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Bone tumor — Clinical Guidelines

Overview

Bone tumors encompass a spectrum of benign and malignant lesions affecting bone tissue, requiring precise diagnostic evaluation and tailored management strategies based on risk stratification and clinical presentation 1.

Diagnosis

Clinical Presentation: Musculoskeletal pain, especially recurrent in pediatric patients, warrants thorough investigation 2.

Imaging: Utilize radiography, CT, MRI, and radioisotope scans for accurate characterization 15.

Risk Stratification: Apply Bone-RADS scoring system to assess malignancy risk and guide management 1.

Radiological Features: Evaluate lytic, sclerotic, or mixed lesions with attention to extent and aggressiveness 15.

Biopsy: Consider when imaging is inconclusive or malignancy risk is high 1 18.

Immunohistological Analysis: Assess macrophage infiltration in malignant tumors for prognostic information 16.

Management

First-Line Treatments:

- Surgical Resection: Local radical en-bloc resection for localized tumors 18. - Endoprosthetic Reconstruction: Use in cases requiring extensive bone replacement 3 5 6.

Adjunctive Therapies:

- Percutaneous Ablation: For pain palliation in bone tumors 9. - Radioiodine Therapy: For palliative treatment of pelvic bone tumors 8. - Embolization: Bland arterial embolization for pain control 10. - Cementoplasty: Combined with low-pressure bone stenting for extensive lytic lesions 7. - Radionuclide Therapy: Samarium Sm 153 lexidronam for palliative effects in dogs (analogous to human considerations) 11.

Special Populations

Pediatrics: Thorough evaluation for recurrent musculoskeletal pain; consider rotationplasty modifications for young patients with large tumors 12.

Elderly: Consider functional outcomes and stability with endoprosthetic options 6.

Comorbidities: Tailor surgical and interventional approaches based on overall health status and resource availability 3.

Key Recommendations

Utilize Bone-RADS for risk stratification and management guidance of bone lesions (Evidence: Strong 1).

Employ imaging modalities including MRI and CT for comprehensive tumor characterization (Evidence: Moderate 15).

Consider percutaneous ablation techniques as effective adjuncts for pain management in bone tumors (Evidence: Moderate 9).

Evaluate and utilize endoprosthetic reconstructions judiciously, considering patient-specific factors like age and resource availability (Evidence: Expert opinion 3 6).

For palliative care, explore radioiodine and embolization techniques based on tumor location and patient preference (Evidence: Moderate 8 10).

References

1 Caracciolo JT, Ali S, Chang CY, Degnan AJ, Flemming DJ, Henderson ER et al.. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee. Journal of the American College of Radiology : JACR 2023. link 2 Nik-Ahd M, Agrawal AK, Zimel M. Diagnosis and management of pediatric primary bone tumors in the emergency department. Pediatric emergency medicine practice 2021. link 3 Idowu OK, Akinmade A, Giwa SO, Eyesan SU. Segmental endoprosthesis replacement in a resource-constrained setting. Musculoskeletal surgery 2021. link 4 Dalili D, Isaac A, Cazzato RL, Åström G, Bergh J, Mansour R et al.. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization. Seminars in musculoskeletal radiology 2020. link 5 Hauer TM, Houdek MT, Bhumbra R, Griffin AM, Wunder JS, Ferguson PC. Component Fracture in the Kotz Modular Femoral Tibial Reconstruction System: An Under-Reported Complication. The Journal of arthroplasty 2018. link 6 Gorter J, Ploegmakers JJW, Ten Have BLEF, Schreuder HWB, Jutte PC. The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series. International orthopaedics 2017. link 7 Cornelis FH, Petitpierre F, Fabre T, Gille O, Amoretti N, Hauger O. Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions. European radiology 2017. link 8 Wang C, Chen Z, Sun W, Yasin Y, Zhang C, Ma X et al.. Palliative treatment of pelvic bone tumors using radioiodine (. World journal of surgical oncology 2016. link 9 Tomasian A, Wallace AN, Hillen TJ, Jennings JW. Percutaneous Ablation in Painful Bone Tumors. Seminars in musculoskeletal radiology 2016. link 10 Marciel AM, Van Zandt BL, Baxter AJ. Transcatheter arterial embolization for the palliation of painful bone lesions. Techniques in vascular and interventional radiology 2011. link 11 Barnard SM, Zuber RM, Moore AS. Samarium Sm 153 lexidronam for the palliative treatment of dogs with primary bone tumors: 35 cases (1999-2005). Journal of the American Veterinary Medical Association 2007. link 12 Merkel KD, Reinus WR, Miller G, Koudsi B. Modification of the Van Nes rotationplasty: report of a case. Clinical orthopaedics and related research 1997. link 13 Varvares MA, Cheney ML, Goodman ML, Ceisler E, Montgomery WW. Chondroblastoma of the temporal bone. Case report and literature review. The Annals of otology, rhinology, and laryngology 1992. link 14 Moffitt ME, Richli WR, Carrasco CH, Wallace S, Zimmerman SO, Ayala AG et al.. MDA-image: an environment of networked desktop computers for teleradiology/pathology. Journal of medical systems 1991. link 15 Ghelman B. Radiology of bone tumors. The Orthopedic clinics of North America 1989. link 16 Roessner A, Zwadlo G, Vollmer E, Sorg C, Grundmann E. Biologic characterization of human bone tumors IX. Occurrence of macrophages. Pathology, research and practice 1987. link80069-9) 17 Maruyama N, Kumagai Y, Ishida Y, Sato H, Sugano I, Nagao K et al.. Epithelioid haemangioendothelioma of the bone tissue. Virchows Archiv. A, Pathological anatomy and histopathology 1985. link 18 Marcove RC. The treatment of malignant bone tumors by conservative surgery. Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer 1976. link

Bone tumor