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Is there consensus regarding surgical treatment of bone sarcomas?

World Journal of Orthopedics 2018年第9期9卷 173-179页

作者： Thomas Baad-Hansen Sarah Stammose Freund Bodil Hammer Bech Johnny Keller Department of orthopaedic oncology Aarhus University Hospital Department of Public Health Aarhus University

AIM To perform an Internet based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons. METHODS All orthopedic surgical members of the Scandinavian Sarcoma Group were invited to participate in an online questionnaire. The questionnaire consisted of a clinical case involving resection of a malignant bone tumor. Several questions were asked, subdivided into categories. Among these, surgical/technical considerations, e.g., choice of implant; choice of antibiotics, dosage, and duration of treatment, choice of antithrombotic drug, initial start-up, dosage, and duration were *** In terms of choice of implant fixation, the majority of surgeons preferred an uncemented prosthesis in younger patients until the age of 50. All participants administer intravenous prophylactic antibiotics for endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less common used was glycopeptide, penicillin, or a combination. Duration of prophylactic antibiotics ranged from less than one day to more than four days. All participants used low molecular weight heparins as antithrombotic prophylaxis and 55% of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Duration of the antithrombotic treatment ranged from five days to more than twenty-eight *** The use of resection prosthesis in the treatment of bone sarcomas is a well-established procedure. However, therse is a significant discrepancy in the surgical treatment algorithm between the sarcoma centers. Still the treatment is mainly based on best clinical practice,due to the lack of evidence-based medicine in the surgical management of bone sarcomas.

关键词： Sarcoma Reconstruction Megaprosthesis Antibiotics Antithrombotic prophylaxis

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Metastatic appendicular soft tissue sarcoma: treatment and survival outcomes of 2,553 patients from the SEER database

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Journal of Cancer Metastasis and Treatment 2023年第1期9卷 480-496页

作者： Marcos R.Gonzalez Paul Rizk Thomas W.Hodo Angad Bedi Daniel Karczewski Santiago A.Lozano-Calderon Division of orthopaedic oncology Department of Orthopaedic SurgeryMassachusetts General HospitalHarvard Medical SchoolBostonMA 02144USA Department of orthopaedic Surgery University of FloridaGainesvilleFL 32608USA Department of orthopaedic Surgery Tulane University School of MedicineNew OrleansLA 70112USA Department of orthopaedic Surgery University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire *** this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)metastatic patterns,(3)treatment strategies,and(4)disease-specific survival(DSS).Materials and Methods:The SEER database was queried to identify patients with histologically confirmed STS of the pelvis or *** and multivariate analysis was performed using the Cox proportional hazards ***-specific survival(DSS)was analyzed using the Kaplan-Meier ***:A total of 22,683 patients were retrieved,out of which 2,553(11.3%)had metastasis at ***,undifferentiated pleomorphic sarcoma(UPS),liposarcoma,synovial sarcoma,spindle cell sarcoma,and alveolar rhabdomyosarcoma(A-RMS)were the six most common STS presenting with *** patients with metastasis,53.7%and 33.2%of patients had primary tumors located in the lower limb and pelvis,*** was the most common site of metastasis in all subtypes except A-RMS,in which bone metastases and lymph node(LN)predominated(85.2%and 62.1%,respectively).Chemotherapy and radiotherapy were associated with higher DSS(HR=0.788 and HR=0.755,respectively).Five-year DSS was below 20%in all tumor ***-year DSS for patients with synchronous lung and liver metastases was 28%.Conclusion:Although the lung was the most common site of metastasis,metastatic patterns are highly variable depending on tumor *** A-RMS is most commonly presented with regional LN and bone ***-specific survival remained poor for patients with metastatic disease at presentation regardless of(neo)-adjuvant radiotherapy or chemotherapy.

关键词： Soft tissue sarcoma metastasis treatment survival

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Bone Regeneration Based on Tissue Engineering Conceptions – A 21st Century Perspective

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Bone Research 2013年第3期1卷 216-248页

作者： Jan Henkel Maria A.Woodruff Devakara R.Epari Roland Steck Vaida Glatt Ian C.Dickinson Peter F.M.Choong Michael A.Schuetz Dietmar W.Hutmacher Institute of Health & Biomedical Innovation Queensland University of TechnologyBrisbane Queensland Australia orthopaedic oncology service Princess Alexandra HospitalBrisbane Australia Department of Surgery University of Melbourne St. Vincent's HospitalMelbourne Australia Department of orthopaedics St. Vincent's HospitalMelbourneAustralia Bone and Soft Tissue Sarcoma service Peter MacCallum Cancer CentreMelbourne Australia orthopaedic and Trauma services Princess Alexandra HospitalBrisbane Australia George W Woodruff School of Mechanical Engineering Georgia Institute of TechnologyAtlanta GA USA

