Surgical treatment of metastatic bone disease of the distal extremities

Abstract

Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.

Acrometástasis de mano como recaída de adenocarcinoma de cérvix: una entidad rara. Revisión de la literatura

“…En pacientes con enfermedad maligna conocida es posible que las imágenes de todo el cuerpo para la estadificación no revelen la enfermedad que afecta las manos o los pies, ya que a menudo no se incluyen en los campos de exploración 2,18 . Por lo que se recomienda que en los controles se obtengan imágenes estándar de cuerpo entero, como una PET-CT 2,19 . La falange distal es el hueso más afectado y el pulgar es el dedo más frecuentemente afectado 2 .…”

Bone metastases – aetiopathogenesis and treatment possibilities. Review of literature

“…Aktualne dowody wskazują, że fiksacja płytką i śrubami lub gwoździe śródszpikowe są nadal preferowaną metodą leczenia zabiegowego, podczas gdy miejscowe wycięcie lub amputacja są częściej stosowane w przypadkach większej liczby uszkodzeń dystalnych (takie jak kostka, stopa i ręka). Po operacji część chorych będzie kwalifikowanych do uzupełniającej radioterapii [40]. Tanaka i wsp.…”

Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review

“…This peculiar tumor location may severely impair function and alter quality of life, thus calling for timely diagnosis and treatment. As regards the latter, surgery procedures ranging from curettage to amputation are the most used therapeutic options for local removal ( 4 ), relegating radiotherapy (RT) to mere pain control by the classic palliative radiation doses commonly employed in metastatic bone disease (i.e. 8 Gy in single fraction, 20 Gy in five daily fractions, 30 Gy in ten daily fractions) ( 5 ).…”