Management of metastatic bone disease (original) (raw)
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European Surgical Orthopaedics and Traumatology, 2014
Bone metastases are only apparently similar lesions, considering the large varieties of istotypes and the spread of the primary tumour. Although these metastases develop early and are not terminal events, they have to be considered as severe complications. When possible, surgical treatment can improve the history of the patient in terms of life expectancy and quality of life. The approach to these lesions should be multidisciplinary in collaboration with oncologists and radiotherapists. In fact the average of survival of these patients has increased in recent years. The evolution of anesthesiological techniques permits surgical treatments that once were considered prohibitive. The application of new adjuvant therapies increases the effectiveness for surgical treatment. Controversy exists over the most appropriate treatment for patients with bone metastatic disease. The purpose was to determine the best sequential process to arrive at the most appropriate treatment considering the individual general conditions and the parameters of the metastases. As the number of treatment options for metastatic bone disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.
Metastatic bone disease: Have we improved after a decade of guidelines?
Bone & joint research, 2013
Guidelines for the management of patients with metastatic bone disease (MBD) have been available to the orthopaedic community for more than a decade, with little improvement in service provision to this increasingly large patient group. Improvements in adjuvant and neo-adjuvant treatments have increased both the number and overall survival of patients living with MBD. As a consequence the incidence of complications of MBD presenting to surgeons has increased and is set to increase further. The British Orthopaedic Oncology Society (BOOS) are to publish more revised detailed guidelines on what represents 'best practice' in managing patients with MBD. This article is designed to coincide with and publicise new BOOS guidelines and once again champion the cause of patients with MBD. A series of short cases highlight common errors frequently being made in managing patients with MBD despite the availability of guidelines. Despite guidelines for the management of patients with MBD b...
Surgical Approach to Metastatic Bone Disease
Operative Techniques in Orthopaedics, 2014
The treatment of metastatic cancer which has spread to the bone is predicated on palliation, not cure. Patients can still derive great benefit from surgical intervention. The prevention of fracture, maintenance of function, and relief of pain are the primary objectives of surgical intervention. Orthopaedic surgeons possess several techniques by which these goals may be realized. This chapter presents a general strategy for approaching patients with metastatic bone disease, and the manner in which different implants may be used to attain the goals of palliation. As with the treatment of primary bone and soft tissue neoplasia, the care of patients with metastatic bone disease should be a multidisciplinary approach that includes orthopaedic surgeons, medical and radiation oncologists, nurses, social workers, physical therapists, the patients, and their families.
Annals of Oncology, 2019
Background The best use of bone targeted agents (BTAs), i.e. how patients (pts) profit most from treatment, optimal timing of treatment start and frequency of administration as well as duration of treatment is unclear to date. Methods Physicians were asked to indicate the criteria they use for the indication and administration of BTAs in pts with bone metastases from solid tumors in Switzerland (physician-related outcomes, PO) during a period of 3 months. Patterns of care (POC) was assessed by questions about reasons for BTA administration, treatment pattern, patient characteristics, and actual treatment. Pts completed a pain and bone-pain related quality of life questionnaire. Results PO: Most of the physicians reported to start treatment with BTAs according to current guidelines (70.9%, 61/86). A smaller proportion would first assess the risk (high vs low) for developing skeletal-related events (SREs) to decide about treatment initiation (24.4%, 21/86). Factors contributing to def...
Pattern of Metastatic Bone Disease- an Observational Study
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Metastasis to the skeletal system is commonly associated with lung, prostate and breast cancers. The pattern of metastatic spread varies depending on the type of the primary tumour and its site. This study aimed to assess the pattern and anatomical distribution of skeletal metastases in histologically proven malignancies. MATERIALS & METHODS 128 consecutive cancer patients with evidence of skeletal metastasis were evaluated for the anatomical distribution of bone metastases. The clinical presentation of the metastatic bone disease was documented and the pattern of skeletal metastasis in various cancers evaluated. RESULTS The 128 patients (76 males and 52 females) consisted of 45 patients (35.2%) with lung cancer, 41 patients (32%) with prostate cancer, 19 patients (14.8%) with breast cancer, 9 patients (7%) with gastrointestinal cancer, 7 patients (5.5%) with renal cell carcinoma and other miscellaneous tumours in the remaining 7. Spine was found to be the most common site of skeletal metastasis (57.8%), followed by pelvic bones (22.6%) and ribs (14.8%). Lung cancers metastasized to spine, pelvis, ribs, scapula, humerus and sternum. Prostate and breast cancers had metastatic lesions in the spine, pelvis, ribs, scapula, femur, sternum, clavicle, and tibia. The clinical presentation varied from no specific symptoms to bone pain, neurological deficit and pathological fracture. CONCLUSION Bone metastasis has been found to occur in a predictable pattern. Thus, the knowledge of the usual pattern of metastasis in the commonly seen malignancies will enable the clinician to formulate a thorough work-up for the diagnosis and management of metastatic bone disease.
