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Abstract
6- Radiofrequency ablation: This is minimally invasive technique that use thermal energy to destroy the tumour cells and can be used in inoperable cases and to treat bone metastases.
7- Proton beam therapy: which is type of external irradiation which has advantage over the x-ray and gamma rays as it has the ability to deliver dose of irradiation to the target mass with minimal exposure to the surrounding healthy tissue .
8- Micro-wave induced hyperthermia: which use the electromagnetic method for producing energy that help to destruct the tumour. It has many advantages include higher intratumoural temperature, larger tumour ablation volumes and faster ablation time and the ability to use multiple applicators.
9- Preoperative chemotherapy :this provide a new hope for limb salvage technique which is used to allow easy resection of bone tumour, facilitating limb sparing surgery with early treatment of micro metastases.
Limb salvage with resection of bone tumour is now widely accepted as treatment option of malignancies of extremities especially when combined with effective adjuvant chemotherapy. Amputation is used selectively and infrequently. Limb salvage has the advantage of maintaining function, appearance and emotional stability of patients.
- Successful management of bone tumour with limb salvage require careful coordination and timing of staging studies, biopsy, surgery, preoperative, post operative chemotherapy and or radiation therapy. Recent advance in diagnosis of bone tumour include:
1- Fine needle aspiration biopsy : which represent quick, rapid, outpatient method for diagnosis of bone tumour and require well trained cytopathologist to interpret tissue sample in addition surgeon, radiologist, cytopthologist must be in close communication.
2- Tumour markers: which can be used to diagnose bone tumour but with other investigations, stage tumour, indicate prognosis, monitor treatment and to follow-up of recurrence.
3- Positron emission tomography (PET): new image technique that can detect functional changes in certain tissue organ before the tumour progress. PET scan can be used alongside with CT or MRI scans which give both anatomic and metabolic information of tumour.
Recent advances in treatment of bone tumour include:
1- Marginal excision with caffeine assisted chemotherapy: can be used to preserve important healthy structures in additions caffeine can enhance the pre-surgical and post surgical chemotherapy, it can provide beneficial alternative to wide excision and amputation and provide better function of affected limb.
2- Concept of curative margin for bone and soft tissue sarcoma: This has practical clinical use, when pre-operative chemotherapy is not done or ineffective. A margin greater than 3-cm wide is required when pre-operative chemotherapy is effective, a 2-cm wide margin is accepted in low grade sarcoma obtaining an adequate wide margin is essential.
3- Locked platting system for pathological fractures: which is a type of biological fixation which aim at minimal surgical damage and maintainace of optimal bone structure and improved healing rate and can be used in poorly osteoporotic bone? 4- Expendable prosthesis for bone tumours in children: which offer practical solution for skeletally immature patients with tumours in the femur and lower tibia. It allows the surgeon to maintain equal limb length through out the growth years.
5- Arterial embolization: This is used to reduce the risk of bleeding during and after surgery of hypervascularized tumours thus simplifying the manipulation of tumours, and palliation of pain, bleeding and preventing further dissemination of tumour.