State of the Art: The Current Concept of Multidisciplinary Management of Musculoskeletal Tumor

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

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 6679

Special Issue Editors


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Guest Editor
West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, China
Interests: musculoskeletal tumor; bone metastasis; orthopedic surgery; 3D-printing; tumor microenvironment; biomechanics in orthopedics
West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, China
Interests: bone oncology; soft tissue sarcomas; metastatic bone disease; preoperative planning; multimodality imaging; 3D printing
West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, China
Interests: bone tumor; soft tissue tumors; tumor microenvironment; biomechanics in orthopedics; orthopedic surgery; 3D-printing; computer-aided design; computer-aided surgery; preoperative planning

Special Issue Information

Dear Colleagues,

Accounting for approximately 1% of all new cancers diagnoses globally, soft tissue and bone sarcomas are rare malignant tumors. As such, generating high-quality evidence for diagnosis and treatment is challenging. The heterogeneity of these tumors has hindered the development of robust, evidence-based treatment strategies, and therapeutic approaches are neither patient-specific nor widely standardized. In the past several decades, emerging state-of-the-art approaches and concepts, including but not limited to transdisciplinary collaboration, targeted therapy, personalized surgical planning, and 3D printing, have attracted a great deal of curiosity regarding musculoskeletal tumors. The aim of this Special Issue is to underline the value of state-of-the-art approaches for musculoskeletal tumors and to provide an overview on emerging topics in the multidisciplinary management of these diseases. We encourage submissions focusing on new clinical methods and tools for diagnosis and treatment as well as on new concepts based on clinical evidence.

Dr. Wenli Zhang
Dr. Xiang Fang
Dr. Hong Duan
Guest Editors

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Keywords

  • musculoskeletal tumor
  • bone oncology
  • soft tissue sarcoma
  • translational research
  • surgery
  • medical treatment
  • multidisciplinary approach

Published Papers (5 papers)

