Orthopaedic perspective on bone metastasis

Abstract

The incidence of cancer is increasing worldwide, with the advent of a myriad of new treatment options, so is the overall survival of these patients. However, from an orthopaedic perspective, there comes the challenge of treating more patients with a variety of metastatic bone lesions. The consequences of such lesions can be significant to the patient, from pain and abnormal blood results, including hypercalcemia, to pathological fracture. Given the multiple options available, the treatment of bone metastasis should be based on a patient-by patient manner, as is the case with primary bone lesions. It is imperative, given the various lesion types and locations, treatment of bone metastasis should be performed in an individualised manner. We should consider the nature of the lesion, the effect of treatment on the patient and the overall outcome of our decisions. The dissemination of primary lesions to distant sites is a complex pathway involving numerous cytokines within the tumour itself and the surrounding microenvironment. To date, it is not fully understood and we still base a large section of our knowledge on Pagets historic “seed and soil” theory. As we gain further understanding of this pathway it will allow us develop more medical based treatments. The treatment of primary cancers has long been provided in a multi-disciplinary setting to achieve the best patient outcomes. This should also be true for the treatment of bone metastases. Orthopaedic surgeons should be involved in the multidisciplinary treatment of such patients given that there are a variety of both surgical fixation methods and non-operative methods at our disposal.

Keywords: Bone metastases, Diagnosis, Pathophysiology, Surgical treatment, Medical treatment

Core tip: This paper discusses the pathophysiology and patient implications of bone metastasis. We aim to describe the orthopaedic input into the management of this condition, especially in a multi-disciplinary setting. We believe that orthopaedics do not have a significant enough involvement in the treatment of long bone metastasis, although from this paper we feel we have many options to offer. The future of metastasis treatment may be targeted at the molecular level but current management options do require an understanding of musculoskeletal oncology to obtain best patient outcomes through operative and non-operative means.