Background: Osteoid Osteomas were first described by Bergstrand (1930), and were later elaborated by Jaffe (1935). They account for 12% of all benign bone tumors. Approximately 6–8% of lesions occur in the hand, and can be extremely difficult to diagnose. Aims: A retrospective review of osteoid osteomas from the Scottish Bone Tumor Registry is presented focusing on the unusual clinical features of lesions of the carpus and hand. Results: 19 patients (8 male, 11 female) were identified from the registry. The mean age at presentation was 27.5 Yrs (10–56 Yrs). 78% of lesions occurred within 2nd–3rd decade of life. Pain over the involved area most noticeably at night, was the usual presentation. 21% gave history of associated trauma. Phalangeal lesions accounted for 68.4% tumors with the proximal phalanx predominating.4 lesions involved the distal phalanx. There were 3 metacarpal and 3 carpal lesions. Carpal bones involved included the Capitate (2), and the Trapezium (1). Clubbing was noticed in distal phalanx lesions. The mean time from presentation to diagnosis was 5.6 months. 9 patients were initially misdiagnosed as having either a traumatic or infective condition.3 patients required a bone scan for diagnosis. All patients underwent surgical excision, with 2 requiring bone grafting. Follow up ranged from 1–9 Yrs (mean 3Yrs). There were no instances of recurrence or spontaneous regression. Discussion: Osteoid Osteoma is an infrequent tumor of the hand. Absence of typical pain pattern, unobtrusive radiographic features (absence of reactive bone, inapparent nidus), and variations in the histological picture make diagnosis in this region difficult. Lesions are easily misdiagnosed and successful treatment often delayed. Isotope bone scan is diagnostic and CT accurately visualizes the nidus. Awareness of these characteristics may aid early diagnosis. Surgical excision is usually curative and has excellent prognosis

Introduction: Authors aim to present an interesting series of calcaneal tumors accrued from Scottish Bone Tumor Registry. The available literature is largely limited to the case reports. Bony tumors of the foot account for approximately 3% of all osseous tumors (1), of which Calcaneal location is the second most common site after the metatarsals in the foot. This study describes tumors of varying aetiology with regard to epidemiology, clinical features, diagnostic findings, treatment modalities and outcome. Material and Methods: This study is a retrospective review of the medical records and imaging modalities of forty patients with calcaneal tumors which were accrued from Scottish Bone Tumor Registry between January 1954 and December 2006. Patient demographics including presentation characteristics, and delay in the presentation from the onset of symptoms were noted. Plain radiographs followed by further imaging with CT, MR and Bone scanning were reviewed. Size, location and spread of the tumors were noted based on imaging modalities. The type of biopsy, histological diagnosis, type of resection and adjuvant therapy was noted. All patients were followed-up clinically and radiologically for a minimum of 2 yrs or until death. Results: There were 28 primary benign, 11 primary malignant and 1 secondary malignant tumors. In the cohot of 40 patients 26 were male and 14 females with mean age of 27 years. Pain (37/40), swelling (27/40) and restriction of movements (25/40) were the main presenting features. Pathological fractures were found in 4 patients. Mean duration of symptoms was 12 months. Histological diagnoses included Osteoid Osteoma (4/40), PVNS (4/40), Chondroblastoma (3/40), Simple bone cyst (3/40), ABC (3/40), GCT (3/40), Osteochondroma (2/40), Chondroblastoma, Enchondroma, Fibrous Histiocytoma and Glomus tumour (1 case each). Chondrosarcoma, Ewing’s and Paget’s sarcoma (2 cases each), Osteosarcoma, Spindle cell and Pleomorphic Sarcoma (1 case each). Thirty eight patients underwent operative management. Summary: Current study is one of the largest reported series of calcaneal tumors. A wide variety of lesions seem to involve patients from different age groups and either sex. Presentation features include mainly pain and swelling aggravated by walking. Radiological features may differ than those reported for common locations for the given tumor type. The recurrence rate for benign bone forming as well as cartilage tumors seem to be low provided adequate curettage or excision has been carried out. Whereas most benign lesions can be managed with limb salvage, below knee amputation sees to be a standard operation for primary malignant tumors. Metastatic lesions have poor survival prognosis

