Current review of surgical management options for extremity bone sarcomas

Cîrstoiu, Cătălin; Creţu, Bogdan; Șerban, Bogdan; Panti, Zsombor; Nica, Mihai

doi:10.1302/2058-5241.4.180048

Cited by 23 publications

(17 citation statements)

References 30 publications

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“…Surgeons are able to combine several different components together intraoperatively to form an implant that best matches the patient's bone defect [95]. As well as the components being standardised for improved quality control [98], the versatility allows modular systems to be utilised for total bone replacements in addition to segmental reconstructions [99]. As a result, for many cases, custom implants are not required and modular systems are effective.…”

Section: Modular Implantsmentioning

confidence: 99%

Surgical Advances in Osteosarcoma

Brookes

Chan

Baljer

et al. 2021

Cancers

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Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

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Section: Modular Implantsmentioning

confidence: 99%

Surgical Advances in Osteosarcoma

Brookes

Chan

Baljer

et al. 2021

Cancers

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“…Overall, dramatic improvements in treatment regimens have made it possible for most patients with bone tumors in the extremities to avoid full limb amputation, allowing prosthetics or limb salvage surgery use instead to attempt to restore limb function. [ 74 ]…”

Section: Current Treatments For Primary Bone Tumors and Established Bone Metastasesmentioning

confidence: 99%

“…[ 76 ] To be effective, MTX must be used in very high doses, as well as in combination with other chemotherapeutic drugs. [ 74,76 ] To improve MTX pharmacokinetics, Ray et al. [ 77,78 ] delivered MTX loaded into PLGA coated Mg‐Al‐layered double hydroxide NPs in a subcutaneous OS murine model.…”

Section: Nanoparticle Treatments For Primary Bone Tumorsmentioning

confidence: 99%

Nanodelivery Systems Face Challenges and Limitations in Bone Diseases Management

Giordano

Lenna

Rampado

et al. 2021

Advanced Therapeutics

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Bone is a highly dynamic tissue. Hence, diseases affecting bone tissue, such as cancer (primary tumors and metastases), osteoporosis, and genetic conditions present many challenges for traditional therapies, leading to poor therapeutic outcome. Nano‐delivery systems are innovative tools used for the treatment of a variety of diseases due to their ability to deliver various therapeutic cargos and specifically target disease sites, including difficult ones like bone. A variety of nano‐delivery strategies are recently explored to treat bone‐related pathologies, with many resulting in better outcomes than traditional approaches. In this review, the authors cover recent attempts to use nano‐delivery systems for the treatment of skeletal‐related disorders including primary bone tumors, metastatic bone tumors, and non‐cancerous bone disorders. Finally, potential barriers for the translation of such new therapeutics into the clinic and possible methods to overcome these barriers, are discussed.

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“…While osteosarcoma is more common in the second decade of life, predominantly affecting the knee, Ewing’s sarcoma is also frequent in the first decade of life [ 1 ]. Treatments are multidisciplinary, and based on a combination of chemotherapy, radiotherapy and surgery [ 2 ]. Previously, amputation was considered the principal surgical treatment assuring a radical margin; however, improved chemotherapy schedules permit sparing the limb and increased survival [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

et al. 2021

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For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation.

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Current review of surgical management options for extremity bone sarcomas

Cited by 23 publications

References 30 publications

Surgical Advances in Osteosarcoma

Surgical Advances in Osteosarcoma

Nanodelivery Systems Face Challenges and Limitations in Bone Diseases Management

A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

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