Treatment Of Bone Tumors Research Articles

Conservative surgery with microwave ablation for recurrent bone tumor in the extremities: a single-center study

BackgroundSurgical treatment for recurrent bone tumors in the extremities still presents a challenge. This study was designed to evaluate the clinical value of microwave ablation in the treatment of recurrent bone tumors.MethodsWe present 15 patients who underwent microwave ablation for recurrent bone tumors during the last 7 years. The following parameters were analyzed for outcome evaluation: general condition, surgical complications, local disease control, overall survival, and functional score measured using the Musculoskeletal Tumor Society (MSTS) 93 scoring system.ResultsPercutaneous microwave ablation in one patient with osteoid osteoma and another with bone metastasis resulted in postoperative pain relief. Thirteen patients received intraoperative microwave ablation before curettage or resection, including those with giant cell tumors of bone (6), chondroblastoma (2), osteosarcoma (2), undifferentiated sarcoma (1), and bone metastases (2). All patients achieved reasonable local tumor control in the mean follow-up of 29.9 months. The functional score was 24.1 for the 15 patients 6 months after the operation. Four patients had tumor metastasis and died, whereas 3 patients with tumors survived, and the remaining 8 patients without the disease survived.ConclusionsMicrowave ablation represents an optional method for local control in treating recurrent bone tumors in the extremities.

Classification and reconstruction of femoral bone defect in the revision of aseptic loosening of distal femoral endoprostheses: a 10-year multicenter retrospective analysis

ObjectiveThis study proposes a system for classifying the aseptic loosening of distal femoral endoprostheses and discusses reconstruction methods for revision surgery, based on different classification types.MethodsWe retrospectively analyzed the data of patients who received revision surgery for aseptic loosening in distal femoral tumor endoprosthesis from January 2008 to December 2020 at 3 bone tumor treatment centers in China. Based on the patient imaging data, we proposed a classification system for the aseptic loosening of distal femoral endoprostheses and discussed its revision surgery strategy for various bone defects.ResultsA total of 31 patients were included in this study, including 21 males and 10 females aged 15–75 y (average: 44.3 y). First-revision surgery was performed on 24 patients, whereas second-revision surgery was conducted on 7 patients. The 31 patients were classified into different types based on the degree of aseptic loosening: Type I, 12 patients (38.7%); Type IIa, 7 patients (22.5%); Type IIb, 7 patients (22.5%); Type III, 4 patient (12.9%); and Type IV, 1 patient (3.2%). For type I, 11 patients underwent revisions with standard longer-stem prostheses (one with the original prosthesis), and one patient had the original prosthesis plus cortical allograft strut. For type II (a and b), 10 patients underwent revisions with original prosthesis or longer-stem prosthesis and 4 patients combined with cortical allograft strut. For type III, one patient underwent revision with a longer-stem prosthesis and the other 3 patients with a custom short-stem prosthesis. For type IV, only one patient underwent revision with a custom short-stem prosthesis.ConclusionsAseptic loosening of the distal femoral prosthesis can be divided into 4 types: type I, type II (a, b), type III and type IV. The reconstruction methods of our centers for different types of bone defects can offer some reference value in the revision of aseptic loosening.

Thermal Evaluation of Multi-Antenna Systems Proposed to Treat Bone Tumors: Finite Element Analysis.

Microwave ablation is commonly used in soft tissue tumors, but its application in bone tumors has been barely analyzed. Antennas to treat bone tissue (~3 cm2), has been lately designed. Bone tumors at pathological stage T1 can reach 8 cm wide. An antenna cannot cover it; therefore, our goal is to evaluate the thermal performance of multi-antenna arrays. Linear, triangular, and square configurations of double slot (DS) and monopole (MTM) antennas were evaluated. A parametric study (finite element method), with variations in distance between antennas (ad) and bone thickness (bt) was implemented. Array feasibility was evaluated by SWR, ablated tissue volume, etc. The linear configuration with DS and MTM antennas showed SWR ≤ 1.6 for ad = 1 mm–15 mm and bt = 20 mm–40 mm, and ad = 10 mm–15 mm and bt = 25 mm–40 mm, respectively; the triangular showed SWR ≤ 1.5 for ad = 5 mm–15 mm and bt = 20 mm–40 mm and ad = 10 mm–15 mm and bt = 25 mm–40 mm. The square configuration (DS) generated SWR ≤ 1.5 for ad = 5 mm–20 mm and bt = 20 mm–40 mm, and the MTM, SWR ≤ 1.5 with ad = 10 mm and bt = 25 mm–40 mm. Ablated tissue was 4.65 cm3–10.46 cm3 after 5 min. According to treatment time and array configuration, maximum temperature and ablated tissue is modified. Bone tumors >3 cm3 can be treated by these antenna-arrays.

