What’s New in Musculoskeletal Tumor Surgery 2021

Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. This month, author Peter S. Rose, MD selected the 5 most clinically compelling findings from among the studies highlighted in the most recent “What’s New in Musculoskeletal Tumor Surgery.” 

Primary Bone Tumors 

–Limited data are available on current treatment protocols for osteofibrous dysplasia-like adamantinoma (OFD-AD) and classic adamantinoma (AD). In a retrospective multicenter cohort study, the Adamantinoma Research Group, in conjunction with the European Musculo-Skeletal Oncology Society and the International Society of Limb Salvage meetings, gathered data on 318 cases (128 OFD-AD and 190 AD)¹. The results showed that no local recurrence in the OFD-AD group progressed to classic AD, and no metastases or deaths were noted in the OFD-AD group. In contrast, in the classic AD group, 18% of patients developed metastases and 11% had fatal outcomes. 

Tumor Reconstruction 

– A recent study presented the early results of 80 patients who underwent periacetabular tumor resection and reconstruction with a 3D-printed modular hemipelvic endoprosthesis². The authors reported stable fixation with acceptable early functional and radiographic outcomes. Sixteen (20%) of the patients had complications, with wound dehiscence being the most common (8 patients). 

– Another recent study provided 5-year follow-up data on the safety and performance of bone-anchored prostheses in 39 patients with transfemoral amputation³. Prosthesis use and health-related quality of life improved, but 77% of the patients had ≥1 infection-related complication. While these infections are generally in the soft-tissue envelope and well-managed, such complications remain a barrier to widespread adoption of the procedure. 

Soft-Tissue Tumors 

– Little data exist regarding the oncological outcomes of patients with lymph node metastases. A recent investigation, which included 120 patients with soft-tissue sarcoma and nodal metastases, provides benchmark data regarding survival⁴. The authors found that patients with isolated metastases had survival that was similar to that of patients with stage-III tumors and notably better than that of patients with systemic metastatic disease.  

General Oncological Interest  

– Given the challenges of soft-tissue tumor diagnosis, review by specialists in soft-tissue pathology is not uncommon. A recent study at a tertiary sarcoma center evaluated the rate of diagnostic differences in second-opinion pathology review for 581 cases⁵. The investigators found that there was a diagnostic discrepancy in 38% of the cases, with major discrepancies impacting patient management in 25% of the cases. 

To access the full text of the newest JBJS Guest Editorial, “What’s New in Musculoskeletal Tumor Surgery,” click here.  

A collection of previous OrthoBuzz Guest Editorial summaries can be found here. 

References 

1. Schutgens EM, Picci P, Baumhoer D, Pollock R, Bovée JVMG, Hogendoorn PCW, Dijkstra PDS, Rueten-Budde AJ, Jutte PC, Traub F, Leithner A, Tunn PU, Funovics P, Sys G, San-Julian M, Schaap GR, Dürr HR, Hardes J, Healey J, Capanna R, Biau D, Gomez-Brouchet A, Wunder J, Cosker TDA, Laitinen MK, Niu X, Kostiuk V, van de Sande MAJ; Adamantinoma Research Group. Surgical outcome and oncological survival of osteofibrous dysplasia-like and classic adamantinomas: an international multicenter study of 318 cases. J Bone Joint Surg Am. 2020 Oct 7;102(19):1703-13. 
2. Ji T, Yang Y, Tang X, Liang H, Yan T, Yang R, Guo W. 3D-printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: early results of 80 consecutive cases. J Bone Joint Surg Am. 2020 Sep 2;102(17):1530-41. 
3. Reetz D, Atallah R, Mohamed J, van de Meent H, Frölke JPM, Leijendekkers R. Safety and performance of bone-anchored prostheses in persons with a transfemoral amputation: a 5-year follow-up study. J Bone Joint Surg Am. 2020 Aug 5;102(15):1329-35. 
4. Basile G, Mattei JC, Alshaygy I, Griffin AM, Catton CN, Chung PW, Shultz DB, Razak ARA, Demicco EG, Ferguson PC, Wunder JS. Curability of patients with lymph node metastases from extremity soft-tissue sarcoma. Cancer. 2020 Dec 1;126(23):5098-108. 
5. Rupani A, Hallin M, Jones RL, Fisher C, Thway K. Diagnostic differences in expert second-opinion consultation cases at a tertiary sarcoma center. Sarcoma. 2020 Sep 29;2020:9810170.