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Pain control with palliative radiotherapy in patients with bone metastases

Introduction Approximately 50% of cancer patients will receive palliative radiotherapy (RT) during the course of their disease [ ]. Bone metastases (BMs) remain a significant concern in the radiation oncology setting, and 70% of BMs occur in the axial skeleton [ ]. RT is frequently employed with palliative intent in order to minimize tumor-related symptoms. RT delivery can be broadly classified as via an external beam…

Involvement of sympathetic nerves in bone metastasis

Introduction Bone metastasis is prevalent in the advanced stages of both breast and prostate cancer, and is a frequent finding in patients that succumb to these two diseases. Although breast cancer metastasizes to multiple body tissues, including bone, lung, liver, brain, and lymph nodes, tumor cell dissemination to bone predominates [ ]. Likewise, almost all patients who die of prostate cancer exhibit some level of skeletal…

Mechanisms and management of bone cancer pain

Research highlights Bone cancer pain is the most common presenting symptom in patients with skeletal metastases. Bone cancer pain has both nociceptive and neuropathic components. Persistent afferent stimulus from tumor-bearing bone induces peripheral and central sensitization. Bone cancer pain is recalcitrant to many standard strategies used for acute and chronic pain. Animal models and clinical trials have led to treatments targeting specific molecular mechanisms. Introduction Bone…

Diagnosis of bone metastases in urological malignancies—an update

Acknowledgments We would like to acknowledge the Nuclear Medicine Department and the Centre for PET at Austin Hospital, Melbourne, Australia, for providing the images; Dr. Alan Wong from the Austin Department of Pathology for assisting with photographing the histology slides. Introduction Bone is a common site for spread of cancer. In regard to urological malignancies, prostate cancer has the highest incidence of bony metastatic spread being…

Interventional radiologic techniques in the management of bone tumors

Research highlights Overview of image-guided biopsies using ultrasound, fluoroscopy, CT fluoroscopy, CT, and MRI Role of transarterial tumor embolization of hypervascular tumors as an adjuvant or radical therapy A review of thermal ablation techniques including radiofrequency ablation and cryoablation Controversies and current practice of vertebral augmentation including spinal metastatic disease A brief description of sacroplasty and acetabuloplasty, predominantly used for palliation Introduction As recently as 30…

Identification of new therapeutic targets of bone cancers by proteomic strategies

Introduction Bone is a site of both primary cancer as well as bone metastasis giving rise to secondary cancers. Primary bone cancers include osteosarcoma (OS), Ewing's sarcoma (ES), and multiple myeloma (MM). The major bone metastatic cancers include breast cancer (BCa), prostate cancer (PCa), renal cell carcinoma (RCC), and lung cancer (LC). All of these cancer types cause significant alterations within bone and result in skeletal-related…

The histopathology of skeletal metastases

Introduction The human skeleton is a multifunctional tissue responsible for a variety of functions including biomechanical support, protection of vital organs, strength, and mobility as well as the maintenances of calcium and phosphate homeostasis [ ]. Stephen Paget was the first to describe the complexity of the bone in 1889, when he proposed that tumor cells have a proclivity for certain organs, where they “seed” into…

New therapeutic advances of bone sarcomas

Research highlights Management of bone sarcomas in reference center improves compliance to guidelines and survival. Antiangiogenic tyrosine kinase inhibitors exert significant antitumor activity in most primary bone cancers. Second-line cytotoxic chemotherapy regimens have demonstrated activity in Ewing's sarcoma. Immunotherapy with anti-PD-1 has limited activity in primary bone cancers beside chordomas. Investigating actionable molecular pathways in primary bone cancer are needed to identify active treatments. Acknowledgments J.Y.B.…

Radiation therapy for primary bone tumors

Introduction Primary malignant tumors of the bone represent less than 1% of all cancer cases in the European population. The world age-standardized incidence rate is in the range of 0.5–2/100,000/year [ ]. In 2020, an estimated 3600 new cases and 17,200 deaths are expected, with 5-year relative survival of 66% [ ]. The age-standardized incidence rate is 0.249 for osteosarcoma, 0.064 for chondrosarcoma and chordoma, and…

Chondrosarcoma of bone: diagnosis and therapy

Introduction Close to 1% of all tumors are primary malignant bone tumors. Out of these, the chondrosarcoma is the second most common primary malignant bone tumor in adults with an incidence of 3–4/100,000 per year. Chondrosarcoma is the collective term for a heterogeneous group of tumors based on a mesenchymal origin with a malignant cartilage differentiation. Based on histology, morphology, and genetics, there is a broad…

Regulated cell death and drug resistance in malignant bone tumors

Research highlights Regulated cell death (RCD) maintaining tissue homeostasis and integrity comprises apoptosis, autophagic cell death, and necroptosis. Chemoresistance involves deregulation of particular mechanisms/pathways of RCD. A better understanding of chemotherapy-induced RCD mechanisms may help to improve treatment options. New drugs addressing particular deregulated mechanisms of RCD may improve therapy of bone sarcoma. Introduction Regulated cell death (RCD) is a physiological cell death program of eukaryotic…

What is an adequate margin after bone tumor resection?

