Innovative Options for Bone Metastasis Treatment: An Extensive Analysis on Biomaterials-Based Strategies for Orthopedic Surgeons

Abstract

Bone is the third most frequent site of metastasis, with a particular incidence in breast and prostate cancer patients. For example, almost 70% of breast cancer patients develop several bone metastases in the late stage of the disease. Bone metastases are a challenge for clinicians and a burden for patients because they frequently cause pain and can lead to fractures. Unfortunately, current therapeutic options are in most cases only palliative and, although not curative, surgery remains the gold standard for bone metastasis treatment. Surgical intervention mostly provides the replacement of the affected bone with a bioimplant, which can be made by materials of different origins and designed through several techniques that have evolved throughout the years simultaneously with clinical needs. Several scientists and clinicians have worked to develop biomaterials with potentially successful biological and mechanical features, however, only a few of them have actually reached the scope. In this review, we extensively analyze currently available biomaterials-based strategies focusing on the newest and most innovative ideas while aiming to highlight what should be considered both a reliable choice for orthopedic surgeons and a future definitive and curative option for bone metastasis and cancer patients.

microRNA Prognostic Signature for Postoperative Success of Metastatic Orthopedic Cancers: Implications for Precision Microsurgery

“…The cohort of samples consisted of bone metastasis from primary lung and breast cancers. These represent two of the very common primary sites from which tumors metastasize to bones (Al Husaini et al, 2009;Pulido et al, 2017;Guerrieri et al, 2020). Firstly pooled samples were analyzed, i.e., samples representing bone metastasis from primary lung as well as breast cancers.…”

Innovative Biomaterials for the Treatment of Bone Cancer

“…The treatment of bone cancer poses a great challenge to contemporary medicine, due to both its significant frequency and the high heterogeneity of malignant lesions within the bone tissue. Traditional treatments, either surgical or conservative, are rarely curative and usually consent to only temporarily ameliorate patients’ quality of life and survival [ 109 ]. Furthermore, these approaches fail to restore bone original morpho-functional properties and are often aggravated by serious adverse effects and irreversible damage to the bone tissue.…”

“…Furthermore, these approaches fail to restore bone original morpho-functional properties and are often aggravated by serious adverse effects and irreversible damage to the bone tissue. Indeed, bone is a natural composite material lacking an artificial correspondent and thus being the second tissue to require transplantation after blood [ 109 , 110 ]. Treatment protocols for bone cancer strictly depend upon the primary or secondary nature of the lesion [ 111 , 112 ].…”

“…Generally, the existence of a bone metastasis is indicative of an advanced-stage primary tumor, against which available treatments are infrequently resolutive. In these cases, applicable strategies aim to prolong patient survival and ameliorate their quality of life through the prevention of SREs [ 109 ]. Current pharmacologic approaches include anti-resorptive drugs such as bisphosphonates and denosumab (an anti-RANK-RANKL inhibitor), which inhibit osteoclast activity thus reducing cancer-related pain, fractures, and the risk of developing new lesions [ 113 ].…”

“…As far as osteosarcoma is concerned, standard care currently consists of neoadjuvant chemotherapy based on the administration of DOX, CDDP and high-dose MTX, followed by surgical resection [ 116 ]. In both primary and secondary bone cancer treatment, surgery should have the goal to remove the tumor while preserving as much function as possible; in this regard, bone replacement and/or the use of prostheses and bioimplants may significantly reduce the disability burden [ 109 ]. Autologous bone grafting remains the gold standard due to its optimal biocompatibility, no risk of immune response and relevant regenerative potential; however, the restricted availability of tissues and donor-site morbidity are often a considerable concern [ 117 ].…”