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Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 21583

Special Issue Editors

Dr. Roberto Biagini

E-Mail Website
Guest Editor
Department of Oncological Orthopaedics, IRCCS - Regina Elena National Cancer Institute, 00144 Rome, Italy
Interests: bone and soft tissue tumors surgery; spine and pelvic surgery; pediatric surgery; reconstructive surgery
Dr. Carmine Zoccali

E-Mail Website
Co-Guest Editor
Department of Oncological Orthopaedics, IRCCS - “Regina Elena” National Cancer Institute, 00144 Rome, Italy
Interests: bone and soft tissue tumors surgery; spine and pelvic surgery; pediatric surgery; reconstructive surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Barbara Rossi

E-Mail Website
Co-Guest Editor
Department of Oncological Orthopaedics, IRCCS - Regina Elena National Cancer Institute, 00144 Rome, Italy
Interests: bone and soft tissue tumors surgery; bone metastases; reconstructive surgery

Special Issue Information

Dear Colleagues,

Oncological orthopedics deals with a wide spectrum of pathologies, ranging from rare diseases such as primary tumors (bone sarcomas account for <0.2% of all malignancies) to bone metastases (up to 70% of patients affected by carcinomas), where the skeleton is the third site of secondary lesions after lung and liver. Therefore, patients of all ages are involved (from childhood to advanced elderly) in ubiquitous anatomical sites of trunk and extremities, with histotypes and clinical prognostic behaviors that are extremely different. Nonetheless, it is intriguing that primary and metastatic bone tumors share some inter-related features in terms of management and approach. First, advances in anticancer therapies and translational research in recent decades have led to a marked prolongation of survival in patients suffering from musculoskeletal cancer. Second, diagnosis, staging, and management of all skeletal tumors benefit from a multidisciplinary team approach in reference centers with a high level of expertise and within reference networks. Finally, in the modern era of limb-salvage and mini-invasive surgery, the innovation of surgical techniques and the optimization of adjuvant radiotherapy and chemotherapy regimens have allowed targeted personalized treatment pathways. The aim of this Special Issue is to provide an updated overview focusing on some emerging topics whose integration is essential for a correct and effective management of bone tumors and metastases.

Dr. Roberto Biagini
Guest Editor
Dr. Carmine Zoccali,
Dr. Barbara Rossi
Co-Guest Editors

Manuscript Submission Information

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Keywords

  • Radiology
  • Medical oncology
  • Radiotherapy/proton therapy
  • Limb salvage surgery and surgical innovations
  • Case and data management
  • Narrative medicine
  • Psychological approach
  • Bone banking

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Published Papers (7 papers)

