Abstract
Metastases can occur as part of the natural progression of a variety of malignancies and their mode of spread, manner of presentation, and prognosis are as variable as their primary sources. The ultimate goal of musculoskeletal treatment of skeletal metastases is to get the patient in question back to his or her previous level of function as soon as possible. Skeletal metastases are seldom life threatening and their treatment will rarely render someone cured of their primary disease. Nevertheless, involvement of a musculoskeletal specialist as a part of the multidisciplinary approach can and very often does provide significant improvement in patients’ qualities of life. The purpose of this chapter is to discuss the evaluation of a patient with suspected metastatic disease involving the musculoskeletal system and their pre-, intra-, and post surgical management as part of a multidisciplinary team.
Keywords
- Musculoskeletal
- Metastasis
- Carcinoma
- Bisphosphonate
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Weber K (2010) Evaluation of the adult patient with a destructive bone lesion. J Am Acad Orthopedic Surgery 18:169–179
Coleman R et al (2010) Metastasis and bone loss: advancing treatment and prevention. Cancer Treat Rev 36(8):615–620 (Published online 2010 May 15)
Narazaki DK, Alverga Neto CC, Baptista AM, Caiero MT, Camargo OP (2006) Prognostic factors in pathologic fractures secondary to metastatic tumors Clinics 61(4):313–320
Coleman R (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243s
Jasmin C, Coleman, RE, Coia LR, Capanna R, Saillant G (2005) Textbook of bone metastases. Wiley, London
Sivasundaram R, Shah S, Ahmadi S, Wunder JS, Schemitsch EH, Ferguson PC, Zdero R (2013) The biomechanical effect of proximal tumor defect location on femur pathological fractures. J Orthopedic Trauma 27(8):e174–e180
Higinbotham NL, Marcove RC (1965) The management of pathological fractures. J Trauma 5:792–798
Healey JH, Brown HK (2000) Complications of bone metastases: surgical management. Cancer 88(S12):2940–2951
Ahn SG, Lee HM, Cho S-H, Lee SA, Hwang SH, Jeong J, Lee H-D (2013) Prognostic factors for patients with bone-only metastasis in breast cancer. Yonsei Med J 54(5):1168–1177
Bloomfield DJ (1998) Should bisphosphonates be part of the standard therapy of patients with multiple myeloma or bone metastases from other cancers? An evidence-based review. J Clin Oncol 16:1218–1225
Katzmann JA (2009) Screening panels for monoclonal Gammopathiesltime to change. Clin Biochem Rev 30(3):105–111
Jung K et al (2004) Comparison of 10 serum bone turnover markers in prostate carcinoma patients with bone metastatic spread: diagnostic and prognostic implications. Int J Cancer 111(5):783–791
Aydiner A (1994) Serum tumor markers for detection of bone metastasis in breast cancer patients. Acta Oncol 33(2):181–186
Mundy G (2002) Metastasis to bone: causes, consequences, and therapeutic opportunities. Cancer 2:584–593
McNeil BJ (1984) Value of bone scanning in neoplastic disease. Semin Nucl Med 14:277–286
Damle NA, Bal C, Bandopadhyaya GP, Kumar L, Kumar P, Malhotra A, Lata S (2013) The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol 31(4):262–269
Rougraff BR, Kneisl JS, Simon MA (1993) Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Joint Surg Am 75:1276–1281
Clayer M, Duncan W (2006) Importance of biopsy of new bone lesions in patients with previous carcinoma. Clin Orthop Rel Res 451:208–211
Cronin CG, Cashell T, Mhuircheartaigh JN, Swords R, Murray M, O’Sullivan GJ, O’Keeffe D (2009) AJR Am J Roentgenol 193(5):W407–W410
Ward WG, Kilpatrick S (2000) Fine-needle aspiration biopsy of primary bone tumors. Clin Orthop Relat Res 373:80–87
Yang YJ, Damron TA (2004) Comparison of needle core biopsy and fine-needle aspiration for diagnostic accuracy in musculoskeletal lesions. Arch Pathol Lab Med 128(7):759–764
Mankin HJ, Mankin CJ, Simon MA (1996) The hazards of the biopsy, revisited. For the members of the musculoskeletal tumor society. J Bone Joint Surg 78(5):656–663
