Bio

Bio


Dr. Steffner specializes in the evaluation, diagnosis, and treatment of bone and soft tissue tumors in pediatric and adult patients. This includes primary bone and soft tissue sarcomas, locally active conditions such as giant cell tumor, aneurysmal bone cyst, and chondroblastoma, as well as impending and pathologic fractures from metastatic carcinoma, multiple myeloma, and lymphoma. He works with an exceptional multidisciplinary group of physicians at the Stanford Cancer Center to provide coordinated, highly specialized treatment strategies. Dr. Steffner also maintains an interest in orthopaedic fracture surgery from trauma.

Research interests include large database outcome studies for rare tumors and metastatic disease, basic science collaboration on systemic treatment strategies for soft tissue sarcoma, and the development of novel surgical techniques.

Clinical Focus


  • Orthopaedic Surgery

Academic Appointments


Boards, Advisory Committees, Professional Organizations


  • Board Certified, American Board of Orthopaedic Surgery (ABOS) (2015 - Present)
  • Fellow, American Academy of Orthopaedic Surgeons (AAOS) (2015 - Present)
  • Member, Children’s Oncology Group (COG) (2015 - Present)
  • Candidate Member, Musculoskeletal Tumor Society (MSTS) (2013 - Present)
  • Faculty Member, AO Trauma (2013 - Present)

Professional Education


  • Oncology Fellowship, University of Chicago, Chicago IL, Department of Orthopaedic Surgery (2013)
  • Trauma Fellowship, University of California-Davis, Sacramento CA, Department of Orthopaedic Surgery (2012)
  • Residency, University of Chicago, Chicago IL, Department of Orthopaedic Surgery (2011)
  • Doctor of Medicine, Wayne State School of Medicine, Detroit MI, Medicine (2006)
  • Bachelor of Arts, Saint John’s University, Collegeville, MN, Natural Sciences and English (2001)

Teaching

Graduate and Fellowship Programs


  • Oncology (Fellowship Program)

Publications

All Publications


  • Conservative management of desmoid tumors is safe and effective. journal of surgical research Park, J. S., Nakache, Y., Katz, J., Boutin, R. D., Steffner, R. J., Monjazeb, A. M., Canter, R. J. 2016; 205 (1): 115-120

    Abstract

    Surgical resection of desmoid tumors has traditionally been the mainstay of therapy, but this is a potentially morbid approach with high rates of recurrence. Given increasing reports of active surveillance in this disease, we sought to evaluate our experience with conservative management hypothesizing this would be an effective strategy.Using a prospectively maintained database of sarcoma patients from 2008 to 2015, we identified 47 patients with a diagnosis of desmoid tumor from all anatomic sites. Data points were abstracted on clinical and pathologic factors, disease stability or progression, and follow-up time. Main outcome measurements were tumor recurrence after surgical resection versus tumor progression with conservative management.In our cohort, 20 patients were managed with surveillance, 24 patients with surgery, and three patients with other approaches. Clinical and tumor characteristics between treatment groups were not significantly different. With a median follow-up of 35.7 mo, there was one complete regression, five partial regressions, and 13 stable diseases among the surveillance group. Only one patient under observation progressed, crossing over to surgical resection. Among 24 patients managed with surgery, 13 patients developed local recurrence. Kaplan-Meier analysis revealed a statistically superior progression-free survival in the surveillance group (P = 0.001).This retrospective analysis adds to the growing body of evidence that observation of desmoid tumors is safe and effective with high rates of stable disease. These data further support an initial conservative approach to desmoid tumors that may spare patients the morbidity and risk of recurrence that accompanies potentially extensive operations.

    View details for DOI 10.1016/j.jss.2016.06.028

    View details for PubMedID 27621007

  • Emerging Concepts in Upper Extremity Trauma Humeral Shaft Fractures ORTHOPEDIC CLINICS OF NORTH AMERICA Steffner, R. J., Lee, M. A. 2013; 44 (1): 21-?

