Bone Tumors, Benign

Background

Clinical KeyBenign bone tumors can occur whenever there is an excessive growth of tissue. In bones, this tissue can cause a lump or protrusion of the bones. Even though benign tumors do not spread like malignant ones, some benign tumors may still cause symptoms and require treatment. Examples of this are when the tumor constrains growth of adjacent normal bone or impacts the range of motion of a joint.

The symptoms of benign tumors are typically pain or swelling on or near a bone or joint. Some benign tumors may not have any symptoms at all.

Diagnosis of benign tumors comes with a physical exam and xrays or some other imaging studies. Biopsies are often needed.

Current Treatment

Some benign tumors can simply be observed, and over time they can grow, stay the same or resorb. Pediatric benign tumors can often resorb as the patient gets older. Some benign tumors have the risk of becoming malignant or can weaken the bone, so they may need to be removed.

Treatment options are mostly surgery or observation. In some situations non-surgical treatments such as corticosteroids or other similar treatments can be used to help with control the symptoms. If there are conditions that may transition to malignancy, then other treatments such as radiation, chemotherapy and stereotactic radiosurgery (Gamma Knife) can also be considered.

Focused Ultrasound Research

Focused ultrasound (FUS) is not approved to treat benign or malignant bone tumors

However, it has been shown to be a promising tool for pain palliation, through local bone denervation, which can be caused by chronic conditions such as arthritis or by malignancy.
Therefore some discussion is included here for perspective. The physician is able to heat the targeted bone and bone-tissue interface where the nerves reside to destroy the pain-reporting nerve fibers and block their ability to transmit pain signals. This is often done in the lumbar spine where there is chronic arthritis or in regions of metastatic lesions. The spine and spinal tumors can get treatment in this scenario, and cancers within the target can even see shrinkage. However, as the ultrasound beam is typically unable to penetrate through bone, so there is little to no impact on the boney structures.

One example of benign use of focused ultrasound is Osteoid Osteoma, where it can non-invasively treat tumors in pediatric and adult patients with much lower risks of side effect than open surgery. Although these tumors are benign, they can be very painful. They can also grow to significant size and have impact on adjacent organs.

Notable Papers

Menikou G, Yiallouras C, Yiannakou M, Damianou C. MRI-guided focused ultrasound robotic system for the treatment of bone cancer. Int J Med Robot. 2016 Jul 15. doi: 10.1002/rcs.1753.

Chen W, Zhu H, Zhang L, Li K, Su H, Jin C, Zhou K, Bai J, Wu F, Wang Z. Primary bone malignancy: effective treatment with high-intensity focused ultrasound ablation. Radiology. 2010 Jun;255(3):967-78. doi: 10.1148/radiol.10090374.

 

     

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