Maria Serena Oliva

Bone and soft tissue sarcomas remain challenging to diagnose and monitor because of their rarity, molecular heterogeneity, low circulating biomarker abundance, and the limited sensitivity of conventional surveillance for microscopic disease. This narrative review synthesizes current evidence on liquid biopsy biomarkers, CRISPR-Cas-based molecular detection, artificial intelligence (AI), nanotechnology, and point-of-care (POC) platforms, with the aim of defining an integrated framework for sarcoma detection and monitoring. Circulating tumor DNA, methylation signatures, fragmentomic profiles, circulating RNAs, extracellular vesicles, and circulating tumor cells provide complementary diagnostic and prognostic information, although most available studies remain small and heterogeneous. CRISPR-Cas9, Cas12a, and Cas13a systems offer complementary strategies for rare-allele enrichment and ultrasensitive DNA or RNA detection, while nanomaterials can further enhance signal transduction and assay miniaturization. AI can integrate mutational, methylomic, fragmentomic, and biosensor-derived features to support classification, risk stratification, treatment-response assessment, and relapse monitoring. Their convergence within microfluidic POC platforms may enable rapid and decentralized testing. However, limited prospective validation, prediction errors, assay standardization, and regulatory challenges currently preclude routine clinical use. Larger multicenter sarcoma-specific studies are required before this framework can inform clinical decision-making.

Background: Pathological fractures of the humerus secondary to metastatic disease represent a significant cause of pain, disability, and reduced quality of life in oncologic patients. Surgical management aims to restore stability, reduce pain, and allow early mobilization. However, the optimal strategy between intramedullary nailing and modular megaprosthesis remains debated, particularly in relation to functional outcomes and long-term results. Methods: A retrospective observational study was conducted on 48 patients treated for pathological or impending humeral fractures between January 2015 and January 2025. Twenty-six patients underwent intramedullary nailing (IMN group), while twenty-two were treated with tumor resection and modular megaprosthesis reconstruction (MP group). Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Western Ontario Shoulder Instability Index (WOSI) at 1, 12, 24, 36, and 60 months, and at 10 years. Complications and overall survival were also analyzed. Results: Intramedullary nailing demonstrated significantly superior early functional outcomes, with higher MSTS scores at 1 month (78% vs. 63%, p < 0.001) and lower QuickDASH scores in the first 24 months (p = 0.002). WOSI scores also favored IMN in the early postoperative period (p = 0.004). Megaprosthesis showed a slower initial recovery but a progressive improvement over time, reaching comparable functional outcomes at long-term follow-up (p > 0.05). The overall complication rate was similar between groups (p = 0.28), although periprosthetic infections occurred only in the MP group. Survival analysis did not show significant differences between groups (p = 0.74). Conclusions: Both intramedullary nailing and modular megaprosthesis represent effective surgical options for pathological and impending humeral fractures. Intramedullary nailing provides faster early functional recovery, whereas megaprosthetic reconstruction offers a durable reconstructive solution for extensive proximal lesions. Functional outcomes progressively converged between the two techniques approximately 2–3 years after surgery. Mid-term outcomes up to five years appeared comparable, suggesting that surgical decision-making should be individualized according to lesion characteristics, tumor biology, expected survival, and functional demands.

Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. We hypothesise that antibacterial coatings and improved soft-tissue techniques reduce infection rates and enhance functional recovery. Methods: A comprehensive narrative review of PubMed, Web of Science, and the Cochrane Library was performed using the terms proximal humerus, shoulder, bone tumor, sarcoma, neoplasm, infection, megaprosthesis, and endoprosthetic replacement. Reference lists were screened manually. Case reports and series with fewer than five patients were excluded. Twenty-seven clinical studies (more than 1100 patients; mainly osteosarcoma, chondrosarcoma, and metastatic lesions) were included and qualitatively analyzed. Results: The reported infection rates ranged from 4% to 20%, with higher risk in patients receiving adjuvant therapy. Silver-coated implants reduced PJI compared with uncoated designs (e.g., 11.2% → 9.2% in primary implants; 29.2% → 13.7% in revisions) without systemic toxicity. Alternative antibacterial coatings (e.g., silver- or copper-enriched hydroxyapatite) showed promising early results but remain supported by limited clinical data. Soft-tissue stabilization with Trevira tube or synthetic mesh improved joint stability and did not increase infection risk. Functional outcomes, usually assessed by MSTS or TESS, were moderate to good (≈60–80%) overall, with better scores when the deltoid and axillary nerve were preserved or when reverse total shoulder arthroplasty was possible. Conclusions: Proximal humerus megaprosthetic reconstruction benefits from meticulous soft-tissue handling, selective use of antibacterial technologies, and multidisciplinary management. The current literature is mainly retrospective, heterogeneous, and non-comparative. Prospective multicenter studies are needed to clarify the long-term effectiveness of silver or alternative coatings, soft-tissue reconstruction techniques, and emerging custom-made 3D-printed prostheses.