    Abstract

    Fractures of the humeral shaft are common in low-energy and high-energy trauma, and optimal clinical management remains controversial. Nonsurgical management has been supported as the preferred treatment based on high union rates and minimal functional deficit due to a rich vascular supply from overlying muscle and the wide motion available at the glenohumeral joint. Recent studies of nonoperative management have challenged surgeons' understanding of these fractures and the perception of favorable outcomes. Current considerations support expanded operative indications with traditional open-plate fixation and with the use of minimally invasive techniques, implants, and a reconsideration of intramedullary nailing.

    View details for DOI 10.1016/j.ocl.2012.08.005

    View details for Web of Science ID 000313135100004

    View details for PubMedID 23174323

  • Humeral shaft fractures. Current reviews in musculoskeletal medicine Spiguel, A. R., Steffner, R. J. 2012; 5 (3): 177-183

    Abstract

    Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

    View details for DOI 10.1007/s12178-012-9125-z

    View details for PubMedID 22566083

  • Surgical Intervention of Nonvertebral Osseous Metastasis CANCER CONTROL Attar, S., Steffner, R. J., Avedian, R., Hussain, W. M. 2012; 19 (2): 113-121

    Abstract

    Nonvertebral osseous metastases can result in pain and disability. The goals of surgical intervention are to reduce pain and to improve function if nonsurgical treatment fails. The indications for proceeding with surgical intervention depend on anatomic location, amount of local destruction, extent of skeletal and visceral disease and, most important, the patient's performance status and life expectancy.This article reviews the evaluation and treatment of metastatic nonvertebral osseous lesions from the perspective of the orthopedic surgeon, based mainly on an assessment of the surgical literature.This article summarizes the approaches to preoperative evaluation, patient selection, and medical optimization. Guidelines for estimating osseous stability and fracture risk are discussed, and surgical implants and their relation to postoperative outcomes are examined. This review also describes less invasive ablative procedures currently available.The surgical management of nonvertebral osseous metastases involves multidisciplinary collaboration. The surgical construct must be a stable, reliable, and durable intervention that is individually tailored and matched to a patient's prognosis and performance status.

    View details for Web of Science ID 000307969100005

    View details for PubMedID 22487973

  • Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? journal of bone and joint surgery. American volume Steffner, R. J., Liao, C., Stacy, G., Atanda, A., Attar, S., Avedian, R., Peabody, T. D. 2011; 93 (21): e1221-9

    Abstract

    Our goal was to assess the effectiveness and safety of argon beam coagulation as an adjuvant treatment for primary aneurysmal bone cysts, to reevaluate the adjuvant effectiveness of the use of a high-speed burr alone, and, secondarily, to identify predictors of aneurysmal bone cyst recurrence.We retrospectively reviewed the records of ninety-six patients with primary aneurysmal bone cysts who were managed at our institution from January 1, 1983, to December 31, 2008. Forty patients were managed with curettage, a high-speed burr, and argon beam coagulation; thirty-four were managed with curettage and a high-speed burr without argon beam coagulation; and the remaining twenty-two were managed with curettage with argon beam coagulation alone, curettage with no adjuvant treatment, or resection of the entire lesion. Demographic, clinical, and radiographic data were viewed comparatively for possible predictors of recurrence. Kaplan-Meier survival analysis with a log-rank test was performed to measure association and effectiveness.The median age at the time of diagnosis was fifteen years (range, one to sixty-two years). The median duration of follow-up was 29.5 months (range, zero to 300 months). The overall rate of recurrence of aneurysmal bone cyst after surgical treatment was 11.5%. The rate of recurrence was 20.6% after curettage and high-speed-burr treatment alone and 7.5% after curettage and high-speed-burr treatment plus argon beam coagulation. The five-year Kaplan-Meier survival estimate was 92% for patients managed with curettage and adjuvant treatment with a high-speed burr and argon beam coagulation, compared with 73% for patients managed with curettage and a high-speed burr only (p = 0.060).Surgical treatment of aneurysmal bone cyst with curettage and adjuvant argon beam coagulation is effective. Postoperative fracture appears to be a common complication of this treatment and needs to be studied further. Treatment with curettage and high-speed burr alone may not reduce recurrence.