Research progress of bone-targeted drug delivery system on metastatic bone tumors.

Bone metastases are common in malignant tumors and the effect of conventional treatment is limited. How to effectively inhibit tumor bone metastasis and deliver the drug to the bone has become an urgent issue to be solved. While bone targeting drug delivery systems have obvious advantages in the treatment of bone tumors. The research on bone-targeted anti-tumor therapy has made significant progress in recent years. We introduced the related tumor pathways of bone metastases. The tumor microenvironment plays an important role in metastatic bone tumors. We introduce a drug-loading systems based on different environment-responsive nanocomposites for anti-tumor and anti-metastatic research. According to the process of bone metastases and the structure of bone tissue, we summarized the information on bone-targeting molecules. Bisphosphate has become the first choice of bone-targeted drug delivery carrier because of its affinity with hydroxyapatite in bone. Therefore, we sought to summarize the bone-targeting molecule of bisphosphate to identify the modification effect on bone-targeting. And this paper discusses the relationship between bisphosphate bone targeting molecular structure and drug delivery carriers, to provide some new ideas for the research and development of bone-targeting drug delivery carriers. Targeted therapy will make a more outstanding contribution to the treatment of tumors.

Surgical Site Infection after Bone Tumor Surgery: Risk Factors and New Preventive Techniques.

Simple SummarySurgical site infection (SSI) is a serious complication of the surgical treatment of malignant bone tumors. Malignant bone tumor surgeries have higher rates of SSI than other orthopedic surgeries. In patients with SSIs, additional surgeries, long-term administrations of antibiotics, extended hospital stays, and the postponement of scheduled adjuvant treatments are required. Therefore, SSIs may deteriorate functional and oncological outcomes. To improve the surgical outcomes of patients with malignant bone tumors, preoperative risk assessments for SSIs, new preventive techniques against SSIs, and the optimal use of prophylactic antibiotics are required. Recently, various studies have shown significant associations between SSIs and age, tumor site (pelvis and tibia), extended operative time, the use of implants, body mass index, leukocytopenia, and reconstruction procedures. Furthermore, prophylactic techniques, including silver and iodine coatings on implants, have been developed. In this review, the predictive factors of SSIs and new prophylactic techniques are discussed.The management of malignant bone tumors requires multidisciplinary interventions including chemotherapy, radiation therapy, and surgical tumor resection and reconstruction. Surgical site infection (SSI) is a serious complication in the treatment of malignant bone tumors. Compared to other orthopedic surgeries, the surgical treatment of malignant bone tumors is associated with higher rates of SSIs. In patients with SSIs, additional surgeries, long-term administrations of antibiotics, extended hospital stays, and the postponement of scheduled adjuvant treatments are required. Therefore, SSI may adversely affect functional and oncological outcomes. To improve surgical outcomes in patients with malignant bone tumors, preoperative risk assessments for SSIs, new preventive techniques against SSIs, and the optimal use of prophylactic antibiotics are often required. Previous reports have demonstrated that age, tumor site (pelvis and tibia), extended operative time, implant use, body mass index, leukocytopenia, and reconstruction procedures are associated with an increased risk for SSIs. Furthermore, prophylactic techniques, such as silver and iodine coatings on implants, have been developed and proven to be efficacious and safe in clinical studies. In this review, predictive factors of SSIs and new prophylactic techniques are discussed.

Fifty years of bone tumors.

There have been enormous advances in the treatment of bone tumors over the past half-century. The most notable of these has been the transition from amputation as the standard of care to limb salvage surgery. This transition is the result of advances in imaging techniques, accurate diagnosis, systemic therapies (including chemotherapy), and prosthetic design for the reconstruction of musculoskeletal defects. Advances have also been made in the management of benign and metastatic bone tumors.