Morbidity and Mortality: A Case Report of Metastatic Bone Disease
Cureus
Metastatic prostate cancer and multiple myeloma (MM) usually present with bone lesions, posing a diagnostic challenge in males presenting in late stages. In this case report, an 86-yearold male who had not seen a physician in over 30 years presented with complaints of hip pain and progressive difficulty in walking for three weeks. Outpatient X-ray of the right hip showed multiple lytic bone lesions, raising suspicion of MM. Other laboratory tests revealed elevated serum calcium and elevated prostate-specific antigen (PSA), supporting a diagnosis of prostate cancer. The patient was admitted for further workup. Magnetic resonance imaging (MRI) of the spine showed diffuse metastatic disease throughout the spine as well as pelvis with multilevel central canal and neuro-foraminal narrowing due to degenerative changes. Central canal narrowing at L1-L2 due to tumor involvement could not be ruled out on MRI. Subsequently, urology was consulted and the patient was taken to the operating room for prostate biopsy and possible bilateral orchiectomy. Two intraoperative prostate biopsies were negative for malignancy but patient underwent bilateral orchiectomy due to high clinical suspicion for prostate cancer. Bone lesions in the pelvis were so extensive that orthopedic surgeons recommended complete non-weight bearing as the risk of fracture with weight bearing was thought to be very high. Eventually, laboratory workup for MM came out to be positive. Radiation oncologist recommended radiation therapy; however, at this point, the patient refused further intervention. He opted for palliative care. Consequently, a bone marrow biopsy could not be obtained for a definitive diagnosis of MM. The patient was eventually discharged to a nursing home for hospice care. This case sheds light on the importance of preventative care in routine outpatient setting, which can often screen, identify, and detect malignancies at earlier stages. It also signifies the importance of an interdisciplinary approach and precise knowledge in differentiating and diagnosing such malignancies. In our patient's case, his extensive bone disease precluded his ability to be weight bearing which is an uncommon finding only seen in extensive metastatic bone disease. A definitive diagnosis is warranted to guide appropriate management.
Surgical therapy of bone metastases
Seminars in oncology, 2007
The treatment of patients with cancer epitomizes the importance of using a collaborative team approach to optimize patient care. Physician team members most commonly are radiation oncologists, general surgeons, surgical oncologists, thoracic surgeons, neurosurgeons, and orthopedic surgeons. When patients are receiving chemotherapy, their medical oncologist frequently takes responsibility for coordinating care among the various team members and initiating consultations with necessary providers. When patients develop bone metastases or chemotherapy-induced bone loss (CTIBL), the orthopedic surgeon may be able to improve the patient's quality of life greatly. Procedures orthopedists perform most commonly include open reduction and internal fixations and arthroplasties (joint replacement surgery). Less invasive procedures currently being tested include stereotactic radiosurgery, radiofrequency ablation (RFA), and percutaneous cementoplasty. By understanding the options available to ...
Pain Management in Metastatic Bone Disease: A Literature Review
Cureus, 2018
Cancer means an uncontrolled division of abnormal cells in the body. It is a leading cause of death today. Not only the disease itself but its complications are also adding to the increase in mortality rate. One of the major complications is the pain due to metastasis of cancer. Pain is a complex symptom which has physical, psychological, and emotional impacts that influence the daily activities as well as social life. Pain acts as an alarm sign, telling the body that something is wrong. Pain can manifest in a multitude fashion. Management of bone pain due to metastasis involves different modes with some specific treatments according to the type of primary cancer. Over the years various treatment modalities have been tried and tested to improve the pain management including the use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, bisphosphonates, tricyclic antidepressants, corticosteroids, growth factors and signaling molecules, ET-1 receptor antagonists, radiotherapy as well as surgical management. The topic of discussion will cover each one of these in detail.
Methodology for Treatment Evaluation in Patients With Cancer Metastatic to Bone
JNCI Journal of the National Cancer Institute, 2001
Background: Patients with cancer metastatic to bone experience several adverse and clinically important skeletal-related events, including pathologic fractures, vertebral compressions with fracture, the need for surgery to treat or prevent fractures, and the need for radiation therapy for the treatment of bone pain. We present appropriate methods for describing and modeling the clinical course of skeletal-related events and comparing treatments for such events. Methods: On the basis of data from a recently completed randomized, placebo-controlled trial involving 380 breast cancer patients with bone metastases, we tested the validity of the "events-per-person-years" method, one of the most commonly used techniques, for the analysis of skeletal-related events. We then used more robust methods of analysis that are based on fewer assumptions, including a random-effects Poisson model, and contrasted the inferences about skeletal-related event rates and treatment effects for the different analytic methods. All statistical tests were two-sided. Results: The events-perperson-years analysis underestimated substantially the variation in the data and is not appropriate to summarize the incidence rate of skeletal-related events. A random-effects Poisson model did provide a valid basis for analyzing such data. Conclusions: The underestimation of variability in data associated with the use of the events-per-personyears analysis leads to unduly narrow confidence intervals for complication rates and inflated false-positive error rates in treatment comparisons. A random-effects Poisson model provides a valid, robust basis for describing the clinical course of bone complications and evaluating treatment effects.