Local Adjuvants in Surgical Management of Bone Metastases

Piccioli, Andrea; Ventura, Antonio; Maccauro, Giulio; Spinelli, Maria Silvia; Bravo, V Del; Rosa, Michele Attilio

doi:10.1177/03946320110241s224

Cited by 23 publications

(28 citation statements)

References 22 publications

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“…Although piecemeal or intralesional excisions may yield the complete resection of tumors, these procedures are associated with a high risk of local recurrence due to tumor contamination and residual tumors [20]. It is, therefore, advantageous to use intralesional curettage in combination with adjuvant therapies, such as radiation therapy, to achieve local control in bone metastases [21]. However, these adjuvants are not generally suitable for the spinal axis due to the risk of iatrogenic injury to neural elements and adverse effects on wound healing and bone fusion [2].…”

Section: Discussionmentioning

confidence: 99%

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

Wei

Dong

et al. 2020

Preprint

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Background: To evaluate the clinical outcomes of total en bloc spondylectomy (TES) combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors.Methods: The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with satellite rod technique by a single posterior approach from June 2015 to September 2018were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH) and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI) and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded.Results: The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI and ASIA scores significantly improved from before to after surgery (P<0.05). The LKA, AVH and PVH significantly improved from before to immediately after surgery and to the final follow-up (P<0.05), and the postoperative and final follow-up values did not significantly differ (P>0.05).Conclusions: TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.

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Section: Discussionmentioning

confidence: 99%

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

Wei

Dong

et al. 2020

Preprint

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“…Around the epiphysis lesion, tumor curettage or resection is performed, and plates or pros-theses are used. However, the use of a tumor prosthesis is costly and more invasive than curettage with plates or bone cement, which is commonly performed [27]. Local adjuvants most commonly used for improving the effect of curettage in local cancer surgery may exert their effects either chemically or physically.…”

Section: Discussionmentioning

confidence: 99%

“…Local adjuvants most commonly used for improving the effect of curettage in local cancer surgery may exert their effects either chemically or physically. In orthopaedic oncology, the most commonly used adjuvants are phenol, liquid nitrogen, and laser [27]. Liquid nitrogen sometimes causes bone fracture or skin erosion; the effect of laser treatment is limited to the bone surface; and phenol has toxicity.…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Surgery for Bone Metastases Using the Combination of Photodynamic Therapy and Hyperthermia Treatment

Matsubara¹,

Matsumine²,

Kusuzaki³

et al. 2013

IJCM

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Cancer patients with bone metastases in their extremities may require surgical intervention to prevent deterioration in their quality of life due to a pathological fracture or severe bone pain. However, curative surgical interventions sometimes have severe complications due to the status of the original cancers. To avoid the decreased quality of life caused by bone metastasis, minimally invasive surgery that avoids additional surgical morbidity is required. We have established two therapeutic treatments for bone metastasis, a photodynamic acridine orange treatment (AOT) and an electronic magnetic hyperthermia treatment (EMHT). The present study investigated the clinical outcomes of combination therapy with EMHT and AOT for patients with bone metastases in their extremities. Methods: The study included 6 patients with 7 bone cancer metastasis locations. For bone metastases, all patients received intraregional tumor excision supported by AOT, in which photodynamic and radiodynamic therapy kills tumor cells during surgery with minimal damage to normal tissues. After the curettage, bone reconstruction was performed by using magnetic materialswith calcium phosphate cement. EMHT was repeatedly performed after surgery. In EMHT, tumor cells are killed with an electric magnetic field generator, and bony union is promoted by electronic stimulation. Results: The mean duration of follow-up was 14 months. During the follow-up period, only one patient experienced a local recurrence, and this recurrence occurred 14 months after surgery. Bony union occurred in 4 of 5 cases (80%), and the pain score was significantly reduced after surgery. Conclusions: In the present study, AOT reduced the invasiveness of surgery. EMHT reduced the tumor growth without major complications and promoted bone formation after surgery. Our clinical results confirmed that EMHT and AOT combination therapy for bone metastasis can preserve limb function without local recurrence or bone absorption.

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“…In the present study, we primarily focus on the surgical treatment of metastatic bone cancer of the limbs. Comprehensive therapy is preferred for the metastatic bone cancer, including surgical intervention, chemotherapy, radiotherapy and other conservative therapies [7,8,17]. Metastatic bone cancer is a systemic disease, thus surgical therapy is usually performed on the basis of other adjunctive therapies.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of en bloc resection of solitary bone metastases in limbs

et al. 2012

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SummaryBackgroundTo evaluate the pain, quality of life (QOL), and limb function of patients after en bloc resection of solitary metastatic bone cancer in the limbs.Material/MethodsA total of 27 patients with solitary metastatic bone cancer in the limbs were recruited. All these patients underwent limb-salvage surgery with en bloc resection of the metastatic tumor. Pain and QOL were evaluated before and after surgery. Pain was assessed with a 10-point scale before and 1 month after surgery. The QOL was evaluated with the SF-30 scale before and 3 months after surgery. Limb function was evaluated with the Musculoskeletal Tumor Society scale (MSTS) 3 months after surgery. Follow-up was performed for 6~31 months (mean: 16.15±7.47 months).ResultsAll procedures were successfully performed. Post-operative complications were found in 6 patients, including incision infection, prosthesis dislocation, deep vein thrombosis, and pulmonary infection. The pain score before and 1 month after surgery was 6.85±3.11 and 1.26±0.81, respectively, indicating obvious improvement (t=9.978, P<0.001). The QOL score before and 3 months after surgery was 38.30±13.05 and 65.78±10.65, respectively, indicating pronounced improvement (t=−18.550, P<0.001). The mean post-operative MSTS score was 23±3 (range: 17–30) (t=−1.450, P=0.016). No local recurrence was observed in any patient during the follow-up.ConclusionsLimb salvage surgery with wide or marginal resection for solitary metastatic bone cancer may significantly improve the pain, QOL, and limb function, but there is no difference in local control between wide and marginal resection.

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Local Adjuvants in Surgical Management of Bone Metastases

Cited by 23 publications

References 22 publications

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

A Minimally Invasive Surgery for Bone Metastases Using the Combination of Photodynamic Therapy and Hyperthermia Treatment

Short-term outcomes of en bloc resection of solitary bone metastases in limbs

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