Biomaterial-based strategy for bone tumor therapy and bone defect regeneration: An innovative application option

Bone tumors are deadly and incurable diseases that invade large areas of bone, resulting in bone defects. Traditional therapies combining surgery, chemotherapy, and radiation have reached their limit of efficacy, motivating efforts to develop new therapeutic methods. Fortunately, the development of biomaterials provides innovative options for bone tumor treatment. Suitable biomaterials are capable of simultaneously providing tumor therapy and promoting bone regeneration. This review summarizes recent progress in the effort to achieve new strategies for bone tumor treatment using biomaterials, focusing on the innovative scaffold design. It also discusses the development of nanocarrier-based drug delivery systems and hyperthermia therapy for bone tumor treatment. In the future, biomaterial-based strategies are likely to become the most effective and reliable options for treating bone tumors, and they have the potential to greatly improve the prognosis and quality of life for patients.

Impact of Level of Surgery on the Functional Outcomes in Patients with Lower Extremity Bone Tumors Undergoing Amputation Versus Limb Salvage Surgery.

Limb salvage surgery is the preferred treatment for bone tumors in the current surgical practice. The aim of this study was to compare the functional outcomes between amputation and limb salvage surgery based on the level of surgery at two levels: knee and hip. A single institutional analysis of 137 patients with lower extremity bone tumors was done between 2014 and 2020. Eighty-seven patients treated with amputation were compared with 50 patients treated with limb salvage surgery based on following variables: age, gender, histology, anatomic site, and MSTS score. The mean MSTS scores were fairly better in patients who underwent surgery at knee level compared to those who underwent surgery at hip level. The mean MSTS score at 1-year follow-up was 22.0 in amputation group compared to 22.4 in limb salvage group, whereas at 2-year follow-up was 24.1 in amputation group compared to 25.1 in limb salvage group. At knee level, functional outcomes were similar after amputation and limb salvage. At hip level, patients undergoing amputation had poorer MSTS scores compared to limb salvage surgery at 2-year follow-up (p = 0.04). The functional outcomes for patients undergoing surgery at knee level were similar irrespective of type of surgery. At longer follow-up, patients undergoing amputation at hip level had a poorer functional outcome compared to limb salvage surgery. Although limb salvage was associated with similar MSTS scores when compared with amputation, it produced a better functional outcome especially for proximally located tumors.

Giant cell tumor of bone: Epidemiological profile (fifth version) – A study protocol

The giant cell tumor of bone (GCTB) represents approximately 5% of primary bone tumors, and more than half of cases affect individuals between 20 and 50 years of age. Despite being a benign neoplasm, 3 to 5% of cases may show pulmonary metastases, besides it has high potential for bone destruction at the main site of the lesion, often in the epiphyses of long bones, which may lead to serious functional problems in affected patients. Multidisciplinary treatment of GCTB has been a cause for discussion in the last decade due to the discovery of drugs such as denosumab that prevent tumor progression and may be useful in cases of patients with local recurrences and unresectable tumors. The therapeutic basis of GCTB remains the isolated surgical treatment by intralesional (with adjuvants), marginal or wide resection. Intralesional treatment presents higher rates of recurrence, however it preserves the adjacent joint function and much of the individual bone stock. Resection with wide margins presents lower recurrence rates but has shown worse functional results and frequent complications in bone reconstructions. Current knowledge of GCTB surgical outcomes has been based on major world series - there is a lack of Brazilian epidemiological and surgical data on this specific type of neoplasm, except for a few series of cases. The primary objective of this paper is to identify the epidemiological profile of GCTB; the secondary objectives are to describe the surgical aspects in the main diagnostic centers and treatment of bone tumors, to analyze the clinical and surgical aspects of patients with GCTB of wrist and hand, and to analyze the clinical and surgical aspects of patients with knee GCTB. These findings may help in the maintenance or change of national guidelines for the treatment of GCTB. This study protocol was submitted to ethical assessment under the CAAE (Ethical Appreciation Presentation Certificate) registry No. 94280918.0.0000.5327 (5th version), evaluated through the substantiated opinion No. 4.770.705, and approved by the Institutional Research Ethics Committee on June 12, 2022.