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Research

13 pages, 421 KiB  
Article
Narrative Medicine: A Digital Diary in the Management of Patients with Bone and Soft Tissue Sarcoma—A Multidisciplinary Pilot Study
by Maria Cecilia Cercato, Concetta Elisa Onesti, Sabrina Vari, Gabriella Maggi, Wioletta Faltyn, Serena Ceddia, Irene Terrenato, Virginia Scarinci, Francesca Servoli, Cristina Cenci, Roberto Biagini and Virginia Ferraresi
J. Clin. Med. 2023, 12(23), 7218; https://doi.org/10.3390/jcm12237218 - 21 Nov 2023
Viewed by 617
Abstract
Although patient narratives have been increasingly introduced in various fields of medicine, a standard method in clinical practice is still lacking. The objectives of this pilot study were to evaluate the feasibility and usefulness of a digital narrative diary integrated into the care [...] Read more.
Although patient narratives have been increasingly introduced in various fields of medicine, a standard method in clinical practice is still lacking. The objectives of this pilot study were to evaluate the feasibility and usefulness of a digital narrative diary integrated into the care pathway of patients with bone sarcoma and limb soft tissue sarcoma both from the patients’ and the healthcare professionals’ (HCPs) perspectives. A digital platform, DNMLAB, was designed to obtain guided narratives from patients during their pathway of care in compliance with confidentiality and data protection laws. The diary was used for patients, often young, facing a rare and impactful disease that is difficult to manage and with few opportunities to share experiences. The multidisciplinary team shared the narratives and integrated them into the patient’s treatment pathway. Narrative prompts were adequate for the care pathway. Patients correctly considered the diary as a shared area to think about their condition, and HCPs considered it “a shared area growing at each meeting with the patient”. The main advantages reported by patients were increased awareness, the opportunity to express their opinion on cures and important personal needs and the perception of better taking charge (score ≥ 4.6). The main advantages of HCP were improved communication, therapeutic alliance, and deeper knowledge of patients. This study confirmed the authors’ previous experiences, showing that a digital narrative process is feasible and useful for oncology clinical practice according to patients and HCPs. Full article
11 pages, 1952 KiB  
Article
Comparative Study of Proximal Femur Bone Tumor Patients Undergoing Hemiarthroplasty versus Total Hip Arthroplasty: A Meta-Analysis
by Nishant Banskota, Xiang Fang, Dechao Yuan, Senlin Lei, Wenli Zhang and Hong Duan
J. Clin. Med. 2023, 12(3), 1209; https://doi.org/10.3390/jcm12031209 - 03 Feb 2023
Cited by 3 | Viewed by 1424
Abstract
Hemiarthroplasty and total hip arthroplasty are routinely performed procedures. A comparison of these procedures in tumor patients can be performed based on complications and functional outcomes. To weigh the advantages and disadvantages of both procedures, a comparative study is indeed required to decide [...] Read more.
Hemiarthroplasty and total hip arthroplasty are routinely performed procedures. A comparison of these procedures in tumor patients can be performed based on complications and functional outcomes. To weigh the advantages and disadvantages of both procedures, a comparative study is indeed required to decide which procedure is more beneficial for primary bone tumor patients. The outcomes of proximal femur tumor-resected patients were collected from research reports from PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar until 30 December 2022. Differences between these two operative procedures in primary bone tumors patients were analyzed based on dislocation, infection, local recurrence, MSTS, and HHS. Six articles were included according to the selection criteria with a total of 360 patients. Our results showed that there was a significant difference in our primary outcome as hemiarthroplasty participants encountered less dislocation than those with total hip arthroplasty. Moreover, the secondary outcomes of our study were similar. Proximal femur bone tumors, when resected, tend to produce more complications and decrease functional ability due to extensive tumor extension and soft tissue involvement. The lower dislocation rate in hemiarthroplasty participants emphasizes the importance of preserving the acetabular head in hemiarthroplasty as a key to preventing dislocation. Full article
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10 pages, 4808 KiB  
Article
GMRS Oncological Prosthesis with a Porous Coating Collar: A Good Option for Revision of Aseptic Loosening in the Lower Extremity
by Hairong Xu, Yuan Li, Feng Yu, Weifeng Liu, Lin Hao, Qing Zhang and Xiaohui Niu
J. Clin. Med. 2023, 12(3), 892; https://doi.org/10.3390/jcm12030892 - 23 Jan 2023
Viewed by 1154
Abstract
Background: Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) [...] Read more.
