The bone tissue can develop a tumour pathology, fortunately, "rare" as cancer. Bone cancer is a generic and general definition that includes numerous subtypes with very different characteristics, such as Osteosarcoma, Adamantinoma, Chondrosarcoma, Ewing's sarcoma.

As with other tumours, even bone neoplasms can be benign or malignant, primary, or secondary. Primary cancer is the tumour that "arises" directly in that bone, instead secondary cancer is the metastases site of other tumours. Indeed, the bone tissue is a metastasis site of other cancers such as prostate or breast tumours.

Bone cancer is, fortunately, a rare disease: for example, in Italy, the incidence of primary bone tumours is about 0.9 cases per 100,000 inhabitants per year (i.e., every year in Italy, out of almost 70 million citizens, about 500 new diagnoses of bone cancer).

Even in the US, the data are similar: new diagnoses of primary bone cancer do not go beyond 2,500 per year.

Finally, it is worth remembering that 25% -30% of these diagnoses mainly concern a primary and malignant bone tumour: osteosarcoma.

BONE CANCERS: SYMPTOMS AND DIAGNOSIS

Initially, the symptoms of bone cancer are mild and non-specific, i.e., very general, and therefore shared with other clinical situations:

• PAIN from a limb without a frank traumatic cause that can justify it (i.e., a fall, a sports accident), pain often unresponsive to painkillers and present constantly even during the night.
• TUMEFACTION is a palpable “draft” present on the profile of a bone, and it usually tends to increase in size over time.

There are no clear and known causes regarding the risk of these tumours onset. However, there are correlations with previous exposures to ionizing radiation (radioactivity) and some genetic factors.

When suspected, confirmation of the bone cancer diagnosis is clinical and radiological (by x-ray, CT, or MRI). In some cases, it is necessary to complete the diagnosis process with a bone biopsy (i.e., by making a minute removal of a bone piece by surgery) to subsequently study it better in the laboratory and under the microscope.

THE THERAPEUTIC PROCESS (CURE) FOR BONE CANCER.

Bone cancer is rare and with a low incidence. Therefore, it is suggested diagnostic-therapeutic process with a multi-speciality approach, such as Orthopaedists, Oncologists, Radiotherapists, Surgeons, Pathologists, Physiatrists, Physiotherapists, Orthopaedic Technicians, Psychologists.

After diagnosis, as the first step, the primary malignant bone tumour treatment (such as osteosarcoma) often involves surgery to remove it. Subsequently, some cycles of chemotherapy (the currently most used chemotherapy molecules are Methotrexate, Adriamycin, Ifosfamide) and radiotherapy may also be considered in specific clinical contexts. Furthermore, the focus of research is on the development of new drugs or new treatment strategies for bone tumours, such as the use of immunomodulating drugs.

In surgery for bone tumour removal, the orthopaedic surgeon can choose to remove small quantities of nearby healthy bone (i.e., conservative approach). Consequently, the most significant challenge for the surgeon is the bone removed reconstruction. Indeed, malignant primitive bone tumours often develop on portions of bone where reconstruction is fundamental and complex.

As can be easily assumed, tumour bone removal requires bone grafts or bone substitutes to reconstruct the portion of removed and missing bone. Therefore, it allows a faster and functional recovery as much as possible optimal and complete.

Thus, the role of bone grafts and bone substitutes is central and considerable for the patient undergoing an orthopaedic surgery for bone cancer.

The options available to orthopaedist are:

• Bone grafts, that can be:
  • Autologous: They are collected from a patient’s donor site, and they have osteoconductivity and osteoinductivity. This type of graft provides vital bone cells and growth factors that stimulate bone regeneration, but also it has several disadvantages, including limited availability and morbidity at the donor site.
  • Homologous: They are collected from a donor or cadaver. They are a scaffold for the new bone tissue formation (osteoconductive property) and, it does not contain live cells.
• Bone substitutes: They are synthetic materials (alloplastic) that have a composition very similar to that of human bone. They have only osteoconductive properties and their disadvantages are high costs, lower mechanical properties, and longer integration times than a healthy bone.

Natural bone substitutes to reconstruct the portion of bone removed due to cancer: the advantages of the Greenbone^® solution

In the panorama of bone substitutes, Greenbone^® represents an innovative and currently unique alternative. Indeed, the developed material is characterized by several properties, such as osteoconductivity, osteoinductivity, osseointegration and mechanical properties very similar to those of healthy human bone. Greenbone^® product is a synthetic, acellular, and absorbable bone substitute derived from Rattan wood. Moreover, it is the only natural material with an internal architecture like that of human bone. This characteristic makes the Greenbone^® product suitable for the natural bone regeneration process. Furthermore, considering other synthetic bone substitutes, its natural derivation allows a significant reduction in costs and its use for considerable portions of missing bone and for bone segments, which are complex to rebuild.

Bone tumours are a great challenge for today's medicine. The treatment protocols are constantly updated, and the research is, fortunately, progressing visibly year after year. Indeed, the cure rates are continuously improving. In this treatment path, the role of the GreenBone^® product is also very significant because they offer a valid option to the surgeon. GreenBone^® solution compensates for the portion of bone removed and missing, potentially allowing the patient to have a faster and complete recovery.