Injectable composite hydrogel based on carbon particles for photothermal therapy of bone tumor and bone regeneration

• Injectable composite hydrogel based on carbon particles is developed. • Carbon particles can serve as photothermal agents to ablate osteosarcoma tissues. • Injectable composite hydrogel facilitates the conformal therapy of bone defects. • Composite hydrogel promotes the new bone formation with a high BV/TV ratio of 76.2%. Surgical resection, as the most efficient treatment for bone tumor, still faces a dilemma between the complete removal of tumor tissue and the maximum reservation of healthy bone tissue. In response to this, an injectable composite hydrogel with chitosan/hyaluronic acid/ β -sodium glycerophosphate as the matrix and carbon particles as the photothermal agent is developed. Owing to the temperature sensitivity, the composite hydrogel can be injected into the irregular bone defect and exhibit the sol-gel phase transition upon body temperature, facilitating the conformal therapy. The composite hydrogel can ablate the human osteosarcoma on Balb/c nude mice model with the tumor inhibition rate of 98.4% after near-infrared laser irradiation (808 nm). The assessment of bone regeneration on calvarial-defect model of Sprague-Dawley rats reveals that the composite hydrogel can promote new bone formation with the bone volume/total volume ratio of 76.2% after 8 weeks, in sharp contrast to the control group of 23.9%.

Application of three-dimensional printing technology in treatment of limb bone tumors

With the developing of three-dimensional (3D) printing technology, it is widely used in the treatment of bone tumors in the clinical orthopedics. Because of the great individual differences in the location of bone tumor, resection and reconstruction are difficult. Based on 3D printing technology, the 3D models can be prepared to show the anatomical part of the disease, so that the surgeons can create a patient-specific operational plans based on better understand the local conditions. At the same time, preoperative simulation can also be carried out for complex operations and patient-specific prostheses can be further designed and prepared according to the location and size of tumor, which may have more advantages in adaptability. In this paper, the domestic and international research progress of 3D printing technology in the treatment of limb bone tumors in recent years were reviewed and summarized.

Research on three-dimensional printing technology based on three-dimensional multimodality imaging to assist the operation of malignant bone tumors of limbs

To explore the role and effectiveness of three-dimensional (3D) printing technology based on 3D multimodality imaging in surgical treatment of malignant bone tumors of limbs. The clinical data of 15 patients with malignant bone tumors of the limbs who met the selection criteria between January 2016 and January 2019 were retrospectively analyzed. There were 6 males and 9 females, with a median age of 34 years (range, 17-73 years). There were 5 cases of osteosarcoma, 3 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 1 case of hemangiosarcoma, 1 case of ameloblastoma, and 3 cases of metastatic carcinoma. The tumors were located in the humerus in 5 cases, ulna in 2 cases, femur in 3 cases, and tibia in 5 cases. The disease duration was 2-8 months (median, 4 months). Preoperative 3D multimodality imaging was administered first, based on which computer-assisted preoperative planning was performed, 3D printed personalized special instruments and prostheses were designed, and in vitro simulation of surgery was conducted, successively. Two cases underwent knee arthroplasty, 2 had semi-shoulder arthroplasty, 2 had proximal ulna arthroplasty, and 9 had joint-preserving surgery. Surgical margins, operation time, intraoperative blood loss, surgical complications, Musculoskeletal Tumor Society (MSTS) score, and oncological outcome were collected and analyzed. All 15 patients completed the operation according to the preoperative plan, and the surgical margins were all obtained wide resection margins. The operation time was 80-240 minutes, with a median of 150 minutes. The intraoperative blood loss was 100-400 mL, with a median of 200 mL. There was no significant limitation of limb function due to important blood vessels or nerves injury during operation. One case of superficial infection of the incision was cured after dressing change, and the incisions of the other patients healed by first intention. All patients were followed up 6-48 months, with a median of 24 months. Two of the patients died of lung metastasis at 6 and 24 months after operation, respectively. No local recurrence, prosthesis dislocation, or prosthesis loosening occurred during follow-up. At last follow-up, the MSTS score ranged from 23 to 30, with an average of 25. 3D printing tecnology, based on 3D multimodality imaging, facilitates precise resection and reconstruction for malignant bone tumors of limbs, resulting in improved oncological and functional outcome.