The role of Bone Tissue Engineering in the field of Regenerative Medicine has been the topic of substantial research over the past two decades. Technological advances have improved orthopaedic implants and surgical techniques for bone reconstruction. However, improvements in surgical techniques to reconstruct bone have been limited by the paucity of autologous materials available and donor site morbidity. Recent advances in the development of biomaterials have provided attractive alternatives to bone grafting expanding the surgical options for restoring the form and function of injured bone. Specifically, novel bioactive （second generation） biomaterials have been developed that are characterised by controlled action and reaction to the host tissue environment, whilst exhibiting controlled chemical breakdown and resorption with an ultimate replacement by regenerating tissue. Future generations of biomaterials （third generation） are designed to be not only osteo- conductive but also osteoinductive, i.e. to stimulate regeneration of host tissues by combining tissue engineer- ing and in situ tissue regeneration methods with a focus on novel applications. These techniques will lead to novel possibilities for tissue regeneration and repair. At present, tissue engineered constructs that may find future use as bone grafts for complex skeletal defects, whether from post-traumatic, degenerative, neoplastic or congenital/developmental ＂origin＂ require osseous reconstruction to ensure structural and functional integrity. Engineering functional bone using combinations of cells, scaffolds and bioactive factors is a promising strategy and a particular feature for future development in the area of hybrid materials which are able to exhibit suitable biomimetic and mechanical properties. This review will discuss the state of the art in this field and what we can expect from future generations of bone regeneration concepts.

关键词： bone tissue engineering regenerative medicine additve manufacturing clinical translation scaffolds

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The versatile functions of Sox9 in development,stem cells,and human diseases

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Genes & Diseases 2014年第2期1卷 149-161页

作者： Alice Jo Sahitya Denduluri Bosi Zhang Zhongliang Wang Liangjun Yin Zhengjian Yan Richard Kang Lewis L.Shi James Mok Michael J.Lee Rex C.Haydon Molecular oncology Laboratory Department of Orthopaedic Surgery and Rehabilitation MedicineThe University of Chicago Medical CenterChicagoIL 60637USA Departments of orthopaedic Surgery The Affiliated Hospitals of Chongqing Medical UniversityChongqing 400046China

The transcription factor Sox9 was first discovered in patients with campomelic dysplasia,a haploinsufficiency disorder with skeletal deformities caused by dysregulation of Sox9 expression during *** then,its role as a cell fate determiner during embryonic development has been well characterized;Sox9 expression differentiates cells derived from all three germ layers into a large variety of specialized tissues and ***,recent data has shown that ectoderm-and endoderm-derived tissues continue to express Sox9 in mature organs and stem cell pools,suggesting its role in cell maintenance and specification during adult *** versatility of Sox9 may be explained by a combination of posttranscriptional modifications,binding partners,and the tissue type in which it is *** its importance during both development and adult life,it follows that dysregulation of Sox9 has been implicated in various congenital and acquired diseases,including fibrosis and *** review provides a summary of the various roles of Sox9 in cell fate specification,stem cell biology,and related human ***,understanding the mechanisms that regulate Sox9 will be crucial for developing effective therapies to treat disease caused by stem cell dysregulation or even reverse organ damage.

关键词： Development Sox9 Stem cells Transcription factor

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Magnetic Resonance Imaging for the Assessment of Long Bone Tumors

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Chinese Medical Journal 2017年第21期130卷 2547-2550页

作者： Tao Jin Zhi-Ping Deng Wei-Feng Liu Hai-Rong Xu Yuan Li Xiao-Hui Niu Department of orthopaedic oncology Surgery Beijing Jishuitan Hospital Peking University Beijing 100035 China

