Cancer and Clinical Services Patient Stories

A rare sarcoma was not part of the plan.

Stephen Pupillo had just completed his medical residency when he experienced a seizure in the fall of 2018. Further tests revealed three spots in his brain, which indicated metastatic cancer that originated from alveolar soft part sarcoma (ASPS) on his left thigh.

“Traditional chemo wasn’t a viable option,” Stephen says. “Honestly, the outcomes for this kind of sarcoma were grim.” Understanding the limitations of more standard treatment, Stephen’s oncologist in Youngstown recommended he see the sarcoma specialists at OSUCCC – James.

“Fortunately, I had quite the team,” Stephen says.

Treatment began on several fronts. Because two of the three masses in his brain were too deep for surgical removal, Stephen was first given functional radiosurgery or stereotactic brain radiation by his radiation oncologist, Dr. Joshua Palmer, MD. This is a high-tech method for delivering precise radiation beams that can provide the same benefits of more invasive procedures but with fewer side effects. Based on the pathology of his disease, Stephen’s medical oncologist at the James, David Liebner, MD, also recommended immunotherapy, which harnesses an individual's immune system to attack the cancer.

The response to both treatments was incredibly positive. Following radiation, Stephen was ready for a craniotomy, a type of brain surgery that was performed by Bradley Elder, MD, to remove the largest of the tumors. After six months of immunotherapy, the mass on his thigh was also reduced enough that Stephen could undergo a limb reconstruction surgery called free vascularized fibular grafting. For this microsurgical procedure, a team from plastic surgery and ortho-oncology cut the healthy fibula from Stephen’s leg and used it to replace the diseased portion of his femur, placing a titanium rod between the two sections. They also reconnected his blood vessels to the newly grafted bone to keep it alive and growing. “My recovery from both surgeries and radiation was remarkable. It did take the expected time, but thankfully I have no major symptoms or residual side effects – I’m able to continue living an active life,” he says.

“Through all of this, I was a doctor in a patient’s bed. To experience medicine from the other side, to understand that your life is in someone else’s hands – to have to trust them – gave me a new perspective.”

He notes the incredible teamwork at the James, which he continues to appreciate during his required follow up visits. “That’s made a huge impression on my family and myself,” Stephen says. “Every doctor I’ve seen already knows my case, and it’s clear that they’ve collaborated because everyone is on the same page. The support I received from my oncology team extended to my family too, in that my wife was and is very involved. They take the time to explain treatments to us both, answer all questions we have and make sure we are well cared for at every visit.

“They’re also incredibly accommodating for my appointments. There’s a 2 ½ hour commute one way for every visit and they do a great job coordinating multiple appointments for the same day. It just makes it so much easier to manage routine follow ups, a full-time job and family.”

Stephen adds the advantage of specialized clinics at the James. “Having a focused Sarcoma Clinic means everyone there, including the nurses and office staff, are really knowledgeable about my specific disease,” he says. “They usually address my concerns before I know I even have any.”

But it’s not only Ohio State’s medical expertise and advanced technology that Stephen appreciates. “There’s such positive energy everywhere at the James,” he says. “They understand the stress of a life-altering diagnosis and really support you holistically as a patient. I wouldn’t want to go through what I did anywhere else.”