Clinical application of three-dimensional printed osteotomy guide plate and personalized prosthesis in knee-preserving tumor resection

To investigate the mid-term effectiveness of three-dimensional (3D) printed osteotomy guide plate and personalized prosthesis in knee-preserving tumor resection. The clinical data of 12 patients who underwent knee-preserving tumor resection and reconstruction with 3D printed osteotomy guide plate and personalized prosthesis between September 2016 and October 2018 were retrospectively analyzed. There were 7 males and 5 females. The age ranged from 7 to 59 years, with a median of 44.5 years. There were 11 cases of osteosarcoma and 1 case of fibrosarcoma, all of which were Enneking grade ⅡB. The distance from the tumor to the joint surface was 5.5-8.2 cm, with an average of 6.94 cm. Incision healing, tumor recurrence, periprosthetic fracture, and aseptic loosening were observed after operation. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the patients, and the knee flexion range of motion was measured. The 12 patients were followed up 41-66 months, with an average of 54.5 months. The length of osteotomy ranged from 14 to 26 cm, with an average of 22.08 cm. Except for 2 patients with superficial infection of incision tissue, no deep infection involving the prosthesis occurred, no patient underwent revision surgery because of prosthesis infection. During the follow-up, local recurrence occurred in 2 cases and distant metastasis occurred in 3 cases. The overall disease-free survival rate was 58.3%. Two patients died of lung metastasis, and the overall survival rate was 83.3%. One patient underwent amputation due to local recurrence, and 1 patient underwent total knee arthroplasty due to prosthesis rupture. No aseptic loosening of the prosthesis and periprosthetic fracture occurred during the follow-up, and the overall prosthesis survival rate was 83.3%. At last follow-up, 10 patients obtained satisfactory knee flexion range of motion that ranged from 95° to 125°, with an average of 110°. Two children could not cooperate with early rehabilitation treatment due to pain, and the knee flexion range of motion was not ideal (50°, 75°). All patients achieved acceptable lower limb function with MSTS scores ranged from 26 to 30, with an average of 28. All patients walked without crutches. The treatment of malignant bone tumors around the knee joint with 3D printed osteotomy guide plate and personalized prosthesis can preserve the articular surface, obtain good limb function, reduce the risk of aseptic loosening of prosthesis, and achieve better mid-term effectiveness.

The use of individual instruments in the surgical treatment of malignant bone tumors created by 3D printing

Introduction. Computer modeling and additive technologies are increasingly used in medicine. Oncoorthopedics is no exception. Careful preoperative planning and the creation of individual instruments make it possible to perform radical operations, which allows maximum preservation of healthy tissues and leads to an increase in the functional potential of patients in the postoperative period.Objective – to improve the results of surgical treatment of patients with malignant bone tumors of complex anatomical localizations using computer modeling and additive technologies.Materials and methods. This study included 44 patients (26 men and 18 women) with malignant bone tumors. The mean age of the patients was 39 ± 15.57 years (range 14 to 66 years). In 39 cases, the anatomical location of PSI application was the pelvis, in four cases it was the distal femur, and in one case the femoral shaft. The most common histological type of tumor was chondrosarcoma (47.7 %).Results. In the case of primary resection of the pelvic bone tumor (26 patients), according to the histological examination, radical resection margins (R0) were observed in 25 cases. In one case, after removal of the tumor, a discrepancy between the preoperative histological conclusion (G2 chondrosarcoma) and postoperative (dedifferentiated G3 chondrosarcoma) was revealed. During operations to remove tumors of the distal segment of the femur and resection of the tumor of the diaphysis of the femur, in all cases, the radicality was R0.Conclusion. Individual navigation devices have proven themselves in clinical practice. The results obtained in our study demonstrate their effectiveness in the treatment of malignant bone tumors.

Three-dimensional-printed titanium prostheses with bone trabeculae enable mechanical-biological reconstruction after resection of bone tumours.