    View details for DOI 10.2106/JBJS.J.01067

    View details for PubMedID 22048101

  • Aneurysmal Bone Cyst Steffner, R. J., Avedian, R., Peabody, T. American Academy of Orthopaedic Surgeons. Orthopaedic Knowledge Online (OKO).. 2009

    Abstract

    Steffner R, Avedian R, Peabody T. Aneurysmal Bone Cyst. American Academy of Orthopaedic Surgeons. Orthopaedic Knowledge Online (OKO). 2009: http://www5.aaos.org/oko/description.cfm?topic=ONC013. Accessed May 21, 2009

  • Ascorbic acid recycling by cultured beta cells: Effects of increased glucose metabolism FREE RADICAL BIOLOGY AND MEDICINE Steffner, R. J., Wu, L., Powers, A., May, A. M. 2004; 37 (10): 1612-1621

    Abstract

    Ascorbic acid is necessary for optimal insulin secretion from pancreatic islets. We evaluated ascorbate recycling and whether it is impaired by increased glucose metabolism in the rat beta-cell line INS-1. INS-1 cells, engineered with the potential for overexpression of glucokinase under the control of a tetracycline-inducible gene expression system, took up and reduced dehydroascorbic acid to ascorbate in a concentration-dependent manner that was optimal in the presence of physiologic D-glucose concentrations. Ascorbate uptake did not affect intracellular GSH concentrations. Whereas depletion of GSH in culture to levels about 25% of normal also did not affect the ability of the cells to reduce dehydroascorbic acid, more severe acute GSH depletion to less than 10% of normal levels did impair dehydroascorbic acid reduction. Culture of inducible cells in 11.8 mM D-glucose and doxycycline for 48 h enhanced glucokinase activity, increased glucose utilization, abolished D-glucose-dependent insulin secretion, and increased generation of reactive oxygen species. The latter may have contributed to subsequent decreases in the ability of the cells both to maintain intracellular ascorbate and to recycle it from dehydroascorbic acid. Cultured beta cells have a high capacity to recycle ascorbate, but this is sensitive to oxidant stress generated by increased glucose metabolism due to culture in high glucose concentrations and increased glucokinase expression. Impaired ascorbate recycling as a result of increased glucose metabolism may have implications for the role of ascorbate in insulin secretion in diabetes mellitus and may partially explain glucose toxicity in beta cells.

    View details for DOI 10.1016/j.freeradbiomed.2004.07.032

    View details for Web of Science ID 000224792100010

    View details for PubMedID 15477012

  • Oxidative stress is a mediator of glucose toxicity in insulin-secreting pancreatic islet cell lines JOURNAL OF BIOLOGICAL CHEMISTRY Wu, L., Nicholson, W., Knobel, S. M., Steffner, R. J., May, J. M., Piston, D. W., Powers, A. C. 2004; 279 (13): 12126-12134

    Abstract

    Pancreatic beta cells secrete insulin in response to changes in the extracellular glucose. However, prolonged exposure to elevated glucose exerts toxic effects on beta cells and results in beta cell dysfunction and ultimately beta cell death (glucose toxicity). To investigate the mechanism of how increased extracellular glucose is toxic to beta cells, we used two model systems where glucose metabolism was increased in beta cell lines by enhancing glucokinase (GK) activity and exposing cells to physiologically relevant increases in extracellular glucose (3.3-20 mm). Exposure of cells with enhanced GK activity to 20 mm glucose accelerated glycolysis, but reduced cellular NAD(P)H and ATP, caused accumulation of intracellular reactive oxygen species (ROS) and oxidative damage to mitochondria and DNA, and promoted apoptotic cell death. These changes required both enhanced GK activity and exposure to elevated extracellular glucose. A ROS scavenger partially prevented the toxic effects of increased glucose metabolism. These results indicate that increased glucose metabolism in beta cells generates oxidative stress and impairs cell function and survival; this may be a mechanism of glucose toxicity in beta cells. The level of beta cell GK may also be critical in this process.

    View details for DOI 10.1074/jbc.M307097200

    View details for Web of Science ID 000220334900018

    View details for PubMedID 14688272