LAMON (Lagos Muscoskeletal Oncology Network) was established in 2012 as a model for improving cancer care in resource-poor countries like Nigeria. It aims to improve care pathways for sarcoma patients, make efficient use of limited resources, and follow international guidelines. In its first 30 months, LAMON reviewed 212 patients, achieved a definitive diagnosis in 91% of cases, and performed limb salvage surgery in 67% of appropriate cases. LAMON demonstrates that a collaborative multidisciplinary network can help address challenges like late presentations and limited facilities in developing healthcare systems. Ongoing challenges include rising cancer rates, complex revision surgeries, and securing long-term funding.

1. IMPROVING OUTCOME FOR
MUSCULOSKELETAL TUMOURS:
The Journey So Far
SEYI IDOWU FWACS FMCS
Based on a presentation at the ISOLS/MSTS Conference in
Orlando, Florida Oct 2015.

2. !
Introduction: Challenges
" Late presentation
" Limited facilities (2 bone
scans for population of 170
million)
" Limited number of
specialists and inadequate
funding
" Services divided along
geographical lines

3. !" Coastal city along west
Africa Coast
" Most populous city in
Africa
" 17 million people (10%
of Nigerian population)
" No dedicated sarcoma
MDT prior to 2012
Introduction - Lagos

5. LAMON
LAgos Muscoskeletal
Oncology Network
A model for Cancer Care in
Resource Poor Countries

6. LAMON

7. !
AIMS OF LAMON
" Improve the care pathway for patients with sarcoma
" Improve efficient use of scarce resources
" Encourage adherence as much as possible to published
national and international guidelines
" Decisions for holistic care plan – diagnosis, radiotherapy,
chemotherapy, surgery and timing of interventions

8. !
" 212 patients reviewed in 1st 30 months
" Definitive histological diagnosis in 192 patients (91%)
" Age range: 3 – 95 years
" Tumour Locations:
! Extremity 82% Central: 18%

9. LAMON
" Diagnosis
! Osteosarcoma – 22%;
! Giant cell tumour – 13%
! Soft tissue sarcoma – 11%
! Metastatic bone disease – 8%
! Other benign lesions
" Limb preservation rate 67%
" Local recurrence rate 8.5%

10. !
10 year old girl with huge osteosarcoma right femur. Late presentation on account of
traditional bone setters precluded limb salvage. Unfortunately required emergency
amputation and chemotherapy
Picture of
amputated stump
Preoperative X-
ray

11. !
30 yr old lady with recurrent GCT distal femur

14. !
ID AGE IN YRS SEX INDICATIONS SYMPTOMS
INTERVAL IN
MONTHS
RESECTION
LENGTH IN CM
PROSTHESIS COMPLICATIONS MSTS SCORE
1 82 F non union hip # with
osteolysis
5 12 RESTOR PFEPR none 60
2 54 F failed DHS for hip # 24 18 RESTOR PFEPR SSI 96
3 58 M pathological # hip secondary
to C.A.P
4 14 RESTOR PFEPR none 70
4 68 M fibrous dysplasia 3 14 RESTOR PFEPR none 96
Proximal Femoral Endoprosthetic Replacement

15. !ID AGE YRS SEX INDICATION SYMPTOMS
INTERVAL IN
MONTHS
RESECTION
LENGTH IN
CM
TYPE OF
PROSTHESIS
COMPLICATIO
NS
MSTS SCORE
IN %
1 28 F GCT 60 17 RESTOR DFEPR SSI 86
2 32 M GCT TENDON
SHEATH
6 15 IMPOL DFEPR NONE 93
3 4 M PLASMACYTO
MA
84 24 IMPOL DFEPR POPLITEAL
ARTERY
THROMBOSIS .
WOUND
DEHISCENCE.
A/K
AMPUTATION
24
4 55 M NON UNION
DISTAL
FEMORAL #
WITH BONE
LOSS
18 20 RESTOR DFEPR DVT 86
Distal Femoral Endoprosthetic Replacement

16. !ID AGE YRS SEX INDICATION SYMPTOMS
INTERVAL IN
MONTHS
RESECTION
LENGTH IN
CM
TYPE OF
PROSTHESIS
COMPLICATIO
NS
MSTS SCORE
IN %
1 63 M INFECTED TKR 14 12 RESTOR PTEPR NONE 93
2 21 M OSTEOSARCO
MA
6 24 RESTOR PTEPR LOOSENING
OF THE HINGE
MECHANISM
86
Proximal Tibial Endoprosthetic Replacement

17. !
ONGOING CHALLENGES

18. !
" Rising life expectancy of cancer
patients
" Main factors include; 1. primary
histology 2. potential instability 3.
neural compression
" Multidsciplinary collaboration is
required
" Median survival of patients with
spinal metastatic disease is 10 months.
" The morbidity of spinal metastatic
disease is important, especially in
patients with paralysis and/or bowel
and bladder involvement.
" Cord compression is normally seen as
preterminal event.
" Median survival at that stage is about
3 months.

19. !
Pelvic MRI cont.
• The lesion is displacing th
e
caecum and colon superior
ly
• Bilateral hip joints, femor
al heads, neurovascular
structures and
sacroiliac joint space appe
ar normal
• No hip joint effusion is see
n

20. !
• Pelvic MRI
• Large lobulated expansile
lesion arising from the anter
ior cortex of the right iliac
bone with extensive
periosteal
reaction and excessive bone
formation
• It appears heterogenously
hyperintense on T2 and hyp
ointense on T1 images
• It measures
approximately 17.5x 9.0 x 1
7.4 cm..
• It invades the surrounding
iliacus muscle and displacin
g it anteriorly

21. !
" Establish a formal referral pathway: Grants
applications!!!
" Funding for MDT: NGO ——MONSUF
" Funding for investigations and specialist care
" Funding for specialist training
Ongoing challenges

22. !
" The network resulted in improvement in diagnosis,
limb salvage rate and follow up care for
musculoskeletal tumours and other conditions.
" Perhaps, with appropriate social and corporate
support, communal tumour boards like LAMON may
translate into model for multidisciplinary cancer care
in resource poor countries
DISCUSSION