ABSTRACTReconstruction after resection has always been an urgent problem in the treatment of bone tumours. There are many methods that can be used to reconstruct bone defects; however, there are also many complications, and it is difficult to develop a safe and effective reconstruction plan for the treatment of bone tumours. With the rapid development of digital orthopaedics, three-dimensional printing technology can solve this problem. The three-dimensional printing of personalised prostheses has many advantages. It can be used to print complex structures that are difficult to fabricate using traditional processes and overcome the problems of stress shielding and low biological activity of conventional prostheses. In this study, 12 patients with bone tumours were selected as research subjects, and based on individualised reverse-engineering design technology, a three-dimensional model of each prosthesis was designed and installed using medical image data. Ti6Al4V was used as the raw material to prepare the prostheses, which were used to repair bone defects after surgical resection. The operation time was 266.43 ± 21.08 minutes (range 180-390 minutes), and intraoperative blood loss was 857.26 ± 84.28 mL (range 800-2500 mL). One patient had delayed wound healing after surgery, but all patients survived without local tumour recurrence, and no tumour metastasis was found. No aseptic loosening or structural fracture of the prosthesis, and no non-mechanical prosthesis failure caused by infection, tumour recurrence, or progression was observed. The Musculo-Skeletal Tumour Society (MSTS) score of limb function was 22.53 ± 2.09 (range 16-26), and ten of the 12 patients scored ≥ 20 and were able to function normally. The results showed that three-dimensional printed prostheses with an individualised design can achieve satisfactory short-term clinical efficacy in the reconstruction of large bone defects after bone tumour resection.

A Comprehensive Understanding of the Genomic Bone Tumor Landscape: A Multicenter Prospective Study.

Complexity and heterogeneity increases the difficulty of diagnosis and treatment of bone tumors. We aimed to identify the mutational characterization and potential biomarkers of bone tumors. In this study, a total of 357 bone tumor patients were recruited and the next generation sequencing (NGS)-based YuanSu450 panel, that includes both DNA and RNA sequencing, was performed for genomic alteration identification. The most common mutated genes in bone tumors included TP53, NCOR1, VEGFA, RB1, CCND3, CDKN2A, GID4, CCNE1, TERT, and MAP2K4. The amplification of genes such as NCOR1, VEGFA, and CCND3 mainly occurred in osteosarcoma. Germline mutation analysis reveal a high frequency of HRD related mutations (46.4%, 13/28) in this cohort. With the assistance of RNA sequencing, 16.8% (19/113) gene fusions were independently detected in 20% (16/79) of patients. Nearly 34.2% of patients harbored actionable targeted mutations, of which the most common mutation is CDKN2A deletion. The different mutational characterizations between juvenile patients and adult patients indicated the potential effect of age in bone tumor treatment. According to the genomic alterations, the diagnosis of 26 (7.28%) bone tumors were corrected. The most easily misdiagnosed bone tumor included malignant giant cell tumors of bone (2.8%, 10/357) and fibrous dysplasia of bone (1.7%, 6/357). Meanwhile, we found that the mutations of MUC16 may be a potential biomarker for the diagnosis of mesenchymal chondrosarcomas. Our results indicated that RNA sequencing effectively complements DNA sequencing and increased the detection rate of gene fusions, supporting that NGS technology can effectively assist the diagnosis of bone tumors.

Analysis of results in patients after treatment using various segmental bone alloplasty techniques

Restoration of bone, adjacent joint and surrounding soft tissue integrity is an important factor in achieving full function of affected limbs in patients with bone tumors. Biological bone reconstruction has a number of advantages over other artificial implants. The aim of the work is to analyze the results of clinical approbation of the segmental alloimplant using by different methods for treatment of malignant bone tumors. Material and methods. The data of 17 patients with malignant tumors, secondary lesions or neoplasms of long bones with an aggressive course of the pathological process were analyzed. All patients underwent surgery to remove en-block tumors and replace post-resection defects of long bones with segmental bone alloimplants. Different methods of fixing bone alloimplants and sterilization of alloimplants were used. Three methods of surgery are presented. Results. The analysis of surgical treatment results in patients with long bone tumors who underwent bioreconstructive surgery was performed. The functional results according to the MSTS scale and complications of bioreconstructive operations according to the classification of Henderson E. et al. were assessed. The total number of complications was 58.8 %, among which local complications of the wound process were observed in 5.9 % of cases (1 patient), atrophic nonunion of the recipient bone and alloimplant – in 4 cases (23.5 %), violation of the metal fixator integrity – in 2 patients 11.8 %), infectious complications – in 5.9 % (1 patient), local recurrence of the tumor was the most common and amounted to 35.3 % (6 patients) of all cases. Conclusions. Bioreconstructive surgical interventions (using bone alloimplants) should be used according to clear indications to achieve the best results. The application of the developed methods presented in the work will reduce the risk of complications associated with bone alloplasty. Biological recovery of lost bone tissue and the fastest recovery of the affected limb through the use of metal structures allows a widespread use of this technique in cancer patients.

