Treatment Of Malignant Bone Tumors Research Articles

En Bloc Surgery in the Thoracic Spine: Indications, Results, and Complications in a Series of Eighty-Five Patients Affected by Primary and Secondary Malignant Bone Tumors

BackgroundEn-bloc resection remains the cornerstone treatment for malignant bone tumors affecting the spine. The thoracic spine poses unique challenges due to the proximity of crucial structures. This study assesses outcomes of patients who underwent en-bloc spondylectomy for malignant bone tumors at the thoracic level. MethodsWe retrospectively reviewed 85 cases of primary and secondary bone tumors in the thoracic spine, undergoing en-bloc spondylectomy from 1996 to 2016. Evaluation encompassed clinical presentation, tumor characteristics, surgical outcomes, complications, survival rates, and recurrence. ResultsOf 85 patients, 40 presented directly, while 45 had undergone prior intralesional surgery. Chondrosarcoma and chordoma comprised the most prevalent primary histological types; thyroid and kidney carcinomas were the most frequent secondary tumors. Pain was reported in 75 patients at diagnosis. Margins were adequate in 54 cases and intralesional in 31. Immediate postoperative deaths amounted to four. Major complications included substantial blood loss, neurological deterioration, and paraplegia. The 5-year Local Recurrence-Free Survival rate was 58.7%, significantly influenced by the surgical margin: patients with wide margins experienced a 5-year LRFS of 85.7%, while those with marginal and intralesional margins had rates of 56.7% and 45.6%, respectively; overall recurrence was 22.3% with no notable disparities between previously treated and untreated patients. The 5-year Overall Survival (OS) rates were 63.2% and 56.2% for primary and secondary tumors, respectively. The OS was not significantly influenced by surgical margins. ConclusionsManaging malignant thoracic bone tumors poses significant challenges. This study underscores the criticality of achieving adequate margins, particularly following previous intralesional approaches.

A “biomimetic bone-magnet” with suitable mechanical properties concurrently performs accurate target collection of nanoparticles for magnetothermally driven osteosarcoma thermo-chemotherapy

Osteolytic lesions of bone tumors lead to stress-induced loss of load-bearing bones, making it difficult to treat tumors and repair bone tissue structures. Magnetic hyperthermia has become an effective minimally invasive treatment for malignant bone tumors without depth limitations. However, the effectiveness of magnetic heat therapy alone is not satisfactory, and if combined with chemotherapy, it can lead to significant systemic side effects. It is important to efficiently target chemotherapy substances to the correct area for combined therapy. We have developed a biomimetic bone magnet (BBM) that uses polymethyl methacrylate (PMMA) bone cement-loaded permanent magnet materials with good support performance to create an intrinsic tumor magnetic field. This magnetic field has magnetothermal properties and collects drug-loaded magnetic phase change nanoparticles (mCNPs) circulating in the blood for magnetothermally triggered chemotherapy. Moreover, PMMA has good mechanical properties, providing potential stress support for bone reconstruction after bone tumor treatment. Importantly, both in vivo and in vitro experimental results demonstrated the effectiveness of magnetic hyperthermia through minimally invasive injection of BBM phase transition. This new method achieves magnetic targeting by manufacturing tumor biomagnets to generate strong magnetic fields within the tumor, which opens up new avenues for treatment strategies for malignant bone tumors.

Features of routing, diagnosis and combined treatment of pathological fractures of long tubular bones of tumor etiology

Introduction. In the structure of fractures of long tubular bones, pathological fractures account for about 1 %, and 2/3 of all cases are pathological fractures associated with bone metastases. Primary bone tumors are complicated by the development of a pathological fracture in 1– 10 % of cases, bone metastases in 8–30 % of cases. With a pathological fracture, as the primary manifestation of the tumor process, as a rule, patients come to the attention of orthopedic traumatologists providing emergency care. In the practice of oncologists, there are often patients with bone tumors who have performed deliberately non-radical surgical interventions associated with insufficient oncological alertness of traumatologists.Aim. To study and present the results of combined treatment of patients with bone tumors complicated by a pathological fracture.Materials and methods. The results of treatment and observation of 159 patients with tumors of long tubular bones complicated by a pathological fracture or the threat of its development, who received combined or surgical treatment and were observed in the polyclinic of the Republican Oncological Dispensary from 2008 to 2020, were analyzed.Results. A pathological fracture that has taken place, in the absence of somatic contraindications, is not a contraindication to neoadjuvant treatment, which allows performing organ-preserving surgical treatment with optimal local and systemic control. However, with verified bone metastases, when segmental bone resections are not shown, and the diagnosis of myeloma (solitary plasmocytoma) is established, it is permissible to perform surgery in a trauma hospital, after consulting an oncologist.Conclusion. The combined approach in the treatment of malignant bone tumors complicated by a pathological fracture makes it possible to perform a functional-saving, organ-preserving surgical intervention, significantly reducing the risk of tumor recurrence and systemic progression.