Introduction. The proximal femur fracture in children is rare. Furthermore osteoporotic fracture associated with bone tumor make it difficult to decide the proper management method. The treatment plan should include both the treatment of the fracture and management of the condition responsible for the fracture. However, the reported literatures are rare and vary. Hypothesis. We identified the results of treatment associated with pathologic fracture of proximal femur in children. Material and Method. We retrospectively reviewed 56 patients who had fracture associated with benign bone femur between May 25th, 1995 and Jan. 14th, 2012. The patients’ mean age was 11.7(2–20) years old and follow-up duration was 55.3(5–132) months. Results. Fifty-six children with pathologic proximal femur fracture due to benign tumor were treated by various methods. Surgery consisted with combination of curettage, graft and internal fixation. We had 13(23%) complication. 6(11%) of them was related with fracture and 7(12%) of them was related with tumor. In six, malunion and shortening due to varus deformity developed after follow-up. In seven, recurrence was treated by curettage and internal fixation. There is no case of nonunion. Discussion and Conclusion. To manage the osteoporotic fracture of proximal femur in children, a thorough understanding of the risks associated with it is essential for decision making of increasing successful results

Background Osteosarcoma is the most common bone sarcoma, and the 3rd most common malignancy in children and adolescents. It accounts for 20% of primary malignant bone tumors. Methods A retrospective review of osteosarcomas from the Scottish National Bone Tumor Registry (1940–2000) involving the upperlimb bones is presented. Patient demography, type and location of lesions, treatment options, recurrence and survival rates, and metastasis have been analysed. Results 75 cases were identified from the registry. Sex incidence showed a slight male preponderance with male: female ratio 1.14: 1.Age at presentation ranged from 4–88 Yrs (mean 28.44 Yrs). 46.7% sarcomas occurred in the second decade (11–20 Yrs). The humerus was the bone most frequently involved (78.6% of lesions), and the proximal humerus the commonest site (60%). The scapula was involved in 9.3% and the forearm in 8%.A rare solitary lesion of the clavicle was encountered.17% presented with pathological fractures at diagnosis. Patients typically present with dull aching pain of weeks to months. All patients underwent radiological studies and diagnostic biopsy. Treatment modalities included amputation, limb-sparing surgery, adjuvant/neoadjuvant chemotherapy and radiotherapy. The cumulative 5 year survival for the series was 32%.Death was usually due to pulmonary and skeletal metastasis, and the mean survival in such patients was 21.5 mts. Patients presenting with metastatic pulmonary disease had poor prognosis. Limb-sparing surgery with wide margins does not compromise survival. Results with custom endoprosthesis are encouraging. Discussion Osteosarcomas require a multidisciplinary approach to diagnosis and treatment to optimise survival. During the first half of the study period amputation was the mainstay of treatment with high incidence of mortality due to metastatic disease. Recent advances in neoadjuvant/adjuvant chemotherapy have improved the ability to perform limb –sparing resections, and disease free and overall survival rates have improved. Regular, long follow-up is indicated in these patients

The authors aim to report the long-term follow-up experience in the reconstruction of bony defects by Ilizarov’s distraction osteogenesis using bone transport method following en bloc resection of bone tumors. En bloc resection was performed nine patients with bone tumors between October 1991–January 2000. The mean age of the patients was 19.3 years. Histological diagnosis was osteosarcoma in four cases, Ewing sarcoma in two cases, giant cell tumor (aggressive) in one, osteofibrous dysplasia (latent) in one and osteoblastoma (aggressive) in one case. The average follow-up period was 122 months and bone defect after resection was 14 cm. The function of the affected leg was excellent in four patients, good in two and poor in one patient according to the modified system of the MSTS. In the case where reconstruction of the ulna was done, MSTS score was excellent and DASH skoru was 2.5. We imply that in patients with long life expectancies, reconstruction with distraction osteogenesis seems to be an efficient method in the long-term follow up, on condition that its complications are promptly managed