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Research

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23 pages, 33759 KiB  
Article
Osteolytic vs. Osteoblastic Metastatic Lesion: Computational Modeling of the Mechanical Behavior in the Human Vertebra after Screws Fixation Procedure
by Daniele Bianchi, Cristina Falcinelli, Leonardo Molinari, Alessio Gizzi and Alberto Di Martino
J. Clin. Med. 2022, 11(10), 2850; https://doi.org/10.3390/jcm11102850 - 18 May 2022
Cited by 6 | Viewed by 3540
Abstract
Metastatic lesions compromise the mechanical integrity of vertebrae, increasing the fracture risk. Screw fixation is usually performed to guarantee spinal stability and prevent dramatic fracture events. Accordingly, predicting the overall mechanical response in such conditions is critical to planning and optimizing surgical treatment. [...] Read more.
Metastatic lesions compromise the mechanical integrity of vertebrae, increasing the fracture risk. Screw fixation is usually performed to guarantee spinal stability and prevent dramatic fracture events. Accordingly, predicting the overall mechanical response in such conditions is critical to planning and optimizing surgical treatment. This work proposes an image-based finite element computational approach describing the mechanical behavior of a patient-specific instrumented metastatic vertebra by assessing the effect of lesion size, location, type, and shape on the fracture load and fracture patterns under physiological loading conditions. A specific constitutive model for metastasis is integrated to account for the effect of the diseased tissue on the bone material properties. Computational results demonstrate that size, location, and type of metastasis significantly affect the overall vertebral mechanical response and suggest a better way to account for these parameters in estimating the fracture risk. Combining multiple osteolytic lesions to account for the irregular shape of the overall metastatic tissue does not significantly affect the vertebra fracture load. In addition, the combination of loading mode and metastasis type is shown for the first time as a critical modeling parameter in determining fracture risk. The proposed computational approach moves toward defining a clinically integrated tool to improve the management of metastatic vertebrae and quantitatively evaluate fracture risk. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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17 pages, 2908 KiB  
Article
Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining
by Leonardo Vivarelli, Marco Govoni, Dario Attala, Carmine Zoccali, Roberto Biagini and Dante Dallari
J. Clin. Med. 2022, 11(10), 2781; https://doi.org/10.3390/jcm11102781 - 15 May 2022
Cited by 1 | Viewed by 2702
Abstract
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a [...] Read more.
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a virtual tissue database based on the scanning of the available allografts for using their 3D shape during virtual surgical planning (VSP) procedures. To promote the use of future VSP bone-shaping protocols useful for machining applications within a cleanroom environment, in our work, we simulate a massive bone allograft machining with two different machines: a four-axes (computer numerical control, CNC) vs. a five-axes (robot) milling machine. The allograft design was based on a real case of allograft reconstruction after pelvic tumour resection and obtained with 3D Slicer and Rhinoceros software. Machining simulations were performed with RhinoCAM and graphically and mathematically analysed with CloudCompare and R, respectively. In this case, the geometrical differences of the allograft design are not clinically relevant; however, the mathematical analysis showed that the robot performed better than the four-axes machine. The proof-of-concept presented here paves the way towards massive bone allograft cleanroom machining. Nevertheless, further studies, such as the simulation of different types of allografts and real machining on massive bone allografts, are needed. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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9 pages, 237 KiB  
Article
Narrative Medicine: A Digital Diary in the Management of Bone and Soft Tissue Sarcoma Patients. Preliminary Results of a Multidisciplinary Pilot Study
by Maria Cecilia Cercato, Sabrina Vari, Gabriella Maggi, Wioletta Faltyn, Concetta Elisa Onesti, Jacopo Baldi, Alessandra Scotto di Uccio, Irene Terrenato, Claudia Molinaro, Virginia Scarinci, Francesca Servoli, Cristina Cenci, Roberto Biagini and Virginia Ferraresi
J. Clin. Med. 2022, 11(2), 406; https://doi.org/10.3390/jcm11020406 - 14 Jan 2022
Cited by 12 | Viewed by 2489
Abstract
Background. Guidelines for the implementation of narrative medicine in clinical practice exist; however, in Italy, no standard methodology is currently available for the management of oncological patients. Since 2017, at the “Regina Elena” National Cancer Institute, studies using “digital narrative diaries” (DNMLAB platform) [...] Read more.
