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Wu KA, Shenoy D, Sachs E, Somarelli JA, Pean C, DeBaun M, Brigman BE, Visgauss JD, Eward WC. Exploring versatile applications of a vacuum-assisted bone harvester in orthopedic surgery. BMC Musculoskelet Disord 2024; 25:688. [PMID: 39217301 PMCID: PMC11365185 DOI: 10.1186/s12891-024-07786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Orthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions. METHODS A retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio. RESULTS The study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%. CONCLUSION The vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device's performance. It is crucial to acknowledge that isolating the device's contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.
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Affiliation(s)
- Kevin A Wu
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA.
- Duke University School of Medicine, Durham, NC, USA.
| | | | - Elizabeth Sachs
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
- Duke University School of Medicine, Durham, NC, USA
| | | | - Christian Pean
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
| | - Malcolm DeBaun
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Hospital, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
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Zheng C, Xu G, Zhou X, Qiu J, Lan T, Zhang S, Li W. Combined preoperative denosumab and adjuvant microwave ablation for high-risk giant cell tumor of bone: a retrospective study in a single center. J Orthop Surg Res 2024; 19:488. [PMID: 39154187 PMCID: PMC11330130 DOI: 10.1186/s13018-024-04981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm with a high propensity for recurrence following intralesional curettage. The introduction of denosumab, a RANKL inhibitor, has shown potential in facilitating joint-sparing surgery. However, concerns exist regarding its impact on local recurrence rates. This study aimed to evaluate the efficacy and safety of combined preoperative denosumab with adjuvant microwave ablation (MWA) for the treatment of high-risk GCTB. METHODS We conducted a retrospective review of 19 patients with high-risk GCTB who underwent preoperative denosumab treatment followed by curettage and adjuvant MWA. The primary outcome measure was the local recurrence rate, with secondary outcomes including functional status assessed by the Musculoskeletal Tumor Society (MSTS) score and safety profile of the treatment. RESULTS In this retrospective analysis, we evaluated the outcomes of 19 patients with high-risk GCTB treated with preoperative denosumab and adjuvant MWA. The median follow-up duration was 33.1 months, 3 patients (15.8%) experienced local recurrence at a median of 21.6 months postoperatively and the local recurrence-free survival was 81.2% at two years. Notably, no patient developed lung metastasis, and all recurrences were successfully managed with repeat curettage and MWA, with a mean MSTS score of 27.3. No patient required joint replacement due to tumor recurrence, resulting in a 100% joint preservation rate. CONCLUSION The combination of preoperative denosumab and adjuvant MWA is a feasible and effective strategy for the management of high-risk GCTB, providing effective local control with preserved joint function. This approach may offer a surgical alternative for young patients where joint preservation is paramount.
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Affiliation(s)
- Chuanxi Zheng
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Gang Xu
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Xiayi Zhou
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Jin Qiu
- Department of Orthopedics, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, 518035, China
| | - Tao Lan
- Department of Spine Surgery, Shenzhen Second People's Hospital, Health Science Center, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Shiquan Zhang
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
| | - Wei Li
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
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Qiu X, He H, Zhang C, Liu Y, Zeng H, Liu Q. Application of microwave ablation assisted degradation therapy in surgical treatment of intramedullary chondrosarcoma of extremities. World J Surg Oncol 2024; 22:164. [PMID: 38914990 PMCID: PMC11194926 DOI: 10.1186/s12957-024-03443-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/16/2024] [Indexed: 06/26/2024] Open
Abstract
AIM Clinical diagnosis and surgical treatment of chondrosarcoma (CS) are continuously improving. The purpose of our study is to evaluate the effectiveness of microwave ablation (MWA) assisted degradation therapy in the surgical treatment of intramedullary chondrosarcoma of the extremities, to provide a new reference and research basis for the surgical treatment of CS. METHODS We recruited 36 patients with intramedullary CS who underwent MWA assisted extended curettage. Preoperative patient demographics and clinical data were recorded. Surgery was independently assisted by a medical team. Patients were followed up strictly and evaluated for oncological prognosis, radiological results, limb joint function, pain, and complications. RESULTS We included 15 men and 21 women (mean age: 43.5 ± 10.1). The average length of the lesion was 8.1 ± 2.5 cm. Based on preoperative radiographic, clinical manifestations, and pathological results of puncture biopsy, 28 patients were preliminarily diagnosed with CS-grade I and eight patients with CS-grade II. No recurrence or metastasis occurred in the postoperative follow-up. The average Musculoskeletal Tumor Society score was 28.8 ± 1.0, significantly better than presurgery. Secondary shoulder periarthritis and abduction dysfunction occurred in early postoperative stage CS of the proximal humerus in some, but returned to normal after rehabilitation exercise. Secondary bursitis occurred at the knee joint in some due to the internal fixation device used in treatment; however, secondary osteoarthritis and avascular necrosis of the femoral head were not observed. Overall, oncological and functional prognoses were satisfactory. CONCLUSIONS The application of MWA assisted degradation therapy in intramedullary CS can achieve satisfactory oncology and functional prognosis, providing a new option for the limited treatment of CS.