Engineering a triple-functional magnetic gel driving mutually-synergistic mild hyperthermia-starvation therapy for osteosarcoma treatment and augmented bone regeneration

Malignant bone tumors result in high rates of disability and death and are difficult to treat in terms of killing tumors and repairing bone defects. Compared with other hyperthermia strategies, magnetic hyperthermia has become an effective therapy for treating malignant bone tumors due to its lack of depth limitations. However, tumor cells express heat shock protein (HSP) to resist hyperthermia, which reduces its curative effect. Competitive ATP consumption can reduce HSP production; fortunately, the basic principle of starvation therapy by glucose oxidase (GOx) is consuming glucose to control ATP production, thereby restricting HSP generation. We developed a triple-functional magnetic gel (Fe3O4/GOx/MgCO3@PLGA) as a magnetic bone repair hydrogels (MBRs) with liquid‒solid phase transition capability to drive magneto-thermal effects to simultaneously trigger GOx release and inhibit ATP production, reducing HSP expression and thereby achieving synergistic therapy for osteosarcoma treatment. Moreover, magnetic hyperthermia improves the effect of starvation therapy on the hypoxic microenvironment and achieves a reciprocal strengthening therapeutic effect. We further demonstrated that in situ MBRs injection effectively suppressed tumor growth in 143B osteosarcoma tumor-bearing mice and an in-situ bone tumor model in the rabbit tibial plateau. More importantly, our study also showed that liquid MBRs could effectively match bone defects and accelerate their reconstruction via magnesium ion release and enhanced osteogenic differentiation to augment the regeneration of bone defects caused by bone tumors, which generates fresh insight into malignant bone tumor treatment and the acceleration of bone defect repair.

The Diagnosis and Treatment of Osteosarcoma and Ewing's Sarcoma in Children and Adolescents.

Osteosarcoma and Ewing's sarcoma in children and adolescents require age-specific interdisciplinary diagnosis and treatment to achieve optimal therapeutic outcomes. The diagnosis and treatment of malignant bone tumors in childhood and adolescence are presented in the light of publications retrieved by a selective search, pertinent guidelines, and the authors' extensive experience in an interdisciplinary cancer center. Bone sarcomas make up approximately 5% of all malignancies in children and adolescents; the most common types are Ewing's sarcoma and osteosarcoma. Patients are often not referred to a specialized center until long after the onset of symptoms, as they and their physicians rarely consider the possibility of a bone tumor, and the symptoms are often trivialized. Bone pain of unknown origin, swelling, and functional limitations should be investigated with conventional x-rays. Lesions of unclear origin should be biopsied after a meticulous clinical and radiologic evaluation. Multimodal treatment consists of neo - adjuvant chemotherapy, limb-preserving resection if possible, and radiotherapy where indicated. In multicenter studies, patients with osteosarcoma achieve event-free survival in 64% of cases if their disease is localized, and 28% if it is metastatic; the corresponding figures for patients with Ewing's sarcoma are 80% and 27%, respectively. With implementation of the current treatment recommendations, most children and adolescents with malignant bone tumors can be treated successfully with curative intent. These patients should be referred to a sarcoma center for diagnosis and treatment.

Follow-up of biological reconstruction of epiphysis preserving osteosarcoma around the knee in children: A retrospective cohort study.

Limb salvage treatment for malignant bone tumors in children includes prosthetic and biological reconstruction. Early function following prosthesis reconstruction is satisfactory; however, there are several complications. Biological reconstruction is another way to treat bone defects. We evaluated the effectiveness of reconstruction of bone defects by liquid nitrogen inactivation of autologous bone with preserving epiphysis in 5 cases of periarticular osteosarcoma of the knee. We retrospectively selected 5 patients with articular osteosarcoma of the knee who underwent epiphyseal-preserving biological reconstruction in our department between January 2019 and January 2020. Femur involvement occurred in 2 cases and tibia involvement occurred in 3 cases, with an average defect of 18 cm (12-30 cm). The 2 patients with femur involvement were treated with inactivated autologous bone by liquid nitrogen with vascularized fibula transplantation. Among the patients with tibia involvement, 2 were treated with inactivated autologous bone with ipsilateral vascularized fibula transplantation and 1 was treated with autologous inactivated bone with contralateral vascularized fibula transplantation. Bone healing was evaluated by regular X-ray examination. At the end of the follow-up, lower limb length, knee flexion, and extension function were evaluated. Patients were followed up for 24 to 36 months. Average bone-healing time was 5.2 months (3-8 months). All patients achieved bone healing with no tumor recurrence and no distant metastasis and all patients survived. The lengths of both lower limbs were equal in 2 cases, with shortening by ≤1 cm in 1 case and shortening by 2 cm in 1 case. Knee flexion was >90° in 4 cases and between 50 and 60° in 1 case. The Muscle and Skeletal Tumor Society score was 24.2 (range 20-26). Inactivation of autogenous bone with the epiphysis preserved by liquid nitrogen combined with vascularized fibula reconstruction for periarticular osteosarcoma of the knee in children is safe and effective. This technique supports bone healing. Postoperative limb length and function, and short-term effects were satisfactory.