Introduction Ewing’s sarcoma family of tumors was first described by James Ewing in 1921. It is a rare tumor and no one center can hope to accrue sufficient numbers over a reasonable period of time to accurately review them. Objectives A retrospective analysis of all Ewing’s sarcomas of the upper limb from the Scottish Bone Tumor registry (1940–2000), is presented. Attempts have been made to elaborate on prognostic factors, and to document improvements in survival with trends in local therapy over the study period. Results The registry included 23 patients with Ewing’s sarcoma of the upper limb bones. Age at diagnosis ranged from 7–58 Yrs (mean −21.6 Yrs). 48% of lesions occurred in the second decade and 26 % in the third decade. Male: Female ratio was 2.8: 1. The commonest site involved was the proximal humerus (30%), followed by scapula (21%), radius (17%) and hand bones (13%).Resectable lesions underwent excision and adjuvant radio/chemo therapy. Cumulative 5 year survival for the series was 52%. Forearm and hand lesions which achieved complete excision had best results (75% five year survival). Proximal humeral lesions had 57 % survival. Scapular lesions had the worst prognosis (20% survival). Death was usually due to metastatic disease (diagnosed mean 12mts after initial presentation). Lesions presenting with pathological fractures, or having metastasis at diagnosis had extremely poor survival. There was an increasing use of surgery, and changes to chemotherapy (Euro-Ewing protocol) during the latter part of the study period. There were no toxic deaths reported. Discussion Ewing’s sarcoma is a rare lesion. Any of the upper limb bones can be involved. Majority of lesions occur within the first 3 decades of life (87%). Survival is highly dependent on initial presentation. The key prognostic factor is the presence of detectable metastasis at diagnosis. Increased use of surgery and newer chemotherapeutic agents have decreased the local relapse rate over the period of study

Introduction: The use of allograft prosthetic composite (APC) of the proximal tibia offers advantages over prosthetic replacement or osteoarticular graft with a better functional outcome since the possibility of a careful soft tissue reconstruction;. Materials and Methods: From 1994 to 2002, 62 APC of the proximal tibia were performed in our department after bone tumor resection (56 malignant bone tumors, 4 cases of previously failed knee implant and 2 stage 3 benign tumors). The patients median age was 18 yrs (range: 11–77 yrs) and the mean resected length was 13.2 cm (range: 8.5–28 cm). The median follow up was 59 months (range: 13–137 months). Results: In three patients (4,8%) a recurrence was reported at 22, 33 an 40 months and amputation was performed. Infection was reported in 15 patients (24.2%): 2 early infections (healed with surgical debridment), 1 femoral stem septic loosening (treated with early revision with cemented stem); in 8 cases removal of the infected APC was required followed by implant of a new prosthetic device after cement spacer; two infections did not healed and patient underwent amputation; in two cases a good functional result was achieved removing the infected graft and covering the proximal tibia with cement and no other surgery was required. Non union of the graft was observed in 8 patients (12.9%): in 4 patients autologous bone grafting was necessary to heal the osteotomy line. In other 3 cases non union was associated with graft fracture. In one case non union was associated with tibial stem loosening and revision of the whole implant was done. Polyethylene wear was assessed in 5 patients (8%) and revision of the polyethylene components was always required. Nine patellar tendon rupture (14.5%) were assessed and repaired was performed in seven cases. The functional outcome of 42 patients with more than two years of follow up was excellent in 25 cases, good in 13, fair in 2 and poor in 2. Discussion: APC of the proximal tibia is an effective alternative to osteoarticular graft and modular prosthesis because it allows good to excellent results in most of the patients (90.4%). The major concern is infection rate (24.2%) that usually lead to amputation (80%). Non union does not usually represent a problem because it’s tendency to spontaneous or bone grafting induced healing. Aseptic loosening of the tibial or femoral stem is rare. Patellar tendon rupture rate (14.5%) is similar to modular prosthetis rate and can be lowered using a femoral component with patellar groove