Bone tumors effective therapy through functionalized hydrogels: current developments and future expectations

Primary bone tumors especially, sarcomas affect adolescents the most because it originates from osteoblasts cells responsible for bone growth. Chemotherapy, surgery, and radiation therapy are the most often used clinical treatments. Regrettably, surgical resection frequently fails to entirely eradicate the tumor, which is the primary cause of metastasis and postoperative recurrence, leading to a high death rate. Additionally, bone tumors frequently penetrate significant regions of bone, rendering them incapable of self-repair, and impairing patients' quality of life. As a result, treating bone tumors and regenerating bone in the clinic is difficult. In recent decades, numerous sorts of alternative therapy approaches have been investigated due to a lack of approved treatments. Among the novel therapeutic approaches, hydrogel-based anticancer therapy has cleared the way for the development of new targeted techniques for treating bone cancer and bone regeneration. They include strategies such as co-delivery of several drug payloads, enhancing their biodistribution and transport capabilities, normalizing accumulation, and optimizing drug release profiles to decrease the limitations of current therapy. This review discusses current advances in functionalized hydrogels to develop a new technique for treating bone tumors by reducing postoperative tumor recurrence and promoting tissue repair.

Novel bone tumor cell targeting nanosystem for chemo-photothermal therapy of malignant bone tumors

The bone microenvironment provides a “barrier” for bone tumors to resist clinical chemoradiotherapy, implying that molecules targeting tumor cells alone cannot effectively target bone tumor cells. One restriction of using nanosystems in the treatment of bone tumors is bone tumor cell-targeting. In this study, a novel chemo-photothermal combined therapy (CPT) bone tumor cell-targeting nanosystem was designed. A bone tumor cell-targeting peptide (BTTP) was covalently attached to the surface of the nanosystem. The nanosystem was constructed by hybridization of a core Mn-Co metal-organic framework and polydopamine as the shell (TM@P). The TM@P/DOX nanosystem could be first targeted to the bone damage interface by the bone-targeting peptide octapolyaspartic acid (D8) of BTTP. Then the KCQGWI↓GQPGCK polypeptide fragment of BTTP could be cut off by matrix metalloproteinases (MMPs) secreted by bone tumors, and finally guided specifically the nanosystem into bone tumor cells by cell penetrating peptides (R8) of BTTP. Doxorubicin (DOX) was loaded onto the TM@P surface (TM@P/DOX). The nanosystem targeted bone tumor cells well in vivo and enhanced the contrast of bone tumor (MRI). Finally, the TM@P/DOX nanosystem-mediated CPT effectively inhibited bone tumor growth and osteolysis. This study provides an effective new approach for the treatment of malignant bone tumors.

Reversing breast cancer bone metastasis by metal organic framework-capped nanotherapeutics via suppressing osteoclastogenesis

Bone metastasis is the major cause of cancer-related morbidity and mortality. To avoid further osteolysis, current treatment ideas focus on tumor cell and the inhibition of osteoclast. Herein, zeolitic imidazolate framework-8–capped Cu2-XSe composite nanoplatform (ICG@Cu2-XSe-ZIF-8) is developed for chemodynamic therapy (CDT) and photothermal therapy (PTT) treatment of malignant breast cancer bone tumors. The rational design of ZIF-8 encapsulation greatly reduces the accumulation of Cu2-XSe to damage the normal cells. Under acidic microenvironment in tumor, ZIF-8 is cleaved to release Cu2-XSe, which can subsequently degrade into Cu (+) and Cu (2+) ions to initiate a Fenton-like reaction inducing CDT. Meanwhile, Cu2-XSe is used to be an effective photothermal transduction agent for exerting the PTT effect. What's more, the selenium element in Cu2-XSe can regulates selenoprotein to inhibit tumor cells and osteoclasts. Of note, the hyperthermia induced by PTT can further enhance the CDT effect in tumor, achieving a synergistic PTT/CDT effect. Based on these advantages, ICG@Cu2-XSe-ZIF-8 effectively suppresses the tumor cells in bone tissue, and reduces the erosion of bone tissue via suppressing osteoclastogenesis. In conclusion, this study demonstrates the potential action mechanism of ZIF-8–capped nanomedicine against osteolysis in bone metastasis.