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New Treatment Techniques and Decision Algorithms for Musculoskeletal Tumors

DiCaprio, Matthew R., MD

doi: 10.1097/BTO.0000000000000325

Albany Medical Center Orthopaedic Oncology, Albany, NY

The authors declare that they have nothing to disclose.

Tumors of the musculoskeletal system affect people of all ages, races, socioeconomic status, and both sexes. As with other rare diseases, they can pose a problem both diagnostically and therapeutically. This symposium focuses on several new technological advances that will assist in treatment of these rare tumors and hopefully improve oncologic and functional outcomes.

The prognosis for individuals faced with a primary bone or soft tissue sarcoma has remained stagnant over the past 30+ years. Molecular-targeted therapies and immunotherapies show promise in advancing current survival data and an update on their current application for musculoskeletal tumors is presented. When it comes to surgical resection of primary musculoskeletal tumors, the surgeon’s goal remains a clear, wide surgical margin. There is still much debate over which margin classification or nomenclature is best, but most would agree that we want to remove all detectable disease without contamination. How do we see this diseased tissue versus normal tissue? There are limitations to utilizing the current standard of frozen section analysis for intraoperative margin detection. New technologies that utilize intraoperative margin detection at the microscopic and molecular level using spectroscopy and fluorescence imaging are presented in this symposium.

Within orthopedic oncology, pelvic tumor resections pose some of the most challenging, complex anatomic approaches and osteotomies for the treating surgeon. A discussion of guided pelvic resections using navigation and patient-matched cutting blocks, reviews their emerging role in improving the safety and efficacy of pelvic resection surgery. Improved precision may translate into improved functional outcomes and fewer complications.

Reconstructing large skeletal defects became easier with modular megaprosthetic implants a few decades ago. Custom implant design using traditional manufacturing methods can take several months from request, to design, to availability. 3D printing technology has allowed for faster more precise custom implant design, and will enhance our reconstructive armamentarium in the coming decades. Within the field of reconstructive science we will review tissue engineering principles using nanoparticles, cell-based, and biological augments to develop implant coatings that improve osteointegration and decrease infection. Techniques being used to improve the interaction between soft tissues and implants are also reviewed.

The growing child presents unique concerns and complex, shared decision making between the surgeon and the patient and their family. An algorithm is presented outlining the pros and cons of each reconstruction option. Lastly, the reader is provided with an update on predicting fracture risk for skeletal lesions. With the prevalence of metastatic bone disease increasing, all practicing orthopedic surgeons will find this review timely and helpful for dealing with a common clinical scenario.

I would like to express my gratitude to all of the authors for sharing their knowledge and expertise so we all can offer improved therapies to our patients.

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