Introduction: Types of cancer occurring in children are very different from those occurring in adults. Reliable data on incidence and mortality of childhood cancers is sparse. Methods: A review of all primary malignant bone tumors in children (0–14 Yrs) from the Scottish National Bone Tumor Registry (1940–2000) is presented. Epidemiology, clinical presentation, pathology, radiological characteristics, treatment options, recurrence rates, geographic distribution and incidence are discussed. Results: Excluding myelomas and lymphomas, 154 patients were identified. 122 (80.2%) lesions were benign, and 30 (19.7%) malignant. There were 20 osteosarcomas (66%), 8 Ewing’s sarcomas (26%), 1 chondrosarcoma and 1 fibrosarcoma. Osteosarcoma – Age at presentation ranged from 4–14 Yrs (mean 10.3Yrs). 70 % involved 10–14 Yrs. Male: Female incidence was 1.5:1. 75% of lesions involved the proximal humerus.15 % presented with pathological fractures. The mean cumulative 5 year survival was 20%. Death was usually due to pulmonary metastasis.65% had pulmonary metastasis at a mean 6.3 mts after diagnosis. Mean survival in these patients was 14mts. Survival was superior with adjuvant chemotherapy and wide excision. Ewing’s Sarcomas- Age at presentation ranged from 7–14 (mean 11.2Yrs).71.4% involved 10–14Yrs. Male: Female was 1.6:1. 62.5% lesions involved the humerus and 25 % the radius and 12.5% the scapula. The mean cumulative 5 year survival was 37.5%.Death was due to pulmonary or skeletal metastasis (mean 21.5mts). All patients had radiotherapy and chemotherapy. Chondrosarcoma- A rare low-grade chondrosarcoma of the proximal humerus was encountered. Excision and grafting yielded good results. Discussion: Majority of bone lesions in this age group are benign. Osteosarcomas and Ewing’s sarcomas predominate among the malignant (93%).The peak incidence occurs with adolescent growth spurt. Mean age is lower for osteosarcomas, and the sex incidence for both show male preponderance. Survival rates for Ewing’s was higher than for osteosarcomas. Pulmonary involvement at presentation had worst prognosis

The presentation of this huge monoinstitutional cumulative experience in bone tumor cryosurgery serves as an illustration of our basic phylosophycal concent: “No man-made implants are even close to God’s natural implants yet”. The result is the concept of conservation surgery in which cryotherapy plays the major role. Materials and Methods: During the period of 1/88 to 12/02 (15 years, FUT 2→17 years, median=6 years) 440 cryosurgical procedures were performed in 405 people. There were 214 male and 191 female patients. The age range was 5 to 80 years but most were between 20 and 59 years. 2/3 of the series included a variety of primary benign aggressive and low grade malignant lesions and 1/3 included primary high grade and metastatic bone tumors. The anatomical location is highly variable and includes almost every bone of the skeleton. Two methods of bone cryosurgery will be presented (including combinations of them and other adjuvants or techniques): The open system according to Marcove and our Closed System. Results and Complications: Overall local recurrence (LR) rate=8%, fractures=1%, infections=2%, skin burns= 1.3%. There were 3 cases of temporary nerve palsies and 2 cases of late OA of an adjacent joint. Functional outcome in 372 NED patients is almost 100% good and excellent (AMSTS, Enneking’s scoring system). Summary: Bone cryosurgery is a safe, reliable and inexpensive technique of conservative limb, joint and even epiphysis sparing surgery in the suitable types of bone tumors, eliminating temporarily or permanently the need for resection surgery

Introduction: Musculoskeletal tumours and lesions resembling tumours present exceptionally difficult diagnostic and treatment problems in children. Presenting symptoms are usually a poor guide to diagnosis, and are often misleading.

Methods: A review of benign bone lesions of the upper limb in the peadiatric age group (0–14 yrs) from the Scottish Bone Tumour Registry is presented.

Results: Excluding myelomas and lymphomas, the registry included 154 lesions. 122 (80.2%) were benign including, 25 unicameral bone cysts, 22 aneurysmal bone cysts, 31 chondromas, 15 osteochondromas, 12 diaphyseal aclasis, 7 osteoidosteomas, 2 chondroblastomas, 2 nonossifying fibromas, and 1 each of giant cell tumour, eosinophilic granuloma and chondromyxoid fibroma.