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Affiliation(s)
- Xinzhu Qiu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, P.R. China.
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Cui H, Li J, Zheng K, Xu M, Zhang G, Hu Y, Yu X. Microwave-assisted intralesional curettage combined with other adjuvant methods for treatment of Campanacci III giant cell tumor of bone in distal radius: a multicenter clinical study. Front Oncol 2024; 14:1383247. [PMID: 38764573 PMCID: PMC11099234 DOI: 10.3389/fonc.2024.1383247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/18/2024] [Indexed: 05/21/2024] Open
Abstract
Objective To compare the clinical outcomes of microwave-assisted intralesional curettage(MAIC) with those of en bloc resection and autogenous fibular reconstruction (EBR-AFR) for treating grade III giant cell tumor of the bone (GCTB) of the distal radius and to elucidate the indications for wrist preservation surgery. Materials and methods In this retrospective study, 19 patients with grade III GCTB of the distal radius who underwent surgery at three medical institutions were included and categorized based on their surgical pattern. Seven patients underwent MAIC and internal fixation with bone cement (MAIC group) and 12 underwent EBR-AFR (EBR-AFR group). To evaluate the function of the affected limb postoperatively, wrist range of motion, grip strength, Musculoskeletal Tumor Society (MSTS) scores were recorded. Results The follow-up time of the MAIC group was 73.57 ± 28.61 (36-116) months, with no recurrence or lung metastasis. In contrast, the follow-up time of the EBR-AFR group was 55.67 ± 28.74 (36-132) months, with 1 case of local recurrence (8.3%, 1/12) and 1 case of lung metastasis (8.3%, 1/12). The wrist flexion, extension, supination, pronation, grip strength were better in the MAIC group than in the EBR-AFR group. Although there was no statistically significant difference in the MSTS score between the two groups, it is noteworthy that the MAIC group exhibited significantly superior emotional acceptance and hand positioning compared to the EBR-AFR group(p < 0.05). Conclusion The functional outcomes of the MAIC group are better. The treatment strategy for grade III GCTB of the distal radius should be determined based on the specific preoperative imaging findings. Nevertheless, MAIC can be the preferred surgical approach for most patients with grade III GCTB of the distal radius, particularly for young patients.
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Affiliation(s)
- Haocheng Cui
- Orthopedic Department, 960 Hospital of People’s Liberation Army, Jinan, Shandong, China
| | - Jianhua Li
- Orthopedic Department, 960 Hospital of People’s Liberation Army, Jinan, Shandong, China
| | - Kai Zheng
- Orthopedic Department, 960 Hospital of People’s Liberation Army, Jinan, Shandong, China
| | - Ming Xu
- Orthopedic Department, 960 Hospital of People’s Liberation Army, Jinan, Shandong, China
| | - Guochuan Zhang
- Department of Musculoskeletal Tumor, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yongcheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Xiuchun Yu
- Orthopedic Department, 960 Hospital of People’s Liberation Army, Jinan, Shandong, China
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Xie M, Gong T, Wang Y, Li Z, Lu M, Luo Y, Min L, Tu C, Zhang X, Zeng Q, Zhou Y. Advancements in Photothermal Therapy Using Near-Infrared Light for Bone Tumors. Int J Mol Sci 2024; 25:4139. [PMID: 38673726 PMCID: PMC11050412 DOI: 10.3390/ijms25084139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Bone tumors, particularly osteosarcoma, are prevalent among children and adolescents. This ailment has emerged as the second most frequent cause of cancer-related mortality in adolescents. Conventional treatment methods comprise extensive surgical resection, radiotherapy, and chemotherapy. Consequently, the management of bone tumors and bone regeneration poses significant clinical challenges. Photothermal tumor therapy has attracted considerable attention owing to its minimal invasiveness and high selectivity. However, key challenges have limited its widespread clinical use. Enhancing the tumor specificity of photosensitizers through targeting or localized activation holds potential for better outcomes with fewer adverse effects. Combinations with chemotherapies or immunotherapies also present avenues for improvement. In this review, we provide an overview of the most recent strategies aimed at overcoming the limitations of photothermal therapy (PTT), along with current research directions in the context of bone tumors, including (1) target strategies, (2) photothermal therapy combined with multiple therapies (immunotherapies, chemotherapies, and chemodynamic therapies, magnetic, and photodynamic therapies), and (3) bifunctional scaffolds for photothermal therapy and bone regeneration. We delve into the pros and cons of these combination methods and explore current research focal points. Lastly, we address the challenges and prospects of photothermal combination therapy.
