Highlights
- Bone cancer presents unique challenges, requiring a multidisciplinary approach for accurate diagnosis and tailored treatment plans.
- Advances in molecular diagnostics are enhancing treatment strategies, offering hope for improved outcomes in sarcoma patients.
- Innovative therapies, including immunotherapy and nanotechnology, are under investigation to maximize efficacy while minimizing side effects.
Overview and Classification of Bone Cancer
Bone cancer includes malignant tumors originating in or spreading to bones, classified as primary (arising from bone tissue) and secondary (metastatic from organs like breast, prostate, lung, or kidney). Common primary types are osteosarcoma and Ewing sarcoma, prevalent in children and young adults, while secondary bone metastases are more frequent and cause significant morbidity.
Symptoms, Diagnosis, and Molecular Advances
Symptoms mainly involve localized pain, swelling, fractures, and sometimes systemic signs. Diagnosis combines clinical evaluation, imaging (radiographs, MRI, PET/MRI), bone scans, and biopsy. Molecular diagnostics like next-generation sequencing aid tumor classification and targeted therapies, especially in sarcomas such as Ewing sarcoma.
Treatment Modalities
Treatment integrates surgery, chemotherapy, radiotherapy, and novel therapies, tailored to tumor type and stage. Surgery aims for complete tumor removal with limb-salvage techniques preferred over amputation. Chemotherapy, notably multi-agent regimens for osteosarcoma and Ewing sarcoma, is used pre- and post-surgery. Radiotherapy assists in cases with inadequate surgical margins or difficult tumor locations. Emerging treatments include immunotherapy and nanotechnology-based drug delivery systems designed to improve targeting and reduce toxicity.
Specific Bone Cancer Treatments
Osteosarcoma treatment combines surgery and MAP chemotherapy, improving survival and function. Ewing sarcoma uses multiagent chemotherapy (VDC/IE) plus surgery or radiotherapy for local control. Chondrosarcoma and chordoma rely mainly on surgery, often supplemented by radiotherapy or proton therapy, especially for tumors in complex anatomical sites. Giant cell tumors are treated surgically, sometimes with adjunct therapies. Bone metastases from other cancers focus on symptom relief via systemic therapy, radiation, and surgery.
Prognosis and Outcomes
Survival depends on tumor type, stage, patient age, and treatment completeness. Limb salvage surgery offers survival rates comparable to amputation with better functional outcomes. Five-year survival for malignant bone tumors ranges from 66% to 82%, driven by advances in multimodal therapy. Challenges remain for tumors in difficult locations, where ongoing trials explore targeted and surgical innovations.
Rehabilitation and Follow-Up
Postoperative rehabilitation with physical and occupational therapy is essential to restore mobility and improve quality of life after limb salvage surgery.
Research and Innovations
Molecular biology and genomics advances have enabled targeted therapies and precision medicine. Clinical trials explore new drugs, radiation techniques like IMRT, SBRT, and proton therapy, and novel drug delivery systems including nanomaterials and multifunctional scaffolds that combine tumor control with bone regeneration.
Prevention and Risk Factors
Genetic predisposition plays a major role in bone cancer risk, with molecular profiling identifying mutations and fusion genes for targeted treatment. Proton therapy reduces secondary cancer risks by minimizing radiation exposure to healthy tissue. Dose escalation in radiotherapy improves local control in radioresistant bone metastases but requires balancing efficacy and toxicity.
The content is provided by Blake Sterling, Scopewires