Background and aim: Cancers are one of the most frequent causes of death and disability in humans. Skeletal involvement has a major impact on the quality of life and prognosis of cancer patients. Electrochemotherapy is a palliative and minimally invasive oncologic treatment that was first used to treat subcutaneous nodules for malignant tumors. The aim of our review is to evaluate the results of electrochemotherapy in the treatment of bone metastases. Methods: A systematic review of the literature indexed in the PubMed MEDLINE and Cochrane Library databases using the search key words “electrochemotherapy” AND (“metastasis” OR “metastases”) was performed. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses was followed. Inclusion criteria were proven involvement of the appendicular skeleton in metastatic carcinoma or melanoma, through at least one percutaneous electrochemotherapy session on the metastatic bone lesion. The exclusion criterion was no skeletal metastatic involvement. Results: Eight articles were finally included. We reached a population of 246 patients. The mean age and follow up were 60.1 years old and 11.4 months, respectively. The most represented primary tumor was breast cancer (18.9%). A total of 250 bone lesions were treated with electrochemotherapy. According to RECIST criteria, in our population we observed 55.5% stable diseases. The mean pre-electrochemotherapy VAS value was 6.9, which lowered to 2.7 after treatment. Adverse events occurred in 3.4% of patients. Conclusions: Electrochemotherapy as a minimally invasive and tissue-sparing treatment should be considered for patients with no other alternative to obtain tumor control and improvement in quality of life.

The incidence of periprosthetic fractures of distal femur (PPDFFx) after primary total knee arthroplasties is described around 0.3% and 2.5% and it is increasing as the number of patients with total knee arthroplasty continues to arise. surgical options treatments for PPDFFx include fixation in the form of eather Open reduction and internal fixation (ORIF), or retrograde intramedullary nailing (RIMN), or conventional (non locked) plating, or locked plating such as the Less Invasive Stabilization System (LISS), or dynamic condylar screws. In recent years, however, the use of megaprostheses has been increasing. Patients with periprosthetic fractures of distal femur after primary total knee arthroplasties treated with ORIF or with the use of Distal femur replacement (DFR) were retrospectively analyzed in this to evaluate differences in intra-operative blood loss, need of blood trasfusion, weight bearing, range of motion, rate of complications, rate of revision surgery and functional outcome according Oxford Knee Score between two groups. Treatment of Periprosthetic distal femur fracture remains controversial. While ORIF seems to guarantee less percentage of complications and reoperation rate, those treated with megaprosthesis seem to gain better range of motion in a very short post-operative time. In the future it will be necessary to investigate with greater numbers possible advantages and disadvantages of the various treatments in periprosthetic distal femur fractures.

OBJECTIVE: Massive bone loss is a serious problem in the elderly. Joint replacement with modular prostheses represents the most common reconstructive technique after oncological and non-oncological resections. Megaprostheses are broadly available, adaptable and versatile and allow early mobilization and rehabilitation. Although segmental endoprosthetic implants are now widely used and despite innovations, complications remain far high. Our purpose is to establish what happens to megaprostheses of a specific anatomical site in the long term in a population with oncologic and non- oncologic indications treated at a single center solely by a few skilled surgeons. MATERIALS AND METHODS: We retrospectively reviewed our institutional database. We collected 35 patients who underwent endoprosthetic reconstruction exclusively of the proximal femur for neoplastic and non-neoplastic disease between 2008 and 2021. The minimum follow-up was 12 months. Complications were collected and classified, and also adapted to the non-oncological setting. RESULTS: Taking into consideration the entire population, 94% of this survived the follow-up at 6 months, subsequently 85% at 1 year and 82% at 2 years. At follow-ups after 5 years, 79% of megaprostheses showed no mechanical failure. Analyzing prosthetic survival in the two groups, this was > 50% at 24 months after surgery in both groups, with better survival for the oncological one. CONCLUSIONS: Proximal femur replacement can be a valid option in treatment of oncological and non-oncological cases. Due to the high complication rate, only selected cases should undergo this kind of surgical procedure.