Unicameral cysts- Age at presentation ranged from 3–14 yrs (mean 9.4).Male: Female incidence was 7.3:1. 92% involved the proximal humerus. 88 % presented with fracture. Recurrence rate after curettage was 20% at a mean of 10.8 mts.

Aneurysmal cysts – Age at presentation ranged from 5–14 yrs (mean 9.3). 55% involved the proximal humerus, and 20% hand bones. 45% presented with fracture. Recurrance rate after curettage was 31.8% at a mean of 15.1mts.

Chondromas- Age at presentation ranged from 3–14 yrs (mean 10.4).20 lesions were solitary and 11 multiple. Among solitary lesions, 16 were central (75% hand) and 4 parosteal.

Osteochondromas- Age at presentation ranged from 1–14 yrs (mean 10.1).Male: female ratio was 2.75:1. 53.3% involved the proximal humerus.

Osteoid Osteoma- Age at presentation ranged from 5–13 yrs (mean 10.14). Male: female ratio was 1:6. 42% involved the hand.

Discussion: Benign tumours compose majority of bone neoplasms in this age group. Unicameral and aneurysmal cysts, along with enchondromas were most frequent. Although the age at presentation shows variations with tumour type, the incidence seems to peak at 9–10 Yrs. Careful analysis of the clinical presentation, radiological characteristics and histology are required to distinguish them from malignant lesions.

Pediatric patients with lower extremity sarcoma often experience long lasting restrictions concerning physical activity and walking due to the required off-loading of the limb and other consequences of surgeries. Activity promotion during treatment in addition to physiotherapy could improve patients’ activity levels and walking capabilities.

In the present study we investigated the ambulatory activity of 31 pediatric patients (13.7 ± 3.1 years, 1.63 ± 0.15 m, 51.9 ± 15 kg, 19.3 ± 3.7 kg/m2) with Osteosarcoma or Ewing sarcoma at the lower limb using the StepWatch™ Activity monitor (SAM; Orthocare Innovations, USA). Sixteen patients regularly underwent supervised exercise interventions during inpatient stays, 15 did not receive any additional intervention. Step activities were measured for seven consecutive days during home stays at five different points in time, to determine a possible transfer of activity to everyday life.

Patients without intervention assembled considerably less steps than those in the intervention group. Before surgery they reached 25.4% of the intervention group (total n=16), six weeks after surgery 40% (total n= 8), after three months 46% (total n=10), after six months 72% (total n=13) and after one year 90%. However differences only reached significance at the first measurement.

Data presented must be considered as preliminary. Not all patients could be measured at all appointments due to impaired walking ability. Nevertheless activity promoting interventions during inpatient stays seem to have a positive influence on patients’ daily walking activity. Though the differences between the groups are not significant they are considerable. Especially during treatment – as reflected by the first three measurements- patients could benefit from additional interventions exceeding typical therapy regimes. Interventions should be individualized to the patients’ capabilities. Conclusions concerning tumor location or surgical procedures are not yet possible. Future research should furthermore concentrate on the effects of activity promotion on other fields of well-being.

Aims

Over time, the locking mechanism of Modular Universal Tumour and Revision System (MUTARS) knee arthroplasties changed from polyethylene (PE) to polyether-ether-ketone Optima (PEEK) and metal-on-metal (MoM) in an attempt to reduce the risk of mechanical failure. In this study, we aimed to assess the cumulative incidence of locking mechanism revision for symptomatic instability by type of material, and assess potential associated risk factors.