Ward WG, Savage P, Boles C, Kilpatrick SE (2001) Fine-needle aspiration biopsy of sarcomas and related tumors. Cancer Control 8(3):232–238
Wong R, Wiffen PJ (2002) Bisphosphonates for the relief of pain secondary to bone metastases. Cochrane Database Syst Rev 2002(2):CD002068
Finley RS (2002) Bisphophonates in the treatment of bone meatastases. Sem Onc 29(1)(4):132–138
Walkington L, Coleman RE (2011) Advances in management of bone disease in breast cancer. Bone 48(1):80–87
Groot MT, Boeken Kruger CGG, Peiger RCM, Uyl-de Groot CA (2003) Costs of prostate cancer, metastatic to the bone in the Netherlands. Eur Urol 43(3):226–232
Jeremic B (2001) Single fraction external beam radiation therapy in the treatment of localized metastatic bone pain. a review. J Pain Symptom Manage 22(6):1048–1058
Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, Paz-Fumagalli R, Hoffman C, Atwell TD, Charboneau JW, Schmit GD, Goetz MP, Rubin J, Brown KJ, Novotny PJ, Sloan JA (2013) Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 119(5):1033–1041
Toyota N, Naito A et al (2005) Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol 28(5):578–583
Fidler M (1973) Prophylactic internal fixation of secondary neoplastic deposits in long bones. BMJ 1(5849):341
Mirels H (1989) Metastatic disease in long bones a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 249:256–264
Robial N, Charles YP, Bogorin I, Godet J, Beaujeux R, Boujan F, Steib JP (2012) Is preoperative embolization a prerequisite for spinal metastases surgical management? Orthop Traumatol Surg Res 98(5):536–542
Fang T, Dong J, Zhou X, McGuire RA Jr, Li X (2012) Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine 17(4):271–279
Nilsson J, Gustafson P, Fornander P, Ornstein E (2000) The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients. Acta Orthopaedica 71(6):591–596
Vena VE, Hsu J, Rosier RN, O’Keefe RJ (1999) Pelvic reconstruction for severe periacetabular metastatic disease. Clin Orthop Relat Res 362:171–180
Walker RH (1993) Pelvic reconstruction/total hip arthroplasty for metastatic acetabular insufficiency. Clin Orthop Relat Res 294:170–175
Allan DG, Bell RS, Davis A, Langer F (1995) Complex acetabular reconstruction for metastatic tumor. J Arthroplasty 10(3):301–306
Wedin R, Bauer HCF (2005) Surgical treatment of skeletal metastatic lesions of the proximal femur Endoproththesis or reconstruction nail? J Bone Joint Surg Br 87(12):1653–1657
Ashford RU et al (2012) The modern surgical and non-surgical management of appendicular skeletal metastases. Orthop Trauma 26(3):184–199
Frassica FJ, Frassica DA (2003) Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res 415:S212–S218
Hill C et al (1981) Prophylactic cefazolin versus placebo in total hip replacement report of a multicentre double-blind randomised trial. Lancet 1(8224):795–796
Donati D, Biscaglia R (1998) The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours. J Bone Joint Surg Br 80(6):1045–1050
Bickels J, Kollender Y, Wittig JC, Cohen N, Meller I, Malawer MM (2005) Vacuum-assisted wound closure after resection of musculoskeletal tumors. Clin Orthop Relat Res 441:346–350
Falanga A, Rickles FR (1999) Pathophysiology of the thrombophilic state in the cancer patient. In: Seminars in thrombosis and hemostasis, vol 25, issue 02. Thieme Medical Publishers Inc, New York, pp 173–182
Townsend PW, Rosenthal HG, Smalley SR, Cozad SC, Hassanein RE (1994) Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol 12(11):2345–2350
Fuchs B, Trousdale RT, Rock MG (2005) Solitary bony metastasis from renal cell carcinoma: significance of surgical treatment. Clin Orthop Relat Res 431:187–192
Evenski A, Ramasunder S, Fox W, Mounasamy V, Temple HT (2012) Treatment and survival of osseous renal cell carcinoma metastases. J Surg Oncol 106(7):850–855
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Creek, A.T., Ratner, D.A., Porter, S.E. (2014). Evaluation and Treatment of Extremity Metastatic Disease. In: Peabody, T., Attar, S. (eds) Orthopaedic Oncology. Cancer Treatment and Research, vol 162. Springer, Cham. https://doi.org/10.1007/978-3-319-07323-1_8
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