Orthopaedic perspective on bone metastasis

Molloy, Anna; O’Toole, Gary

doi:10.5312/wjo.v4.i3.114

Cited by 7 publications

(17 citation statements)

References 34 publications

(32 reference statements)

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“…Therefore, highest priority is given to diagnostic workup rather than to rapid surgical treatment of the fracture (23). Although sensitivity for detecting small metastases is limited, x-rays of the symptomatic bone and surrounding joints should always be performed (21,22,28,29). It is essential to avoid missing proximal or distal metastases, as this can cause pathological fractures in precisely those areas when full weight bearing is applied after surgical fixation (30).…”

Section: Resultsmentioning

confidence: 99%

“…Radiologically, the characteristics of such lesions can be described as osteoblastic, osteolytic or mixed lytic-sclerotic and may hint at the possible primary (20,21,23,28,31,32). While metastases due to prostate carcinoma are mostly osteoblastic, the bony lesions of lung, thyroid or renal primaries usually appear to be osteolytic (21,23,25,31).…”

Section: Resultsmentioning

confidence: 99%

“…Additional three dimensionality of the anatomical sites as well as higher resolution are given by CT and magnetic resonance imaging (MRI) (20-22, 25, 27, 33). CT allows accurate visualization of cortical integrity and consequently assists in the evaluation of cortical bone destruction (20,25,28,33,34). As previously mentioned, CT can also be useful in localizing the lesion in the setting of a percutaneous biopsy (20,21).…”

Section: Resultsmentioning

confidence: 99%

“…With 91% sensitivity and 95% specificity, MRI is well suited to detect small bony metastases (21,26,28). In addition, it provides valuable information about the extent of intramedullary as well as extraosseous soft tissue involvement, which helps in planning surgical and radiation therapy (20,21,32,33).…”

Section: Resultsmentioning

confidence: 99%

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Common Pitfalls in the Management of Bone Metastasis of the Extremities - a Current Concept and Systematic Review of the Literature

et al. 2021

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Background/Aim: The surgical treatment of patients with bone metastasis of the extremities poses a set of unique challenges. We aimed to highlight common hazards when treating pathological fractures as well as hazards surrounding assumptions on metastatic status and life expectancy. Materials and Methods: This systematic literature review includes studies published from January 1, 1985 to May 7, 2021. Published articles were surveyed using PubMed. Of 99 studies, 32 original articles were found to meet the inclusion criteria. The PRISMA guidelines were used to select articles. Results: Current literature reports a variety of common pitfalls. In order to avoid pitfalls, it is essential to secure the diagnosis. Furthermore, life expectancy must be given consideration when planning surgical therapy. In addition, a well-functioning multidisciplinary team is needed to coordinate further options such as radiation or embolization. Conclusion: Despite the fact that the surgical principles for treating bone metastases of the extremities are often to the point, incorporating all the nuances of treatment is a meticulous procedure.A pitfall is an imperceptible hazard that often produces unforeseen difficulties and an unwanted result (1). Treating patients with metastatic disease means circumnavigating numerous potential pitfalls, many of which stem from the physician's bias when treating patients with "palliative" intent (1). In some cases, metastatic cancer of the bone requires consideration similar to primary sarcomas of the bone, while in other cases the palliative aims are obvious (1). The literature reports that approximately four million people experience bone pain from a malignant disease (2), with metastatic bone pain being one of the major complaints (2, 3). Additionally, bone metastases are a leading cause of comorbidity, characterized by pain, pathological fractures (impending and complete), impaired mobility, and potential neurological compromise (4).The spread of malignant cells from the primary tumor to other sites proceeds in a number of highly selective steps known as the metastatic cascade (5). Only 0.02% of malignant cells that enter the bloodstream are estimated to result in clinically detectable metastases (6). Histopathologically, the metastatic cascade commences when malignant cells are released by the primary tumor (5, 7). These cells subsequently invade healthy tissue and pass into the bloodstream by traversing the basal membrane of blood vessels or lymphatics (5, 7). The malignant cells leave the vessels and settle in a new organ away from the primary tumor, where they form metastases (5, 7).When bone metastases are established, median survival is reported to range from two to three years in breast cancer, two years in prostate cancer, and not even one year in lung cancer (8). However, it can also be substantially shorter, for example six months in melanoma, six to seven months in lung cancer or six to nine months in bladder cancer (5,(9)(10)(11)(12)(13).According to the literature, the lung, the live...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Common Pitfalls in the Management of Bone Metastasis of the Extremities - a Current Concept and Systematic Review of the Literature

et al. 2021

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“…No entanto, o local mais frequente é a coluna vertebral, seguido pelos ossos constituintes da bacia, os arcos costais e o fémur 3 . O microambiente do osso é ideal para a progressão tumoral e, desta forma para a metastização, dada a sua vascularização e a produção de moléculas de adesão, sendo também uma fonte de moléculas de angiogénese e reabsorção 4 . Com este estudo, pretende-se caracterizar uma amostra de doentes internados com o diagnóstico de metastização óssea, assim como comparar um grupo de doentes com neoplasia previamente conhecida com um grupo de doentes sem neoplasia identificada.…”

Section: Introductionunclassified

Caracterização de metástases ósseas em neoplasias ocultas e neoplasias previamente diagnosticadas

Lucas¹,

Vidal²,

Costa³

et al. 2016

Gal. Clin.