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Affiliation(s)
- Mengzhang Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Taojun Gong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Zhuangzhuang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
| | - Xingdong Zhang
- National Engineering Biomaterials, Sichuan University Research Center for Chengdu, Chengdu 610064, China;
- NMPA Key Laboratory for Quality Research and Control of Tissue Regenerative Biomaterials, Institute of Regulatory Science for Medical Devices, National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Qin Zeng
- National Engineering Biomaterials, Sichuan University Research Center for Chengdu, Chengdu 610064, China;
- NMPA Key Laboratory for Quality Research and Control of Tissue Regenerative Biomaterials, Institute of Regulatory Science for Medical Devices, National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China; (M.X.); (T.G.); (Y.W.); (Z.L.); (M.L.); (Y.L.); (L.M.); (C.T.)
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Jiang W, Lee S, Caruana D, Zhuang KD, Cazzato R, Latich I. Recent Advances in Minimally Invasive Management of Osteolytic Periacetabular Skeletal Metastases. Semin Intervent Radiol 2024; 41:154-169. [PMID: 38993598 PMCID: PMC11236455 DOI: 10.1055/s-0044-1787165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Sangmin Lee
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
| | - Dennis Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Roberto Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
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Sayag D, Jacques D, Thierry F, Castell Y, Aumann M, Gauthier O, Wavreille V, Tselikas L. Combination of CT-Guided Microwave Ablation and Cementoplasty as a Minimally Invasive Limb-Sparing Approach in a Dog with Appendicular Osteosarcoma. Animals (Basel) 2023; 13:3804. [PMID: 38136841 PMCID: PMC10740973 DOI: 10.3390/ani13243804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Image-guided microwave ablation and cementoplasty are minimally invasive techniques that have been used as part of a limb-sparing approach in the treatment of appendicular bone tumors in humans. The objective of this case report was to describe the feasibility and result of microwave ablation (MWA) and cementoplasty in a dog with stage-1 osteoblastic appendicular osteosarcoma of the right distal radius. A microwave antenna was inserted in the osteolytic area using computed tomography (CT) guidance. Three ablation cycles of 5 min at 60 watts were performed. Immediately after the MWA procedure, a tricalcium phosphate-based cement was injected through the bone trocar to consolidate the ablated zone. Adjuvant chemotherapy with six sessions of carboplatin was performed, without major complication. Response to the treatment was evaluated according to RECIST criteria every 6 weeks. Twenty-four hours after MWA, the dog was pain-free and had excellent mobility. Based on CT measurements, a reduction of the size of the lytic area was observed at the 2-month and at the 7-month follow-up (from 13% to 25% of the longest diameter), classified as stable disease according to RECIST criteria. The dog died 18 months after the initial diagnosis due to distant metastases.