Background： Wide resection margins of osseous tumors are associated with a low incidence of local recurrence, making accurate measurement of the intraosseous extent of primary malignant long bone tumors is crucial. We compared the intraosseous tumor extent assessed by magnetic resonance imaging （MRI） with the gross specimen to evaluate the accuracy of MRI. Methods： A total of 255 patients with primary malignant tumors in the long bones were included. Using MRI, we defined the length of tumor as the distance from the articular surface to the boundary between abnormal and normal marrow signal. The extent of the abnormal intraosseous signal was measured on unenhanced T1-weighted （T1WI） magnetic resonance images after chemotherapy. All gross surgical specimens were sectioned, and tumor extent was measured. Wilcoxon signed-rank test was used to test the differences between MRI and gross specimen findings. Spearman＇s correlation analysis was used to test the correlation between groups. Results： Median tumor length by gross specimen （112 mm; range, 45–300 mm） was longer than that by MRI （108 mm; range, 45–304 mm;Z = -6.916, P 〈 0.001）. Of 255 images, tumor length was accurately represented on 27 T1WI magnetic resonance images, overestimated on 79 images, and underestimated on 149 images. The median difference between imaging and gross specimen measurements was 2.0 mm （range： 1.0–15.0 mm） for the 79 cases where tumor length was overestimated, and 5.0 mm （range： 1.0–18.0 mm） for the 149 cases where tumor length was underestimated. The Spearman correlation demonstrated a high correlation of tumor length on gross specimen with the tumor length on MRI （R = 0.99, P 〈 0.01）. Conclusions： We conclude that preoperative MRI could be a useful method in determining intramedullary malignant bone tumor boundaries and may serve as an accepted assessment method of long bone tumors before limb-sparing surgery.

关键词： Bone Tumor Gross Specimen Long Bone Magnetic Resonance Imaging Tumor Length

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Bioadaptive Nanorod Topography of Titanium Surface to Control Cell Behaviors and Osteogenic Differentiation of Preosteoblast Cells

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Journal of Materials Science & Technology 2016年第9期32卷 944-949页

作者： Shao Xu Zhiyu Zhou Manman Gao Changye Zou Yinglin Che Bünger Cody Xuenong Zou Lei Zhou Department of Stomatology The Third Affiliated Hospital of Southern Medical University Guangdong Provincial Key Laboratory of Orthopedics and Traumatology/Orthopedic Research Institute The First Affiliated Hospital of Sun Yat-sen University Department of Musculoskeletal oncology The First Affiliated Hospital of Sun Yat-sen University orthopaedic Research Laboratory Department of Orthopaedic Surgery Aarhus University Hospital Guangdong Provincial Stomatological Hospital Southern Medical University

Titanium （Ti） nanorods fabricated using selective corrosion of Ti substrate by anodic technology show better biocompatibility with pre-osteoblast cells. The current study investigated the response of the murine pre-osteoblast cell MCST3-E1 on Ti nanorod topography and untreated Ti surfaces by means of examination of the morphology and osteogenic differentiation responsible for the pre-osteoblast reaction. The morphology of MCST3-E1 cells was observed using scanning electron microscopy, and alkaline phosphatase （ALP） activity was measured using a colorimetric assay after incubation for 7, 14, and 21 days. The expression of three osteogenic differentiation markers including ALP, osteocalcin （OCN）, and collagen type 1A1 （COL1A1） and two transcription factors including runt related transcription factor 2 （Runx2） and osterix （Osx） at different time points was detected using real-time polymerase chain reaction analysis in both groups. Osx was used to confirm the protein level. The results showed that Ti nanorod surfaces provided prolonged higher levels of ALP activity compared with unmodified Ti surface on the 14th and 21st days. Gene expression analysis of ALP, OCN, and COL1A1 showed significant upregulation with modified nanorod topography after incubation for 14 and 21 days. Osteogenic transcription factors of Runx2 and Osx exhibited changes consistent with the osteogenic differentiation markers, and this may contribute to the persistently active differentiation of MC3T3-E1 cells in the Ti nanorod group. These results demonstrated that the current nanostructured surface may be considered bioadaptive topography to control cellular behaviors and osteoblast differentiation. The in vivo performance and applicability are further required to investigate osseointegration between implant and host bone in the early stages for prevention of aseptic implant loosening.

关键词： Titanium Nanorods Osteointegration Osteoblast differentiation

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orthopaedic perspective on bone metastasis

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World Journal of Orthopedics 2013年第3期4卷 114-119页

作者： Alan P Molloy Gary C O’Toole Department of orthopaedic oncology St Vincents HospitalDublin 4Ireland

