Nuove frontiere nella chirurgia oncologica dell’apparato muscolo-scheletrico

Great advances in oncological orthopaedic surgery have been accomplished in recent years due to development of new prosthetic systems, improvement in the use of allografts, new microsurgical procedures. Often a combination of them (allograft + prosthesis or allograft + vascularized bone transplant) has been the key to obtain major improvement in results. Some of these advances are addressed on the basis of the experience of the Authors in the treatment of bone and soft tissue tumors. Mini-invasive techniques are also finding a place in the oncological practice and their role is going to grow, even if limited to specific issues. Recent development in technology and instruments for cryotherapy makes this technique a valuable aid for the surgeons in many oncological situation

Image-guided Cryotherapy for Musculoskeletal Tumors

Background: This article represents a review about the use of image-guided cryotherapy in the treatment of musculoskeletal tumor lesions. Cryotherapy is able to induce a lethal effect on cancer cells through direct and indirect mechanisms. In this manuscript, we combined our experience with that of other authors who have published on this topic in order to provide indications on when to use cryotherapy in musculoskeletal oncology. Discussion: Image-Guided percutaneous cryotherapy is a therapeutic method now widely accepted in the treatment of patients with musculoskeletal tumors. It can be used both for palliative treatments of metastatic bone lesions and for the curative treatment of benign bone tumors such as osteoid osteoma or osteoblastoma. In the treatment of bone metastases, cryotherapy plays a major role in alleviating or resolving disease-related pain but it has also been demonstrated that it can have a role in local disease control. In recent years, the use of cryotherapy have also expanded for the treatment of both benign and malignant soft tissue tumors. Conclusion: Percutaneous cryotherapy can be considered a safe and effective technique in the treatment of benign and malignant musculoskeletal tumors. Cryotherapy can be considered the first option in benign tumor lesions such as osteoid osteoma and a valid alternative to radiofrequency ablation. In the treatment of painful bone metastases, it must be considered secondarily to other standard treatments (radiotherapy, bisphosphonate therapy and chemotherapy) where they are no longer effective in controlling the disease or when they cannot be repeated (for example radiotherapy)