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Affiliation(s)
- David Sayag
- ONCOnseil, Unité D’expertise en Oncologie Vétérinaire, 31200 Toulouse, France
| | - David Jacques
- Clinique Vétérinaire Occitanie, 31200 Toulouse, France
| | | | | | - Marcel Aumann
- Unité Medecine Interne, Urgences et Soins Intensifs, École Nationale Vétérinaire de Toulouse, 31300 Toulouse, France
| | - Olivier Gauthier
- Unité de Chirurgie, Anesthésie, ONIRIS—École Nationale Vétérinaire de Nantes, 44300 Nantes, France;
| | - Vincent Wavreille
- Vetspecialistes, Service de Chirurgie, 1218 Grand-Saconnex, Switzerland;
| | - Lambros Tselikas
- Service de Radiologie Interventionnelle, Gustave Roussy Cancer Campus, 94805 Villejuif, France;
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Hay AN, Ruger L, Hsueh A, Vickers E, Klahn S, Vlaisavljevich E, Tuohy J. A review of the development of histotripsy for extremity tumor ablation with a canine comparative oncology model to inform human treatments. Int J Hyperthermia 2023; 40:2274802. [PMID: 37994796 PMCID: PMC10669778 DOI: 10.1080/02656736.2023.2274802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023] Open
Abstract
Cancer is a devasting disease resulting in millions of deaths worldwide in both humans and companion animals, including dogs. Treatment of cancer is complex and challenging and therefore often multifaceted, as in the case of osteosarcoma (OS) and soft tissue sarcoma (STS). OS predominantly involves the appendicular skeleton and STS commonly develops in the extremities, resulting in treatment challenges due to the need to balance wide-margin resections to achieve local oncological control against the functional outcomes for the patient. To achieve wide tumor resection, invasive limb salvage surgery is often required, and the patient is at risk for numerous complications which can ultimately lead to impaired limb function and mobility. The advent of tumor ablation techniques offers the exciting potential of developing noninvasive or minimally invasive treatment options for extremity tumors. One promising innovative tumor ablation technique with strong potential to serve as a noninvasive limb salvage treatment for extremity tumor patients is histotripsy. Histotripsy is a novel, noninvasive, non-thermal, and non-ionizing focused ultrasound technique which uses controlled acoustic cavitation to mechanically disintegrate tissue with high precision. In this review, we present the ongoing development of histotripsy as a non-surgical alternative for extremity tumors and highlight the value of spontaneously occurring OS and STS in the pet dog as a comparative oncology research model to advance this field of histotripsy research.
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Affiliation(s)
- Alayna N. Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Lauren Ruger
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Andy Hsueh
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Elliana Vickers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
- Graduate program in Translation Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Joanne Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
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Ma L, Zhou J, Wu Q, Luo G, Zhao M, Zhong G, Zheng Y, Meng X, Cheng S, Zhang Y. Multifunctional 3D-printed scaffolds eradiate orthotopic osteosarcoma and promote osteogenesis via microwave thermo-chemotherapy combined with immunotherapy. Biomaterials 2023; 301:122236. [PMID: 37506512 DOI: 10.1016/j.biomaterials.2023.122236] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/04/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023]
Abstract
Tumor recurrence and a lack of bone-tissue integration are two critical concerns in the surgical treatment of osteosarcoma. Thus, an advanced multifunctional therapeutic platform capable of simultaneously eliminating residual tumor cells and promoting bone regeneration is urgently needed for efficient osteosarcoma treatment. Herein, to thoroughly eliminate tumors and simultaneously promote bone regeneration, an intelligent multifunctional therapeutic scaffold has been engineered by integrating microwave-responsive zeolitic imidazolate framework 8 (ZIF-8) nanomaterials loaded with a chemotherapeutic drug and an immune checkpoint inhibitor onto 3D-printed titanium scaffolds. The constructed scaffold features distinct microwave-thermal sensitization and tumor microenvironment-responsive characteristics, which can induce tumor immunogenic death by microwave hyperthermia and chemotherapy. Orthotopic implantation of the nanocomposite scaffold results in an enhanced immune response against osteosarcoma that may effectively inhibit tumor recurrence through synergistic immunotherapy. During long-term implantation, the zinc ions released from the degradation of ZIF-8 can induce the osteogenic differentiation of stem cells. The porous structure and mechanical properties of the 3D-printed titanium scaffolds provide a structural microenvironment for bone regeneration. This study provides a paradigm for the design of multifunctional microwave-responsive composite scaffolds for use as a therapy for osteosarcoma, which could lead to improved strategies for the treatment of the disease.
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Affiliation(s)
- Limin Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Jielong Zhou
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Qiong Wu
- Laboratory of Controllable Preparation and Application of Nanomaterials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Guowen Luo
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Manzhi Zhao
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Guoqing Zhong
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, PR China
| | - Xianwei Meng
- Laboratory of Controllable Preparation and Application of Nanomaterials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China.
| | - Shi Cheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China.
| | - Yu Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China.
