Curettage of benign bone tumors without grafts gives sufficient bone strength: A case-series of 78 patients

Background and purpose The defect that results after curettage of a bone tumor is usually filled in the same way. We report the outcome in patients with benign bone tumors that were treated with curettage but no filling

MDM2 antagonist Nutlin-3a potentiates antitumour activity of cytotoxic drugs in sarcoma cell lines

<p>Abstract</p> <p>Background</p> <p>Frequent failure and severe side effects of current sarcoma therapy warrants new therapeutic approaches. The small-molecule MDM2 antagonist Nutlin-3a activates the p53 pathway and efficiently induces apoptosis in tumours with amplified <it>MDM2 </it>gene and overexpression of MDM2 protein. However, the majority of human sarcomas have normal level of MDM2 and the therapeutic potential of MDM2 antagonists in this group is still unclear. We have investigated if Nutlin-3a could be employed to augment the response to traditional therapy and/or reduce the genotoxic burden of chemotherapy.</p> <p>Methods</p> <p>A panel of sarcoma cell lines with different <it>TP53 </it>and <it>MDM2 </it>status were treated with Nutlin-3a combined with Doxorubicin, Methotrexate or Cisplatin, and their combination index determined.</p> <p>Results</p> <p>Clear synergism was observed when Doxorubicin and Nutlin-3a were combined in cell lines with wild-type <it>TP53 </it>and amplified <it>MDM2</it>, or with Methotrexate in both <it>MDM2 </it>normal and amplified sarcoma cell lines, allowing for up to tenfold reduction of cytotoxic drug dose. Interestingly, Nutlin-3a seemed to potentiate the effect of classical drugs as Doxorubicin and Cisplatin in cell lines with mutated <it>TP53</it>, but inhibited the effect of Methotrexate.</p> <p>Conclusion</p> <p>The use of Nutlin in combination with classical sarcoma chemotherapy shows promising preclinical potential, but since clear biomarkers are still lacking, clinical trials should be followed up with detailed tumour profiling.</p

Advances in modular endoprosthetic reconstruction of osseous defects

Purpose of review: Reconstruction of segmental skeletal defects after resection of tumors remains a technically challenging procedure. Recent advances and improvements in modular endoprosthetic systems have led to an increased acceptance of this form of reconstruction. Results of recent publications and presentations are summarized. Recent findings: The advent of modular, off-the-shelf components that are assembled during the surgical procedure has virtually replaced the use of custom implants in a majority of patients. Recent reports from large institutions demonstrate the durability of these modular systems, which significantly outperform the older generation of custom implants. Further developments have expanded the indications for modular reconstruction to include anatomically challenging sites such as the shoulder and pelvic girdle, and the skeletally immature patient. Summary: In addition to reconstruction of segmental defects after tumor resection, modular endoprostheses are increasingly used for complicated revisions of the hip and knee after failed total joint replacement. Complications, although less frequent than with custom implants, can often be successfully managed with additional surgery. Further work in reducing the risk of periprosthetic infection and aseptic loosening will advance this growing field