Metastases to the Long Bones: Algorithm of Treatment

Scorianz, Maurizio; Gherlinzoni, F.; Campanacci, Domenico Andrea

doi:10.1007/978-3-319-73485-9_9

Cited by 6 publications

(19 citation statements)

References 66 publications

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“…The bone cement is the most popular material for replacing excised bone tissue for several reasons. Among its benefits are: enhanced structural stability, rapid recovery and better local control after curettage due to its thermic characteristic [36,37]. The drawbacks are longer prolonged surgery, a risk of wound healing disorders and local bleeding.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Using the bone cement requires the use of PMMA (PolyMethyl MethAcrylate) of low viscosity, applied under minimal pressure. A proper level of patient hydration is also important -it reduces the risk of fat embolisms [37]. Using an intramedullary nail also has its limitations.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…One of the reasons is the lower healing potential of bone tissue affected with metastases. Heling indications were present in 5-20% of pathological fractures caused by metastases [37,39]. The healing potential in bone metastases from breast cancer is estimated to be 34% -but from lung cancer 0% [40].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Especially when using an intramedullary nail to stabilize a bone, a quick mobilization of the patient is recommended. During the surgery and right after it, a prophylactic anti-coagulant and antibiotic treatment is recommended [37]. If radiotherapy is required as an adjuvant treatment, it should be administered after 3-4 weeks after the surgery to allow for a full healing of the wound.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Bone diaphysis metastases from the perspective of an orthopedic surgeon – review

Ciechanowicz¹,

Pawlik²,

Ziętek³

et al. 2022

Chir. Narzadow Ruchu Ortop. Pol.

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Bone metastases are a great challenge in the practice of an orthopedic surgeon. Due to the development of oncological treatment, the approach to patients with bone metastases is changing. Previously, these patients were treated palliatively, mainly to decrease the pain intensity. However, with appropriate systemic, surgical and orthopedic treatment, patients with bone metastases often live for many years. Therefore, proper diagnosis and appropriate orthopedic treatment can significantly improve patients’ prognosis. On the other hand, poor qualification for surgery and selection of the wrong treatment method contribute to shortening the patients’ survival. Hence, knowledge of the diagnosis and qualification of patients for surgical treatment is essential in the practice of an orthopedist. In the presented review, the authors focused on summarizing the knowledge in the field of diagnostics, qualification for surgical treatment and orthopedic treatment methods for patients with bone diaphysis metastases.

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Bone diaphysis metastases from the perspective of an orthopedic surgeon – review

Ciechanowicz¹,

Pawlik²,

Ziętek³

et al. 2022

Chir. Narzadow Ruchu Ortop. Pol.

View full text Add to dashboard Cite

show abstract

“…Additionally, the literature shows that patients with a single bone metastasis should be treated radically, similar to patients with primary bone tumors, rather than receive palliative treatment only [ 6 ]. This is seen especially in the case of metastases of clear cell carcinoma of the kidney, where the longer survival of patients undergoing radical treatment has been achieved [ 11 , 12 ]. Nevertheless, each case of a patient with MBD should be evaluated individually within the group of oncologists, radiotherapists, and orthopedists.…”

Section: Introductionmentioning

confidence: 99%

Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons

Ciechanowicz

Kotrych

Dąbrowski

et al. 2022

JCM

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Background: The proper diagnosis and treatment of bone metastases are essential for patient survival. However, several strategies for the treatment are practiced. Therefore, the aim of the study was to analyze what factors influence the choice of a method of treatment. Methods: An online survey was conducted within the Polish Society of Orthopedics and Traumatology. It consisted of 45 questions and was divided into four main parts: Participant Characteristics, Diagnosis and Qualification, Treatment, and Clinical Cases. Results: A total number of 104 responses were collected. The most frequently chosen methods were: Intramedullary nail (IMN) + Resection + Polymethyl methacrylate (PMMA) (30.47%) and IMN without tumor resection (42.13%), and in third place, modular endoprosthesis (17.25%). The less experienced group of orthopedic surgeons more often (47.5% vs. 39.5%) decided to perform IMN without tumor resection than the more experienced group (p = 0.046). Surgeons from district hospitals less frequently (13.7% vs. 23.1%) would decide to use modular endoprosthesis than surgeons from university hospitals (p = 0.000076). Orthopedists who performed ≥ 11 bone metastases surgeries per year would more often use modular endoprosthesis (34.8% vs. 13.2%) than those who performed ≤ 10 operations per year (p = 0.000114). Conclusion: Experience, place of work, and the number of metastasis surgeries performed during a year may influence the choice of treatment method in patients with bone metastases.

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Treatment algorithm for metastatic malignancies in the lower extremities

Hashimoto,

Nishimura,

Ito

et al. 2024

Preprint

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Background A high prevalence of proximal femoral metastases persists in cancer patients, especially regarding lower extremity fractures. This study offers a detailed analysis of the clinical characteristics in patients undergoing surgical treatment for pathological or impending fractures, enhancing treatment strategies in metastatic malignancies. Methods Thirty patients who underwent treatment for impending and pathological fractures at our hospital were included. The retrospective study covered parameters such as age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcome, and follow-up period. We compared post-treatment MSTS scores in cases of impending and pathological fractures, and between intramedullary nailing and other surgical procedures. The one-year postoperative survival rate was also calculated. Furthermore, we compared the operative time, blood loss, and survival rates of impending and pathological fractures. Results Participants had a median age of 70.5 years, with disease sites primarily in the subtrochanteric femur, trochanteric femur, femoral diaphysis, femoral neck, and other locations. Pathologies included multiple myeloma, unknown primary, lung, breast, kidney, liver, gastric, esophageal, and uterine cancers. The median ECOG-PS score pre-fracture was 2. Treatment approaches involved radiotherapy, chemotherapy, and a combination of both. Surgical interventions included intramedullary nailing (16 cases), endoprosthesis (1 case), bipolar head replacement (3 cases), and compression hip screw (3 cases), among others. A negative correlation (r = -0.63) existed between MSTS and pre-fracture ECOG-PS scores. Operative time was significantly shorter in impending than pathological fractures, with impending fractures also showing significantly lower blood loss. Conclusion Our treatment algorithm for malignant bone tumors of the lower extremity was efficient, potentially optimizing treatment strategies for such cases, and contributing to improved patient care and outcomes in oncology and orthopedic surgery.

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Metastases to the Long Bones: Algorithm of Treatment

Cited by 6 publications

References 66 publications

Bone diaphysis metastases from the perspective of an orthopedic surgeon – review

Bone diaphysis metastases from the perspective of an orthopedic surgeon – review

Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons

Treatment algorithm for metastatic malignancies in the lower extremities

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