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Zheng K, Yu X, Xu M, Cui H, Wu J, Hou Z, Tian D. Using 3D Printing Technology to Manufacture Personalized Bone Cement Placeholder Mold for Bone Defect Repair and Reconstruction with Infection: A Case Report. Orthop Surg 2023; 15:2724-2729. [PMID: 37382443 PMCID: PMC10549869 DOI: 10.1111/os.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Limb salvage surgery is the preferred treatment for most malignant bone tumors, but postoperative infection treatment is very challenging. Simultaneously controlling infection and solving bone defects are clinical treatment challenges. CASE PRESENTATION Here we describe a new technique for treating bone defect infection after bone tumor surgery. An 8-year-old patient suffered an incision infection after osteosarcoma resection and bone defect reconstruction. In response, we designed her a personalized, anatomically matched, antibiotic-loaded, bone cement spacer mold using 3D printing technology. The patient's infection was cured, and limb salvage was successful. In follow-up, the patient had returned to normal postoperative chemotherapy and was able to walk with the help of a cane. There was no obvious pain in the knee joint. At 3 months after operation, the range of motion of the knee joint was 0°-60°. CONCLUSION The 3D printing spacer mold is an effective solution for treating the infection with large bone defect.
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Affiliation(s)
- Kai Zheng
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Xiu‐chun Yu
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Ming Xu
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Haocheng Cui
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Junyi Wu
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Zhiwei Hou
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Dongmu Tian
- ShanDong Weigao Haixing Medical Device Co., LTDShanDongChina
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11
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Zheng K, Yu XC, Xu M, Wang JM. Conservative surgery with microwave ablation for recurrent bone tumor in the extremities: a single-center study. BMC Cancer 2022; 22:1122. [PMID: 36320002 PMCID: PMC9628094 DOI: 10.1186/s12885-022-10233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Surgical treatment for recurrent bone tumors in the extremities still presents a challenge. This study was designed to evaluate the clinical value of microwave ablation in the treatment of recurrent bone tumors. METHODS We present 15 patients who underwent microwave ablation for recurrent bone tumors during the last 7 years. The following parameters were analyzed for outcome evaluation: general condition, surgical complications, local disease control, overall survival, and functional score measured using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. RESULTS Percutaneous microwave ablation in one patient with osteoid osteoma and another with bone metastasis resulted in postoperative pain relief. Thirteen patients received intraoperative microwave ablation before curettage or resection, including those with giant cell tumors of bone (6), chondroblastoma (2), osteosarcoma (2), undifferentiated sarcoma (1), and bone metastases (2). All patients achieved reasonable local tumor control in the mean follow-up of 29.9 months. The functional score was 24.1 for the 15 patients 6 months after the operation. Four patients had tumor metastasis and died, whereas 3 patients with tumors survived, and the remaining 8 patients without the disease survived. CONCLUSIONS Microwave ablation represents an optional method for local control in treating recurrent bone tumors in the extremities.
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Affiliation(s)
- Kai Zheng
- Department of Orthopedics, The 960Th Hospital of the PLA Joint Logistice Support Force, No. 25 Shifan Road, Jinan, 250031 China
| | - Xiu-chun Yu
- Department of Orthopedics, The 960Th Hospital of the PLA Joint Logistice Support Force, No. 25 Shifan Road, Jinan, 250031 China
| | - Ming Xu
- Department of Orthopedics, The 960Th Hospital of the PLA Joint Logistice Support Force, No. 25 Shifan Road, Jinan, 250031 China
| | - Jing-ming Wang
- Department of Orthopedics, The 960Th Hospital of the PLA Joint Logistice Support Force, No. 25 Shifan Road, Jinan, 250031 China
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12
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Jiang X, Chen J, Zhou W, Zhang C, Wang G, Dong D, Xia P, Liu X, Xu F. Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04348-9. [PMID: 36190550 DOI: 10.1007/s00432-022-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). METHODS This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. RESULTS All patients were followed up for 21 to 110 months, with an average of 63.79 months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. CONCLUSIONS The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. LEVEL OF EVIDENCE IV: case series.