Background: Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) prosthesis after revision? and (2) what are the long-term functional outcomes of these patients? Methods: We retrospectively reviewed 16 patients who developed aseptic loosening of a lower extremity prosthesis. There were nine males and seven females with a mean age of 28 years (range, 14–55 years). The 5-year and 8-year survivorship of the prosthesis were calculated. Function outcome was evaluated according to the score of the Musculoskeletal Tumor Society (MSTS). Results: At a mean of 90 months follow-up (range, 52–118 months), the cumulative survival of all revision prosthesis was 94% at both 5 and 8 years. There were two prosthesis failures including one infection and one repeated aseptic loosening. At the last follow-up, except for the infection case, 93.3% (14/15) of the patients did not develop repeated aseptic loosening. The mean MSTS score was 27.7 (range, 24–30). Conclusions: GMRS prosthesis demonstrated significant satisfactory long-term outcomes for revisions of lower extremity oncological prosthesis. Full article
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12 pages, 1686 KiB  
Article
The Outcome of Discontinuing Tyrosine Kinase Inhibitors in Advanced Sarcoma Following a Favorable Tumor Response to Antiangiogenics Therapy
by Zhusheng Zhang, Qiyuan Bao, Yucheng Fu, Junxiang Wen, Meng Li, Zhuochao Liu, Guoyu He, Beichen Wang, Yuhui Shen and Weibin Zhang
J. Clin. Med. 2023, 12(1), 325; https://doi.org/10.3390/jcm12010325 - 31 Dec 2022
Cited by 2 | Viewed by 1150
Abstract
(1) Background: The use of antiangiogenic TKIs (AA-TKIs) has recently emerged as a major paradigm shift in the treatment of advanced sarcoma. However, the feasibility of drug holidays for patients demonstrating a very favorable response remains unknown. (2) Methods: We aim to explore [...] Read more.
(1) Background: The use of antiangiogenic TKIs (AA-TKIs) has recently emerged as a major paradigm shift in the treatment of advanced sarcoma. However, the feasibility of drug holidays for patients demonstrating a very favorable response remains unknown. (2) Methods: We aim to explore the outcomes of patients with advanced sarcoma who discontinued AA-TKIs after a (near-) complete remission or were long-term responders. Patients with advanced disease were included if they had bilateral or multiple lung metastases, extrapulmonary recurrence, a short disease-free interval, etc., at the initiation of AA-TKIs. (3) Results: A total of 22 patients with AA-TKI discontinuation were analyzed, with a median follow-up of 22.3 months post-discontinuation. Prior to discontinuation, there were four drug-induced complete remissions (CRs), twelve surgical CRs, and six long-term responders. Disease progression was observed in 17/22 (77.3%) patients, with a median of 4.2 months. However, since the majority were still sensitive to the original AA-TKIs and amenable to a second surgical remission, 7 out of these 17 patients achieved a second CR after disease progression and were thus considered as relapse-free post-discontinuation (pd-RFS). Therefore, the pd-RFS and post-discontinuation overall survival (pd-OS) in the last follow-up were 12/22 (54.5%) and 16/22 (72.7%), respectively. Remarkably, surgical CR and drug tapering off (versus abrupt stopping) were associated with a greater pd-RFS and pd-OS (p < 0.05). Furthermore, higher necrosis rates (p = 0.040) and lower neutrophil-to-lymphocyte ratios (NLR) (p = 0.060) before discontinuation tend to have a better pd-RFS. (4) Conclusions: Our results suggest that AA-TKI discontinuation with a taper-off strategy might be safe and feasible in highly selected patients with advanced sarcoma. Surgical CR, NLR, and tumor necrosis rates before discontinuation were potential biomarkers for AA-TKI withdrawal. Full article
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13 pages, 2210 KiB  
Article
Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors
by Zhaohui Li, Zhen Pan, Hua Guo, Xiang Fei, Dongdong Cheng and Qingcheng Yang
J. Clin. Med. 2022, 11(23), 7225; https://doi.org/10.3390/jcm11237225 - 05 Dec 2022
Cited by 5 | Viewed by 1681
Abstract
This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time [...] Read more.
This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time to bony union, functional outcomes, and complications were evaluated in all cases. The median follow-up was 72.5 months. The limb salvage rate was 100%. Primary osseous union was achieved in 90.4% of the junctions. The union rates at the metaphyseal and diaphyseal junctions were 100% and 85.7%, respectively (p = 0.255). The mean time of bony union in the upper (87.5%) and lower (91.7%) extremity was 4.6 ± 1.6 months and 6.9 ± 2 months, respectively. The mean MSTS score was 27.2 ± 3.2, with a mean MSTS rating of 90.7%. Complications occurred in 15.4% of the cases. The administration of vascularized or non-vascularized grafts did not significantly influence the union time (p = 0.875), functional outcome (p = 0.501), or blood loss (p = 0.189), but showed differences in operation time (p = 0.012) in lower extremity reconstruction. A composite free fibula inside other biological grafts provides a reasonable and durable option for osseous oncologic reconstruction of the long bone diaphysis of the extremities with an acceptable rate of complications. A higher union rate was achieved after secondary bone grafting. In lower-extremity reconstruction, two plates may be considered a better option for internal fixation. Vascularizing the fibula did not significantly affect the union time. Full article
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