Introduction When a medical team is dealing with a primary malignant bone tumor, the standard goal of the treatment is to totally eradicate the disease with minimal treatment-related adverse effects. In that way, for more than three decades, complete surgical removal of the primary tumor has been an unavoidable step in the strategy treatment of the more frequent primary bone tumors: chondrosarcoma, osteosarcoma, Ewing's sarcoma, and…

Current therapeutic approaches of bone sarcomas

Introduction Bone sarcomas include a variety of primary, nonepithelial, malignant neoplasms with metastatic potential originating from bone cells or their precursors. Some are purely osteolytic, while others produce a calcified matrix (e.g., osteosarcoma), a cartilaginous matrix (e.g., chondrosarcoma), or a mixed osteolytic/osteoblastic matrix [ ]. Bone sarcoma genesis can be explained by a conjunction between a minimum of one oncogenic event and an adequate microenvironment leading…

Imaging of bone sarcomas

Introduction Sarcomas of the bone are relatively rare neoplasms with an estimated 2890 new cases in the United States in 2012 [ ]. Because of the rarity of primary bone sarcomas and interpretive uncertainty, management may be delayed from initial misdiagnosis [ ]. After biopsy, pathologic diagnosis may be confounding with disagreements in interpretation among pathologists [ ]. Therefore the best approach to diagnose and treat…

Biology of cartilage tumor family

Research highlights The cartilage tumor family is a heterogeneous group of tumors, driven by mutations, translocations, or unknown factors. The biology of cartilage tumors is reflected by defective growth plate signaling pathways. Chondrosarcomas can arise within a benign precursor or arise de novo. Some benign cartilage tumors (enchondroma and osteochondroma) are composed of a mixture of mutant and wild-type cells. Molecular alterations used in diagnostics include…

Osteoclast-rich lesions of bone: a clinical and molecular overview

Learning points ⇒ The H3-3A.Gly34Trp (G34W) missense mutation is essentially pathognomonic of giant cell tumor of bone, occasionally to p.Gly34Leu (G34L) alterations. There are good antibodies available for detecting this mutation by immunohistochemistry. Malignant giant cell tumor of bone harbors the same H3-3A mutations but in dedifferentiated cases the mutated H3-3A protein is lost as is the osteoclast population ⇒ Whole-genome sequencing identified that benign metastasizing…

Molecular aspects of Ewing’s sarcomas

Introduction Since the mid-1990s when Ewing's sarcoma started to be studied at the molecular level, a very large number of investigations aimed at deciphering the biology of this disease, particularly by exploring the role of the Ewing's sarcoma–specific oncogene. Even though the conducted research increased our knowledge, a large number of questions remain, such as the cell of origin of Ewing's sarcoma, precise functional roles of…

Ewing’s sarcoma family of tumors

Introduction First described by James Ewing in 1921 [ ], Ewing's sarcoma (ES) represents a family of morphologically similar small round cell sarcomas (SRCSs) including “classic” Ewing's sarcoma of bone, extraskeletal Ewing's sarcoma [ ], small cell tumor of the thoracopulmonary region (Askin tumor) [ ], and soft-tissue-based primitive neuroectodermal tumors (PNETs) [ ]. Though initially considered as distinct clinical entities given their subtle variation in…

Genomic and proteomic profiling of osteosarcoma

Abbreviation OS Osteosarcoma Acknowledgments This work has been supported in part by funds provided by the Foundation AECC “Proyectos Estratégicos” to F.L. Introduction Classical pediatric human osteosarcoma (OS) is considered a heterogeneous entity characterized by inactivation of tumor suppressors, altered oncogene signaling, and/or activation of classical development pathways required for its initiation, maintenance, and dissemination. In recent years, emerging technological advances have allowed better characterization of…

Molecular pathology of osteosarcoma

Acknowledgments This work has been supported in part by funds provided by the Haley's Hope Memorial Support Fund for Osteosarcoma Research at the University of Alabama at Birmingham. Introduction Although osteosarcoma is a relatively rare neoplasm, it is the most common primary bone malignancy, especially with a high incidence rate in childhood and adolescents [ ]. The diagnosis of osteosarcoma largely relies on the correlation of…