Orthopaedic surgery in the palliation of cancer

Metastatic spread of cancer to bone is frequent and causes pain, disability, and functional limitation. Non-surgical treatments such as chemotherapy and hormone therapy are effective in early disease. Administration of bisphosphonates or osteoprotegerin inhibitors prevent new ‘bone events’, thereby avoiding pain, radiation, and surgery. Radiotherapy arrests disease and relieves pain in many cases. Surgery is needed when the bone is weak or fractured. It effectively relieves pain and preserves function by bypassing the deficient bone with site-specific reconstructive surgery. Surgery should be selected based on projections of patient survival. New tools to make these projections are now available (https://www.pathfx.org/). New targeted drug therapies appear to be changing metastatic bone disease into a more chronic condition. This will alter the management of local disease in many histological subtypes of metastatic cancers.