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Affiliation(s)
- Xiang Jiang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, 1023-1063 Shatai South Road, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Chen Zhang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Dan Dong
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Pingguang Xia
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China.
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
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13
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Zuo D, Sun M, Mu H, Shen J, Wang C, Sun W, Cai Z. O-arm-guided percutaneous microwave ablation and cementoplasty for the treatment of pelvic acetabulum bone metastasis. Front Surg 2022; 9:929044. [PMID: 36171820 PMCID: PMC9510637 DOI: 10.3389/fsurg.2022.929044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to evaluate the indications, safety, and efficacy of microwave ablation combined with cementoplasty under O-arm navigation for the treatment of painful pelvic bone metastasis. Methods We retrospectively collected data from 25 patients with acetabulum bone metastasis who underwent microwave ablation combined with cementoplasty. All patients underwent percutaneous microwave ablation combined with cementoplasty under O-arm navigation. The postoperative follow-up included evaluations of pain, quality of life, function, the incidence of bone cement leakage, and the presence of perioperative complications. Pain and quality of life were evaluated using the visual analog scale (VAS) and the QLQ-BM22 quality of life questionnaire for patients with bone metastases, respectively. The functional scores were calculated using the MSTS93 scoring system of the Bone and Soft Tissue Oncology Society. Results There were 10 males and 15 females with an average age of 52.5 ± 6.5 years, all 25 patients received percutaneous procedures, and no technical failure occurred. Major complications, including pulmonary embolism, vascular or nervous injury, hip joint cement leakage, and infection, were not observed in the current study. Pain regression was achieved in 24 of 25 patients. The mean VAS scores significantly decreased to 3.4 ± 1.0, 2.5 ± 1.2, and 1.2 ± 0.6 points at 1 week, 1 month, and 3 months after the procedure, respectively, compared with 7.0 points before the procedure (P < .05). The mean QLQ-BM22 score significantly decreased to 36.2 ± 4.9, 30 ± 5.6, and 25.4 ± 2.3 points at 1 week, 1 month, and 3 months after the procedure, respectively, compared with 55.8 points before the procedure (P < .05). The preoperative Musculoskeletal tumour society (MSTS) functional score of 25 patients was 18.5 ± 5.3 points, and MSTS score was 20.0 ± 3.0, 21.4 ± 4.9, and 22.8 ± 2.3 at 1 week, 1 month, and 3 months after the procedure, respectively (P < .05). The average bone cement injection volume was 8.8 ± 4.6 ml. Conclusion The use of O-arm-guided percutaneous microwave ablation combined with cementoplasty for the treatment of pelvic metastases could quickly and significantly alleviate local pain, prevent pathological fracture, and improve the quality of life of patients with reduced complications.
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Affiliation(s)
- Dongqing Zuo
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengxiong Sun
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Mu
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Bone Tumor Institute, Shanghai, China
| | - Jiakang Shen
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chongren Wang
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Sun
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Wei Sun
| | - Zhengdong Cai
- Department of Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Bone ablations in peripheral skeleton: rationale, techniques and evidence. Tech Vasc Interv Radiol 2022; 25:100804. [DOI: 10.1016/j.tvir.2022.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Bădilă AE, Rădulescu DM, Niculescu AG, Grumezescu AM, Rădulescu M, Rădulescu AR. Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review. Cancers (Basel) 2021; 13:4229. [PMID: 34439383 PMCID: PMC8392383 DOI: 10.3390/cancers13164229] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
In the last decades, the treatment of primary and secondary bone tumors has faced a slow-down in its development, being mainly based on chemotherapy, radiotherapy, and surgical interventions. However, these conventional therapeutic strategies present a series of disadvantages (e.g., multidrug resistance, tumor recurrence, severe side effects, formation of large bone defects), which limit their application and efficacy. In recent years, these procedures were combined with several adjuvant therapies, with different degrees of success. To overcome the drawbacks of current therapies and improve treatment outcomes, other strategies started being investigated, like carrier-mediated drug delivery, bone substitutes for repairing bone defects, and multifunctional scaffolds with bone tissue regeneration and antitumor properties. Thus, this paper aims to present the types of bone tumors and their current treatment approaches, further focusing on the recent advances in new therapeutic alternatives.
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Affiliation(s)
- Adrian Emilian Bădilă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Dragoș Mihai Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Adrian Radu Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
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