Residual tumor cells left in the bone defect after malignant bone tumor resection can result in local tumor recurrence and high mortality. Therefore, ideal bone filling materials should not only aid bone reconstruction or regeneration, but also exert local chemotherapeutic efficacy. However, common bone substitutes used in clinics are barely studied in research for local delivery of chemotherapeutic drugs. Here, we aimed to use facile manufacturing methods to render polymethylmethacrylate (PMMA) cement and ceramic granules suitable for local delivery of cisplatin to limit bone tumor recurrence. Porosity was introduced into PMMA cement by adding 1-4% carboxymethylcellulose (CMC) containing cisplatin, and chemotherapeutic activity was rendered to two types of granules via adsorption. Then, mechanical properties, porosity, morphology, drug release kinetics, ex vivo reconstructive properties of porous PMMA and in vitro anti-cancer efficacy against osteosarcoma cells were assessed. Morphologies, molecular structures, drug release profiles and in vitro cytostatic effects of two different drug-loaded granules on the proliferation of metastatic bone tumor cells were investigated. The mechanical strengths of PMMA-based cements were sufficient for tibia reconstruction at CMC contents lower than 4% (≤3%). The concentrations of released cisplatin (12.1% and 16.6% from PMMA with 3% and 4% CMC, respectively) were sufficient for killing of osteosarcoma cells, and the fraction of dead cells increased to 91.3% within 7 days. Functionalized xenogeneic granules released 29.5% of cisplatin, but synthetic CaP granules only released 1.4% of cisplatin over 28 days. The immobilized and released cisplatin retained its anti-cancer efficacy and showed dose-dependent cytostatic effects on the viability of metastatic bone tumor cells. Bone substitutes can be rendered therapeutically active for anticancer efficacy by functionalization with cisplatin. As such, our data suggest that multi-functional PMMA-based cements and cisplatin-loaded granules represent viable treatment options for filling bone defects after bone tumor resection

Functional outcomes are commonly reported in studies of musculoskeletal oncology patients undergoing limb salvage surgery; however, interpretation requires knowledge of the smallest amount of improvement that is important to patients – the minimally important difference (MID). We established the MIDs for the Musculoskeletal Tumor Society Rating Scale (MSTS) and Toronto Extremity Salvage Score (TESS) in patients with bone tumors undergoing lower limb salvage surgery. This study was a secondary analysis of the recently completed PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) study. This data was used to calculate: (1) the anchor-based MIDs using an overall function scale and a receiver operating curve analysis, and (2) the distribution-based MIDs based on one-half of the standard deviation of the change scores from baseline to 12-month follow-up, for both the MSTS and TESS. There were 591 patients available for analysis. The Pearson correlation coefficients for the association between changes in MSTS and TESS scores and changes in the external anchor scores were 0.71 and 0.57, indicating “high” and “moderate” correlation. Anchor-based MIDs were 12 points and 11 points for the MSTS and TESS, respectively. Distribution-based calculations yielded MIDs of 16-17 points for the MSTS and 14 points for the TESS. The current study proposes MID scores for both the MSTS and TESS outcome measures based on 591 patients with bone tumors undergoing lower extremity endoprosthetic reconstruction. These thresholds will optimize interpretation of the magnitude of treatment effects, which will enable shared decision-making with patients in trading off desirable and undesirable outcomes of alternative management strategies. We recommend anchor-based MIDs as they are grounded in changes in functional status that are meaningful to patients

Infections are among the most diffused complications of the implantation of medical devices. In orthopedics, they pose severe societal and economic burden and interfere with the capability of the implants to integrate in the host bone, significantly increasing failure risk. Infection is particularly severe in the case of comorbidities and especially bone tumors, since oncologic patients are fragile, have higher infection rate and impaired osteoregenerative capabilities. For this reason, prevention of infection is to be preferred over treatment. This is even more important in the case of spine surgery, since spine is among the main site for tumor metastases and because incidence of post operative surgical-site infections is significant (up to 15-20%) and surgical options are limited by the need of avoiding damaging the spinal cord. Functionalization of the implant surfaces, so as to address infection and, possibly, co- adjuvate anti-tumor treatments, appears as a breakthrough innovation. Unmet clinical needs in infection and tumors is presented, with a specific focus on the spine, then, new perspectives are highlighted for their treatment