Design and evaluation of 32P-labeled hydroxyapatite nanoparticles for bone tumor therapy

The clinical diagnosis and treatment of malignant bone tumors are still major clinical challenges due to their high incidence are difficulty. Targeted therapies have become a critical approach to treat bone tumors. In recent years, radiopharmaceuticals have been used widely and have shown potent and efficient results in treating bone tumors, among which 32P and the labeled radiopharmaceuticals play an essential role. In this study, the 32P-labeled hydroxyapatite (HA) was prepared through chemical synthesis (32P-Hap) and physical adsorption (32P-doped-Hap). The in vitro stability of 32P-labeled HA was analyzed to assess the superiority of the new-found chemical synthesis. The radiolabeling yield and stability of chemical synthesis (97.6 ± 0.5%) were significantly improved compared with physical adsorption (92.7 ± 0.4%). Furthermore, the CT results corroborate that 32P-Hap (100 μCi) +DOX group has the highest tumor suppression rate and can effectively reduce bone destruction. The results corroborate the effectiveness of the chemical synthesis and validate the application of 32P-Hap in bone tumors. Therefore, 32P-Hap (100 μCi) + DOX may be an effective strategy for bone metastasis treatments.

High Intensity Focused Ultrasound for Treatment of Bone Malignancies—20 Years of History

High Intensity Focused Ultrasound (HIFU) is the only non-invasive method for percutaneous thermal ablation of tissue, with treatments typically performed either under magnetic resonance imaging or ultrasound guidance. Since this method allows efficient heating of bony structures, it has found not only early use in treatment of bone pain, but also in local treatment of malignant bone tumors. This review of 20 years of published studies shows that HIFU is a very efficient method for rapid pain relief, can provide local tumor control and has a very patient-friendly safety profile.

Diagnosis of malignant bone tumors in children

Bone cancers occur mainly in adolescents and young adults, and benign lesions are more frequent than malignant ones. The most common malignant tumors include osteosarcoma, Ewing's sarcoma and chondrosarcoma. The course of the disease may not be obvious and symptoms may be ambiguous, so it is important to catch them early and take appropriate action. Laboratory tests such as CRP, ESR, LDH, ALP may prove useful in the diagnosis of bone neoplasms in children. All children with suspected malignant bone cancer should undergo an x-ray examination. MRI, CT scans are performed to expand the diagnosis and determine the extent of the disease. The basis of diagnosis is histopathological examination. The result of this study is very important in the selection of therapeutic procedures, it influences decisions regarding the scope and degree of radicality of the operation. It is crucial that the entire diagnostic process is carried out in highly specialized centers that have extensive experience in the diagnosis and treatment of malignant bone tumors in children. It is most beneficial to conduct diagnosis and treatment at the same center, and preferably by the same team of specialists. This team should include doctors from orthopedics, radiology, oncology, radiation therapy and pathomorphology. Conducting diagnosis and treatment in highly specialized centers has a positive effect on the prognosis and quality of life of patients. The purpose of this article is to highlight the early and uncharacteristic symptoms of bone cancer in children and to present the complexity of the diagnostic process, as well as the importance of carrying it out in highly specialized centers with extensive experience in treating pediatric bone malignancies.

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.

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.

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.

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.

Principles of orthopedic treatment for malignant bone tumors in children

Primary bone sarcomas are not frequent entities, but constitute important issue especially in pediatric population. Advances in chemotherapy and diagnostic modalities allowed limb saving resections of malignant bone tumors became leading surgical option. To be successful the treatment of primary bone tumors should be conducted in dedicated centers by experienced team of specialists. Nevertheless, the rules of such treatment should be known widely to improve diagnosis, medical care over oncologic patient and communication between specialists. In this review paper the authors present current rules of surgical approach to bony malignancies in children and adolescents.