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ResumoIntrodução: A metastização óssea associa-se, geralmente, a mau prognóstico, com evidência de doença neoplásica avançada. Este estudo caracteriza uma amostra de doentes com metastização óssea e neoplasia primária conhecida, comparando com doentes sem neoplasia diagnosticada previamente. Material e métodos: Estudo observacional retrospectivo, onde foram incluídos doentes com diagnóstico de "neoplasia óssea secundária" ou "metástases ósseas", admitidos no nosso hospital, de 2009 a 2013. Analisados os dados de doentes com metástases ósseas com neoplasia primária conhecida ou oculta. Resultados: Incluídos 94 doentes, média de idades de 69±12. 66anos, 68% do sexo masculino. Os sintomas apresentados eram principalmente dorso-lombalgia (34%) e défice de força muscular dos membros (15%). Eám 42% dos doentes, existia previamente o diagnóstico de neoplasia. A coluna vertebral constituiu o principal local de metastização. Em 22% dos doentes não se identificou a neoplasia primária. A taxa de mortalidade durante o internamento foi de 14%, e no follow-up após um ano de 31%. Discussão: No estudo efectuado, verifica-se que a mortalidade à data de alta do internamento em doentes com neoplasia conhecida é superior à dos doentes com neoplasia indeterminada, o que não se verifica no follow-up a 1 ano. Pode considerar-se que os doentes com neoplasia previamente conhecida podem apresentar metastização óssea mais tardia, e assim, com pior prognóstico. Conclusão: A disseminação tumoral com expressão através da metastização relaciona-se com um agravamento do prognóstico no follow-up. Palavras-chave: metástases ósseas, coluna vertebral, neoplasia AbstractIntroduction and aims: The bone metastases usually have a bad prognosis, with evidence of advanced malignancy. This study evaluates the characteristics of patients with bone metastases and known primary neoplasia, comparing to those without previous diagnosed neoplasia. Material and methods: A retrospective observational study, was conducted to gather patients with diagnosis of "secondary bone cancer" or "bone metastasis", admitted to our hospital, from 2009 to 2013. Data from patients with known primary neoplasia, comparing to those with unkown origin neoplasia, were analyzed. Results: Ninety four patients were included, mean age 69+12. 66 years, 68% male. The symptoms were mostly back pain (34%) and limbs muscle strength deficits (15%). In 42% of them, there was a previous diagnosis of neoplasia. The spine was the primary site of metastasis. In 22% of patients, the primary tumor was not identified. The mortality rate during hospitalization was 14%, and 31% at one year follow-up. Discussion: In the study carried out, mortality at the end of hospitalization in patients with known neoplasia was higher than that of the patients with unkown neoplasia, which is not maintained at one year follow-up. Therefore, later presentation as bone metastasis in patients with known neoplasia, could confer a worse prognosis. Conclusion: The tumor spread with presentation through bone metastases, appe...

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Bone Metastasis from Solid Tumors: Biologic and Clinical State of the Art

Roato¹,

Massè

Piana

et al. 2017

Clinic Rev Bone Miner Metab

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Bone metastases are a frequent and debilitating consequence for many tumors, of which breast, lung, prostate, and kidney cancer are the most common. The dialog among cancer cells, bone microenvironment, and immune system regulates bone metastasis formation. Indeed, bone and immune system are strictly linked to each other because bone regulates the hematopoietic stem cells from which all cells of the immune system derive. Many immunoregulatory cytokines influence the fate of bone cells and promote the growth of tumor cells in bone, contributing to sustain the vicious cycle of bone metastasis. Bone is an attractive soil for cancer cells, which can remain dormant for years or directly form bone lesions. The fate of cancer cells after their arrival to bone marrow depends on a complex cross-talk among cancer, bone, and immune cells in the microenvironment. This review provides an overview of the different steps occurring during bone metastatic process, with particular attention to the osteoimmunology field. Furthermore, we will revise the current available clinical approaches for the therapy of bone metastatic patients

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Orthopaedic perspective on bone metastasis

Cited by 7 publications

References 34 publications

Common Pitfalls in the Management of Bone Metastasis of the Extremities - a Current Concept and Systematic Review of the Literature

Common Pitfalls in the Management of Bone Metastasis of the Extremities - a Current Concept and Systematic Review of the Literature

Caracterização de metástases ósseas em neoplasias ocultas e neoplasias previamente diagnosticadas

Bone Metastasis from Solid Tumors: Biologic and Clinical State of the Art

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