop Relat Res. 2023 Nov 21. doi: 10.1097/CORR.0000000000002918. Epub ahead of print. PMID: 37988003.
    • Pal R, Lwin TM, Krishnamoorthy M, Collins HR, Chan CD, Prilutskiy A, Nasrallah MP, Dijkhuis TH, Shukla S, Kendall AL, Marshall MS, Carp SA, Hung YP, Shih AR, Martinez-Lage M, Zukerberg L, Sadow PM, Faquin WC, Nahed BV, Feng AL, Emerick KS, Mieog JSD, Vahrmeijer AL, Rajasekaran K, Lee JYK, Rankin KS, Lozano-Calderon S, Varvares MA, Tanabe KK, Kumar ATN. Fluorescence lifetime of injected indocyanine green as a universal marker of solid tumours in patients. Nat Biomed Eng. 2023 Dec;7(12):1649-1666. doi: 10.1038/s41551-023-01105-2. Epub ahead of print. PMID: 37845517.
    • Gonzalez MR, Bedi A, Karczewski D, Lozano-Calderon SA. Are Pathologic Fractures in Patients With Osteosarcoma Associated With Worse Survival Outcomes? A Systematic Review and Meta-analysis. Clin Orthop Relat Res. 2023 Dec 1;481(12):2433-2443. doi: 10.1097/CORR.0000000000002687. Epub ahead of print. PMID: 37184541; PMCID: PMC10642876.
    • Thomas NP, Pierce TT, Ozturk A, Lee SJ, Crawford B, Hennessy DW, Park A, Sagar P, Heng M, Lozano Calderón S. Assessment of the added value of intravenous gadolinium for knee osteosarcoma resection planning in pediatric and young adult patients. J Surg Oncol. 2023 Dec;128(7):1190-1194. doi: 10.1002/jso.27415. Epub ahead of print. PMID: 37525571.
    • Karczewski D, Gonzalez MR, Bedi A, Newman E, Raskin K, Anderson ME, Lozano-Calderon SA. Dual Mobility for Oncological Hip Reconstruction: Significantly Reduced Dislocation Rates at 5 years. J Am Acad Orthop Surg. 2023 Dec 5. doi: 10.5435/JAAOS-D-23-00608. Epub ahead of print. PMID: 38052029.
    • Denwood H, Gonzalez MR, Sodhi A, Werenski J, Clunk M, Newman ET, Lozano-Calderón SA. Risk factors for local recurrence of upper extremity desmoid tumors. J Surg Oncol. 2023 Dec 10. doi: 10.1002/jso.27559. Epub ahead of print. PMID: 38073165.
    • Larque AB, Lozano-Calderon S, Cote GM, Chen YL, Hung YP, Deshpande V, Nielsen GP, Chebib I. Multivariate evaluation of prognostic markers in synovial sarcoma. J Clin Pathol. 2023 Dec 14;77(1):16-21. doi: 10.1136/jcp-2022-208518. PMID: 36288948.

    See our publications from 2021-2023.

    See our active protocols (updated January 2024).

    See our presentations from 2021-2023.

    Video: Why train with us?