Background. Guidelines for the implementation of narrative medicine in clinical practice exist; however, in Italy, no standard methodology is currently available for the management of oncological patients. Since 2017, at the “Regina Elena” National Cancer Institute, studies using “digital narrative diaries” (DNMLAB platform) have been carried out; this article focuses on a pilot, uncontrolled, real-life study aiming to evaluate the utility of DNM integrated with the care pathway of patients with bone and limb soft tissue sarcomas. Methods. Adult patients completed the diary during treatment or follow-up by writing their narrative guided by a set of narrative prompts. The endpoints were: (a) patients’ opinions about therapeutic alliance, awareness, and coping ability; (b) healthcare professionals’ (HCPs’) opinions about communication, therapeutic alliance, and information collection. Open- and closed-ended questions (Likert score: 1–5) were used to assess the items. Results. At the interim analysis of data from seven patients and five HCPs, DNM was shown to improve: (a) the expression of patients’ point of view, the perception of effective taking charge, disease awareness, and self-empowerment (score: 4.8/5); (b) patients’ communication, relationships, and illness knowledge (score: 4.6–4.8/5). Conclusions. The preliminary results supported the need to integrate patients’ narratives with clinical data and encourage further research. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
9 pages, 4636 KiB  
Article
Anterior Corpectomy and Plating with Carbon-PEEK Instrumentation for Cervical Spinal Metastases: Clinical and Radiological Outcomes
by Sokol Trungu, Luca Ricciardi, Stefano Forcato, Antonio Scollato, Giuseppe Minniti, Massimo Miscusi and Antonino Raco
J. Clin. Med. 2021, 10(24), 5910; https://doi.org/10.3390/jcm10245910 - 16 Dec 2021
Cited by 6 | Viewed by 2382
Abstract
Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: [...] Read more.
Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: Demographical, clinical, surgical and radiological data were collected from 2017 to 2020. The Neck Disability Index (NDI) questionnaire for neck pain, EORTC QLQ-C30 questionnaire for quality of life, Nurick scale for myelopathy and radiological parameters (segmental Cobb angle and cervical lordosis) were collected before surgery, at 6 weeks postoperatively and follow-up. Results: Seventeen patients met inclusion criteria. Mean age was 60.9 ± 7.6 years and mean follow-up was 12.9 ± 4.0 months. The NDI (55.4 ± 11.7 to 25.1 ± 5.4, p < 0.001) scores and the EORTC QLQ-C30 global health/QoL significantly improved postoperatively and at the last follow-up. The segmental Cobb angle (10.7° ± 5.6 to 3.1° ± 2.2, p < 0.001) and cervical lordosis (0.9° ± 6.7 to −6.2 ± 7.8, p = 0.002) significantly improved postoperatively. Only one minor complication (5.9%) was recorded. Conclusions: Carbon/PEEK implants represent a safe alternative to commonly used titanium ones and should be considered in cervical spinal metastases management due to their lower artifacts in postoperative imaging and radiation planning. Further larger comparative and cost-effectiveness studies are needed to confirm these results. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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19 pages, 2837 KiB  
Article
3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up
by Carmine Zoccali, Jacopo Baldi, Dario Attala, Alessandra Scotto di Uccio, Luca Cannavò, Gennaro Scotto and Alessandro Luzzati
J. Clin. Med. 2021, 10(16), 3539; https://doi.org/10.3390/jcm10163539 - 12 Aug 2021
Cited by 21 | Viewed by 2952
Abstract
Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications [...] Read more.
Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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9 pages, 5363 KiB  
Article
Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients
by Giovanni Beltrami, Gabriele Ristori, Anna Maria Nucci, Alberto Galeotti, Angela Tamburini, Guido Scoccianti, Domenico Campanacci, Marco Innocenti and Rodolfo Capanna
J. Clin. Med. 2021, 10(5), 1056; https://doi.org/10.3390/jcm10051056 - 4 Mar 2021
Cited by 8 | Viewed by 2796
Abstract
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants [...] Read more.
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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31 pages, 688 KiB  
Review
Interventional Radiology in the Management of Metastases and Bone Tumors
by Ferruccio Sgalambro, Luigi Zugaro, Federico Bruno, Pierpaolo Palumbo, Nicola Salducca, Carmine Zoccali, Antonio Barile, Carlo Masciocchi and Francesco Arrigoni
J. Clin. Med. 2022, 11(12), 3265; https://doi.org/10.3390/jcm11123265 - 7 Jun 2022
Cited by 17 | Viewed by 3543
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone [...] Read more.
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to −40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis. Full article
(This article belongs to the Special Issue Oncological Orthopedics: An Overview on Management on Bone Tumors and Bone Metastases)
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