Functionalization of biomimetic nanomaterials allows to reproduce the composition of native bone, permitting better regeneration, while nanoscale surface morphologies provide cues for cell adhesion, proliferation and differentiation. Functionalization of 3D printed and bioprinted constructs, by plasma-assisted deposition of calcium phosphates-based (CaP) nanostructured coatings and by nanoparticles, respectively, will be presented. Stoichiometric and ion doped CaP- based nanocoatings, including green materials (mussel seashells and cuttlefish bone), will be introduced to guide tissue regeneration. We will show interactions between biomimetic surfaces and MSCs to address bone regeneration and SAOS-2 cells for bone tumor models. Our results show that combining AM and nanostructured biomimetic films permits to reproduce the architecture and the mechanical and compositional characteristics of bone. Stability behavior of the coatings, as well as MSCs behavior strongly depend on the starting CaP material, with more soluble CaPs and ion-doped ones showing better biological behavior. Green materials appear promising, as biomimetic films can be successfully obtained upon conversion of the marine precursors into hydroxyapatite. Last-not-least, nanoparticles-loaded scaffolds could be bioprinting without loss of cell viability, but ink characteristics depend on ion-doping as demonstrated for SAOS-2 cells over 14 days of culture. Biomimetic nanomaterials for functionalization in AM is a promising approach for bone modelling and regeneration

Primary bone tumors are rare, complex and highly heterogeneous. Its diagnostic and treatment are a challenge for the multidisciplinary team. Developments on tumor biomarkers, immunohistochemistry, histology, molecular, bioinformatics, and genetics are fundamental for an early diagnosis and identification of prognostic factors. The personalized medicine allows an effective patient tailored treatment. The bone biopsy is essential for diagnosis. Treatment may include systemic therapy and local therapy. Frequently, a limb salvage surgery includes wide resection and reconstruction with endoprosthesis, biological or composites. The risk for local recurrence and distant metastases depends on the primary tumor and treatment response. Cancer patients are living longer and bone metastases are increasing. Bone is the third most frequently location for distant lesions. Bone metastases are associated to pain, pathological fractures, functional impairment, and neurological deficits. It impacts survival and patient quality of life. The treatment of metastatic disease is a challenge due to its complexity and heterogeneity, vascularization, reduced size and limited access. It requires a multidisciplinary treatment and depending on different factors it is palliative or curative-like treatment. For multiple bone metastases it is important to relief pain and increases function in order to provide the best quality of life and expect to prolong survival. Advances in nanotechnology, bioinformatics, and genomics, will increase biomarkers for early detection, prognosis, and targeted treatment effectiveness. We are taking the leap forward in precision medicine and personalized care

Extensive bone defects, caused by severe trauma or resection of large bone tumors, are difficult to treat. Regenerative medicine, including stem cell transplantation, may provide a novel solution for these intractable problems and improve the quality of life in affected patients. Adipose-derived stromal/stem cells (ASCs) have been extensively studied as cell sources for regenerative medicine due to their excellent proliferative capacity and the ability to obtain a large number of cells with minimal donor morbidity. However, the osteogenic potential of ASCs is lower than that of bone marrow-derived stromal/stem cells. To address this disadvantage, our group has employed various methods to enhance osteogenic differentiation of ASCs, including factors such as bone morphogenetic protein or Vitamin D, coculture with bone marrow stem cells, VEGF transfection, and gene transfer of Runx-2 and osterix. Recently, we mined a marker that can predict the osteogenic potential of ASC clones and also investigated the usefulness of the molecule as the enhancer of osteogenic differentiation of ASCs as well as its mechanism of action. Through RNA-seq gene analysis, we discovered that GSTT1 was the most distinguished gene marker between highly osteogenic and poorly osteogenic ASC clones. Knockdown of GSTT1 in high osteogenic ASCs by siGSTT1 treatment reduced mineralized matrix formation while GSTT1 overexpression by GSTT1 transfection or GSTT1 recombinant protein treatment enhanced osteogenic differentiation of low osteogenic ASCs. Metabolomic analysis confirmed significant changes of metabolites related to bone differentiation in ASCs transfected with GSTT1. A high total antioxidant capacity, low levels of cellular reactive oxygen species and increased GSH/GSSG ratios were also detected in GSTT1- transfected ASCs. GSTT1 can be a useful marker to screen the highly osteogenic ASC clones and also a therapeutic factor to enhance the osteogenic differentiation of poorly osteogenic ASC clones