The incidence of cancer is increasing worldwide, with the advent of a myriad of new treatment options, so is the overall survival of these patients. However, from an orthopaedic perspective, there comes the challenge of treating more patients with a variety of metastatic bone lesions. The consequences of such lesions can be significant to the patient, from pain and abnormal blood results, including hypercalcemia, to pathological fracture. Given the multiple options available, the treatment of bone metastasis should be based on a patientby patient manner, as is the case with primary bone lesions. It is imperative, given the various lesion types and locations, treatment of bone metastasis should be performed in an individualised manner. We should consider the nature of the lesion, the effect of treatment on the patient and the overall outcome of our decisions. The dissemination of primary lesions to distant sites is a complex pathway involving numerous cytokines within the tumour itself and the surrounding microenvironment. To date, it is not fully understood and we still base a large section of our knowledge on Pagets historic "seed and soil" theory. As we gain further understanding of this pathway it will allow us develop more medical based treatments. The treatment of primary cancers has long been provided in a multi-disciplinary setting to achieve the best patient outcomes. This should also be true for the treatment of bone metastases. orthopaedic surgeons should be involved in themultidisciplinary treatment of such patients given that there are a variety of both surgical fixation methods and non-operative methods at our disposal.

关键词： Bone metastases Diagnosis Pathophysiology Surgical treatment,Medical treatment

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Local Adjuvants in Surgical Management of Bone Lesions

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Journal of Cancer Therapy 2015年第6期6卷 473-481页

作者： Giulio Di Giacomo Antonio Ziranu Carlo Perisano Andrea Piccioli Giulio Maccauro Department of orthopaedic and Traumatology Catholic University of the Sacred Heart Rome Italy orthopaedic oncology University La Sapienza Rome Italy

One of the most common methods for surgical treatment of bone metastasis is curettage. Local adjuvants are used to improve the effect of curettage in local cancer surgery and they may exerted their effects either chemically either physically;in orthopaedic oncology the most common are phenol, liquid nitrogen, laser, cement and argon beam coagulation. The purpose of this article is to review the main characteristics of the most common chemical and physical agents used in bone oncology, emphasizing the toxic effects of some of them, especially phenol and liquid nitrogen.

关键词： Local Adjuvant Bone Lesions orthopaedic oncology Cryotherapy

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Glycogen synthase kinase 3b biology in bone and soft tissue sarcomas

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Journal of Cancer Metastasis and Treatment 2020年第1期6卷 660-674页

作者： Kensaku Abe Shingo Shimozaki Takahiro Domoto Norio Yamamoto Hiroyuki Tsuchiya Toshinari Minamoto Department of orthopaedic Surgery Graduate School of Medical SciencesKanazawa UniversityKanazawa 920-8641Japan Division of Translational and Clinical oncology Cancer Research InstituteKanazawa UniversityKanazawa 920-0934Japan Shimozaki orthopaedic Hospital HakusanIshikawa 924-0802Japan

Bone and soft tissue sarcomas are malignant neoplasms probably originating from musculoskeletal and mesenchymal progenitor *** than 80 different histopathological subtypes are encountered in *** standard of care for sarcoma patients involves a multidisciplinary combination of surgery,anthracycline-based multiagent chemotherapy and ***,these are associated with adverse events and occasionally disappointing *** genomic-,biologically-,and immunologically-based therapies are still under evaluation in early-phase clinical ***,there are strong barriers to the development and clinical translation of new therapeutic *** is due to the rarity of these diseases,the broad spectrum of tumor subtypes with genetic and biological heterogeneity,and the wide variability in clinical manifestation,response to treatment and prognosis.A potential approach toward overcoming this barrier is to identify therapeutic targets that cover multiple sarcoma *** synthase kinase 3b(GSK3b)has emerged as a common therapeutic target in more than 25 different cancer *** we review the evidence for tumor-promoting roles of GSK3b in the major types of bone and soft tissue sarcomas including osteosarcoma,rhabdomyosarcoma,synovial sarcoma,and *** this review,we describe the therapeutic effects of inhibiting GSK3b in these sarcoma types,while also protecting healthy cells and tissues from detrimental effects associated with conventional therapies,such as doxorubicin-induced ***,we highlight GSK3b as a potential therapeutic target spanning multiple sarcoma types.

关键词： Osteosarcoma rhabdomyosarcoma synovial sarcoma fibrosarcoma glycogen synthase kinase 3b

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Biomechanical Properties of Synthetic Mesh Reconstructed Glenohumeral Joint Capsule

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Chinese Medical Journal 2017年第14期130卷 1743-1744页

作者： Tao Jin Wei-Feng Liu Hai-Rong Xu Yuan Li Xiao-Hui Niu Department of orthopaedic oncology Surgery Beijing Jishuitan Hospital Peking University Beijing 100035 China

Synthetic mesh is often used in soft tissue reconstruction after artificial prosthesis replacement for patients with proximal humeral bone *** carried out biomechanical and histological tests on two amputated extremit... 详细信息

关键词： Biomechanical Shoulder Joint Stability Synthetic Mesh Tumors

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