Bone and Soft Tissue Tumor Center of the University of Basel (KWUB)

With the official cooperation between the University Children’s Hospital and the University Hospital Basel regarding bone and soft tissue sarcoma treatment, sarcoma patients of all ages can be treated in an interdisciplinary way by the Bone and Soft Tissue Tumor Center of the University of Basel (KWUB) in a correspondingly highly qualified clinical structure.

In 2005, Prof. Dr. F. Hefti and Prof. Dr. G. Jundt founded the interdisciplinary Bone and Soft Tissue Tumor Center at the University of Basel (KWUB) (as the first such institution in Switzerland).

With the signing of the Intercantonal Agreement on Highly Specialized Medicine (IVHSM) in 2009, all cantons in Switzerland committed themselves to joint planning and allocation of highly specialized medicine (HSM). The joint planning of highly specialized medicine (HSM) is carried out with a view to providing needs-based, high-quality and economically viable medical care. The concentration of highly specialized treatments and interventions contributes to the improvement of treatment quality.

The foundation of the Bone – and Soft Tissue Tumor Center of the University of Basel (KWUB) with the gathering of clinical specialists in an interdisciplinary circle pursues this above described Highly Specialized Medicine already 4 years before the decision of the politicians. Here, children and adults with tumors of the musculoskeletal system can be optimally treated in the sense of highly specialized medicine (HSM). This tends to result in fewer complications and improves the survival chances of the patients concerned. In addition, unnecessary transfers can be avoided and valuable time gained for optimal treatment. Optimized primary care leads to lower costs for treatment and follow-up care. As a result, significant economic cost savings can also be expected in the long term.

The main goal is to establish and expand the KWUB, which provides the latest knowledge to patients and accompanies them in an interdisciplinary clinical board. Since 2009, KWUB has been one of only four interdisciplinary treatment centers in Europe recognized by the International Working Group on Bone Tumors (AGKT) and the only one in Switzerland.

The KWUB consists of the Surgery of Bone and Soft Tissue Tumors (Prof. Dr. C. Kettelhack Stv. CA USB (Head KWUB); PD Dr. A. Krieg, LA UKBB (Head KWUB); Prof. Dr. F. Hefti, Consultant UKBB), Plastic Surgery (PD Dr. M. Haug, Deputy CA USB), Radiology (Dr. F. Prüfer, LA UKBB; Dr. D. Harder, LA USB; Dr. T. Wischer and PD Dr. U. Studler, external clinics), pathology (Prof. Dr. D. Baumhoer, LA USB; Prof. Dr. G. Jundt, Consultant USB), medical oncology (Dr. F. Krasniqi, OÄ USB), pediatric oncology (Prof. Dr. Th. Kühne, LA UKBB; Prof. Dr. N. von der Weid, CA UKBB; PD Dr. K. Scheinemann, LA KS Aarau and Dr. F. Schilling, LA KS Luzern) as well as Radiation Oncology (PD Dr. M. Gross, LA USB). This group meets regularly at the University Children’s Hospital of Basel (UKBB) to discuss and determine the treatment plan for sarcoma patients. Patients from external hospitals from the cantons of Aarau, Solothurn, Jura, Lucerne, Ticino as well as from the region of South Baden (D) are also discussed.

External consultation hours are held by the tumor orthopedists PD Dr. A. Krieg and Prof. Dr. F. Hefti in the hospitals of Lörrach, Aarau, Lucerne and Locarno and own referral consultation hours from Langenthal, Olten, Brig, Visp, etc.. Most of these consultations have been established for over 20 years.

Thus, for many years, sarcoma patients from the above-mentioned cantons have been discussed oncologically at the center (KWUB), treated decentrally with medication close to home, and treated for optimal surgical therapy at the center.

The increasing numbers of patients treated by the KWUB over the years show the success and the necessity of such a center:

Another goal of the KWUB is translational research so that our patients can benefit from the latest diagnostic, predictive and therapeutic options:

Reviewed and approved by the Ethics Committee of both Basel (EKBB), tumor and blood samples are preserved after thorough patient education and consent in order to be available for further molecular investigations. In-house as well as national (e.g. in cooperation with ETH Zurich) and international (e.g. International Cancer Genome Consortium (ICGC, Wellcome Trust Sanger Institute, Hinxon, UK) or Clinical Cooperation Group Osteosarcoma (Helmholtz Zentrum München, D)) research projects are supported and designed. Research projects supported and designed. The focus of all scientific studies is the translational translation of basic research into clinical application (“from bench to bedside”), where new diagnostic and predictive options will be uncovered and potentially new therapeutic targets will be identified. Of course, patients are absolutely free to make their tissue available for scientific research.

With regard to complex tumor surgery, we are developing computer-aided diagnostics and surgical planning using fusion of multimodal data (CT, MRI, angio-MR and PET) and 3D visualization of tumor topography with regard to intraoperative navigation (see Fig. 1).

Fig. 1. 3D visualization of fused CT and MR images showing the exact localization of the tumor (green) in the bony and important soft tissue (e.g. artery) environment.

Replacement of bony parts of the pelvis (especially involving the hip joint) after major resection is still one of the most unsatisfactorily solved problems in musculoskeletal tumor surgery. Therefore, the aim of one of our research projects in tumor orthopedics is the individual fabrication of computer-formed scaffolds for bridging defects after tumor resections (see Fig. 2). The scaffolds are intended to function as guide rails for biological remodeling by the patient’s own bone cells from the resection margins, supported by methods of “tissue engineering” (see Fig. 3). Thus, a biological and long-term stable solution at the pelvis after tumor resections shall be established.

Fig. 2 Optimization of the scaffold design process based on the experience gained in the initial planning and experiments with the surface processing methods as well as with the application of forces and mechanical stresses.

Fig. 3. biomechanical tests of the pelvis without scaffold (left). Scaffold design with a place for a bioreactor in the titanium mesh area (right).

Clinical studies deal with the specially offered surgical techniques:

Techniques that are particularly specialized nationally and throughout Europe include reimplantation of the patient’s own bone after extracorporeal radiation (1 of 4 centers in Europe), reverse plasty (1 of 2 centers in Switzerland), and isolated hyperthermic limb perfusion in patients with locally advanced soft tissue sarcomas (1 of 2 centers in Switzerland).

The aim of the Bone and Soft Tissue Tumor Center in Basel is to provide clinical oncological expertise to every patient with bone or soft tissue sarcomas within an interdisciplinary team, thus further developing a supra-regional center linked to other national and European sarcoma groups.