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Soccer player Nick Manzoni returns to the field after battle with Ewing sarcoma

“There was a chance I wouldn’t play again, but I didn’t want cancer to take anything away from me.”
After years of treatment and rehabilitation following his battle with Ewing sarcoma, star soccer player Nick Manzoni (left) was once again able to compete. Manzoni credits University of Minnesota Health Orthopaedic Surgeon Denis Clohisy, MD, with helping him return to the field.

2011 was supposed to be Nick Manzoni’s year.

A star soccer player at Orono High School—and at the time widely considered one of the best high school soccer players in Minnesota—Nick and his teammates had their eyes on the state tournament.

“We were right up there with any of the teams in the division,” Nick said. “We were going to make a run at it.”

But in the months leading up to the fall season, Nick, then 17 years old, began experiencing swelling and pain in his right calf. When the pain worsened, he and his family visited a pediatrician, and then an orthopaedic specialist. An MRI revealed a mass in his calf, and after a follow biopsy, Nick was diagnosed with Ewing sarcoma.

“My first thought, right after they told me, was: ‘What’s going to happen with soccer? Will I be able to play a couple of games that season?’”

Decades of research

Days after the biopsy and diagnosis, Nick and his family met with Pediatric Hematologist/Oncologist Brenda Weigel, MD, at University of Minnesota Masonic Children’s Hospital. The news she delivered was mixed: Fortunately, Nick’s cancer had not metastasized beyond his right calf. But playing soccer that fall was out of the question.

Nick began a three-month chemotherapy regimen at Masonic Children’s Hospital in preparation for a surgery to remove the tumor. After surgery, he would endure an additional six months of chemo. Nick’s treatment came in the wake of a recently released clinical study, which found frequent chemotherapy treatment, with sessions occurring every two weeks instead of the previous standard of three weeks, improved patient outcomes.

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Weigel and other members of Nick’s care team adopted this new standard. The innovative approach worked: The tumor shrunk dramatically before his surgery.

“Nick benefited from a whole lot of knowledge that came before him,” Weigel said. “Decades ago, survival rates for Ewing sarcoma were between 20 and 30 percent. Now, the survival rate is higher than 80 percent if the cancer has not spread.”

Saving Nick’s Leg

The successful chemotherapy set the stage for Nick’s surgery. Ewing sarcoma often originates within leg bones, and surgeons are sometimes required to remove some or all of the affected bone. In Nick’s case, the cancer was clustered in the muscle tissue around his tibia—rather than the bone itself. Chemotherapy had caused the tumor to recede, but scans and testing showed it still pressed up against the surface of the bone.

Nick’s surgeon, Orthopaedic Surgeon Denis Clohisy, MD, knew he would need to remove a portion of Nick’s tibia to ensure that none of the cancer cells remained. Rather than removing a segment across the entire width of the bone, however, Clohisy and his team opted to take only the tumor and the adjacent side of Nick’s tibia. This approach left the other side of the bone—the side facing away from the tumor—intact. Clohisy and his team then grafted a portion of a donor’s bone—cut to match the extracted piece—onto Nick’s tibia, essentially making the bone whole again.

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Nick credits Clohisy with saving his leg—and helping him retain his ability to play soccer.

“The surgery was so impressive. Most doctors would have taken out the full bone and replaced it,” Nick said. “But Dr. Clohisy was able to cut the bone perfectly.”

And Clohisy, in turn, says Nick’s determination was more important.

“In spite of the challenges posed by chemotherapy treatment, Nick kept his drive. He didn’t want to lose any ground to cancer,” Clohisy said.

Nick stayed on the sidelines his senior season, and spent two years in rehab to strengthen his leg so that he could continue to play soccer in college. Five years after his diagnosis, he now plays on the Drake University team, where he averages 30-40 minutes of play time each game. This year, he and several friends also received an entrepreneurial grant to develop a smartphone app for teaching soccer tactics.

 “Without somebody like Dr. Clohisy working on me, I wouldn’t have been able to get back to where I am,” Manzoni said. “There was a chance I wouldn’t play again, but I didn’t want cancer to take anything away from me.”