Personalized 3D-printed guide in malignant bone tumor resection and following reconstruction – 17 cases in pelvic and extremities

IntroductionCustomized accurate tumor resection and individualized reconstruction is a challenging in treatment of malignant bone tumor. Three-dimensional (3D)-printing technique is now widely used in the resection and following reconstruction of malignant bone tumor, which included but not limited to tumor model, osteotomy guide and customized implant. MethodsWe retrospectively reviewed 17 patients, who underwent limb salvage surgery by using 3D-printed guide at a single center between August 2014 and October 2019. The median duration of follow-up was 26.5 months. Osteosarcoma (41.2%) were the predominant diagnoses. The functional outcomes were assessed by Musculoskeletal Tumor Society (MSTS) functional score. We also analyzed survival status, intraoperative data (blood loss, operation time and resection length), reconstruction method, margin outcomes and complications. ResultsWe totally performed 93 guided osteotomies on affected bone and allograft bone in 17 patients. Reconstruction in 12 cases was performed with biological technique: allograft combined with autograft was used in 7 cases. 11 of 12 (91.7%) cases showed a good bone healing in both allograft and autograft. 1 of 12 (8.3%) cases had allograft necrosis. Additional intra-operative extracorporeal radiation was performed in 3 pelvic cases for reconstruction. 63 of 64 (98%) osteotomies achieved wide resection and negative margin. All the cases had successful limb salvage result without amputation. At the latest follow up, the mean MSTS Score was 24 (range: 13–30), 12 patients alive with no evidence of disease, 1 patient alive with disease, 5 patients had died of disease and 5 years overall survival is 73.3%. The most common complications are wound healing disorder in 4 cases (23.5%) and infection in 3 cases (17.6%). ConclusionThe 3D-printed resection guide was easy to use and showed promise in the field of orthopedic oncology. It can not only used in primary malignant bone tumor personalized resection but also in shaping structural bone allograft in biological reconstruction, which can achieve a safety surgical margin and individualized resection at the same time.

Effects of neoadjuvant chemotherapy combined with customized tumor-type total knee arthroplasty on immune function and limb function in the treatment of malignant bone tumors around the knee joint

Objectives:To explore the effects of neoadjuvant chemotherapy combined with customized tumor-type total knee arthroplasty (TKA) on immune function and limb function in the treatment of malignant bone tumors around the knee joint.Methods:Sixty-one patients with malignant bone tumors around the knee joint treated in Sichuan Provincial Orthopedics Hospital from February 2018 to February 2020 were retrospectively enrolled and divided into two groups according to treatment methods. The differences in immune function indexes before and after treatment were compared between the two groups. And their postoperative complications were recorded.Results:Before treatment, no significant difference can be observed in the comparison, values between the two groups (P>0.05); After treatment, the levels in Group-A were higher than before treatment (P<0.05), but the levels were not different from those before treatment (P>0.05). In contrast, the levels in Group-B were higher than before treatment and higher than that in Group-A, while the level of CD8+ was lower than before treatment and lower than that in Group-A (P<0.05). At six months postoperatively, no significant difference was observed in the excellent and good rate of limb function between the two groups (P>0.05). There were no differences in the incidence of postoperative prosthesis complications and the incidence of adverse chemotherapy reactions between the two groups (P>0.05)Conclusion:Neoadjuvant chemotherapy combined with customized tumor-type TKA for knee malignant bone tumors is an excellent safety treatment for malignant bone tumors around the knee joint, boasting a variety of benefits, such as significantly ameliorating the immune function of patients and promoting the recovery of limb function, which is worthy of clinical application.

Recent developments in the treatment of malignant bone tumors

Recent developments in the treatment of malignant bone tumors

Osteogenic and anti-tumor Cu and Mn-doped borosilicate nanoparticles for syncretic bone repair and chemodynamic therapy in bone tumor treatment

Critical bone defects caused by extensive excision of malignant bone tumor and the probability of tumor recurrence due to residual tumor cells make malignant bone tumor treatment a major clinical challenge. The present therapeutic strategy concentrates on implanting bone substitutes for defect filling but suffers from failures in both enhancing bone regeneration and inhibiting the growth of tumor cells. Herein, Cu and Mn-doped borosilicate nanoparticles (BSNs) were developed for syncretic bone repairing and anti-tumor treatment, which can enhance bone regeneration through the osteogenic effects of Cu2+ and Mn3+ ions and meanwhile induce tumor cells apoptosis through the hydroxyl radicals produced by the Fenton-like reactions of Cu2+ and Mn3+ ions. In vitro study showed that both osteogenic differentiation of BMSCs and angiogenesis of endothelial cells were promoted by BSNs, and consistently the critical bone defects of rats were efficiently repaired by BSNs through in vivo evaluation. Meanwhile, BSNs could generate hydroxyl radicals through Fenton-like reactions in the simulated tumor microenvironment, promote the generation of intracellular reactive oxygen species, and eventually induce tumor cell apoptosis. Besides, subcutaneous tumors of mice were effectively inhibited by BSNs without causing toxic side effects to normal tissues and organs. Altogether, Cu and Mn-doped BSNs developed in this work performed dual functions of enhancing osteogenesis and angiogenesis for bone regeneration, and inhibiting tumor growth for chemodynamic therapy, thus holding a great potential for syncretic bone repairing and anti-tumor therapy.