Surgical Treatment of Bone Sarcoma

Abstract

Bone sarcomas are rare primary malignant mesenchymal bone tumors. The three main entities are osteosarcoma, chondrosarcoma, and Ewing sarcoma. While prognosis has improved for affected patients over the past decades, bone sarcomas are still critical conditions that require an interdisciplinary diagnostic and therapeutic approach. While radiotherapy plays a role especially in Ewing sarcoma and chemotherapy in Ewing sarcoma and osteosarcoma, surgery remains the main pillar of treatment in all three entities. After complete tumor resection, the created bone defects need to be reconstructed. Possible strategies are implantation of allografts or autografts including vascularized bone grafts (e.g., of the fibula). Around the knee joint, rotationplasty can be performed or, as an alternative, the implantation of (expandable) megaprostheses can be performed. Challenges still associated with the implantation of foreign materials are aseptic loosening and infection. Future improvements may come with advances in 3D printing of individualized resection blades/implants, thus also securing safe tumor resection margins while at the same time shortening the required surgical time. Faster osseointegration and lower infection rates may possibly be achieved through more elaborate implant surface structures.

Immune checkpoint inhibitors in osteosarcoma: A hopeful and challenging future

“…Traditionally, radical resection of the primary tumor has a higher opportunity to thoroughly remove malignant tumor cells. Therefore, radical resection surgeries such as amputation and rotationplasty are supposed to result in higher survival rates, even though these treatments seriously worsen quality of life ( Bläsius et al, 2022 ). However, recent studies have reached the opposite conclusion.…”

One-Dimensional Ferroelectric Nanoarrays with Wireless Switchable Static and Dynamic Electrical Stimulation for Selective Regulating Osteogenesis and Antiosteosarcoma

“…Osteosarcoma is a significant malignant primary bone tumor that is primarily diagnosed in children and young adults. , Most osteosarcomas are osteolytic rather than sclerosing, resulting in the formation of destructive lesions in the bone tissue. , At present, surgical resection is the standard clinical treatment method for osteosarcoma, however, it is usually accompanied by a large area of bone defect which seriously restricts patient recovery. − Although numerous artificial load-bearing bone implants have been used clinically, orthopedic surgeons continue to face significant difficulties with poor implant osseointegration and forming new bone in tumor environments. , Additionally, insufficient surgical removal of osteosarcoma tissue results in the dissemination of tumor cells, resulting in 8% of tumor recurrences. , …”

Inflammatory Surrogate Parameters for Predicting Ifosfamide-Induced Neurotoxicity in Sarcoma Patients

“…Sarcoma include both slow-growing tumors and highly malignant histological subtypes requiring a multimodal therapy regimen [ 2 , 3 ]. These interdisciplinary treatment concepts include surgery, radiotherapy, and systemic cancer therapy, as well as, in selected cases, regional hyperthermia [ 3 , 4 , 5 , 6 , 7 , 8 ]. In sarcoma, systemic chemotherapy-based treatment still plays a central role in patients with both curative and palliative disease [ 4 , 8 ].…”

“…These interdisciplinary treatment concepts include surgery, radiotherapy, and systemic cancer therapy, as well as, in selected cases, regional hyperthermia [ 3 , 4 , 5 , 6 , 7 , 8 ]. In sarcoma, systemic chemotherapy-based treatment still plays a central role in patients with both curative and palliative disease [ 4 , 8 ]. Regarding the clinical data existing so far, anthracyclines alone or in combination with the alkylating agent ifosfamide are most commonly used [ 4 , 7 ].…”