scholarly journals The Surgical Treatment of Pelvic Bone Metastases

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Daniel A. Müller ◽  
Rodolfo Capanna
Keyword(s):  
Bone Metastases ◽  
Orthopedic Surgery ◽  
Treatment Algorithm ◽  
Long Bone ◽  
Pelvic Bone ◽  
Percutaneous Ablation ◽  
Pathological Fractures ◽  
Osteolytic Lesions ◽  
Pelvic Metastasis

Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient’s prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases.

Bone Diaphysis Metastases, the Ways and Results of Surgical Treatment Saving the Joints

2019 ◽  
Vol 21 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Piotr Szczerba ◽  
Grzegorz Guzik ◽  
Andrzej Bohatyrewicz ◽  
Daniel Kotrych
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Bone Metastases ◽  
Surgical Management ◽  
Surgical Techniques ◽  
Long Bone ◽  
Pathological Fractures ◽  
Oncological Treatment ◽  
Modular Prostheses

Background. A consequence of the progress in oncological treatment is an increasing number of bone complications asso­ciated with metastases. With appropriate choice of oncological treatment and appropriate surgical management, patients may recover their physical function and maintain the previous level of quality of life. Available surgical techniques include intrame­dullary nailing, stabilisation with plates and screws and the use of modular prostheses. Aim of the study: to retrospectively assess the techniques and outcomes of surgical treatment of long bone metastases at the Oncology Orthopaedics Department of the Speciality Hospital in Brzozów, present the possibilities of surgical management and benefits of the chosen method and tentatively choose the most effective approach for restoring function. Material and methods. Between 2013 and 2017, a total of 82 patients were treated for long bone metastases at the Depart­ment of Oncological Orthopaedics. The most common cancers causing bone metastases were breast cancer (37%), myeloma (16%), lung cancer (8%), kidney (15%), prostate (8%), thyroid 4%, colon 1%, uterus 1%, with other sites accounting for 10%. Pathological fractures were diagnosed in 68 patients. Before the surgical treatment, the patients’ quality of life was assessed using the Karnofsky scale, Bollen prognostic scale, severity of pain in a VAS scale, and MSTS performance scale. Metastasis morpho­logy was evaluated with conventional radiographs, CT and PET-CT. Types of surgery comprised intramedullary nailing, the use of plates and screws and the placement of modular prostheses. Patients were divided into three groups with regard to the stabi­li­sation systems used and another three related to tumour location (humerus, femur or tibia). Results. Post-operatively, there was a reduction of pain in the VAS scale. Function (MSTS) was best in patients treated with minimally invasive methods and modular prostheses (p <0.05). An improvement in quality of life in the Karnofsky scale was also noted. The complication rate was 7% and was related to wound healing and thromboembolic complications. Conclusions. 1. Patients with long-bone cancer metastases with pathological fractures or risk of fracture require surgical management. 2. Nailing or modular prosthesis produced the best functional result at 6 weeks post-operatively. 3. All methods of surgical treatment reduced pain and improved the quality of life.

scholarly journals Analysis of orthopedic surgery of patients with metastatic bone tumors and pathological fractures

2018 ◽  
Vol 46 (8) ◽  
pp. 3262-3267 ◽  
Author(s):  
Resit Sevimli ◽  
Mehmet Fatih Korkmaz
Keyword(s):  
Quality Of Life ◽  
Bone Metastasis ◽  
Orthopedic Surgery ◽  
Bone Tumors ◽  
Early Mobilization ◽  
Pathological Fractures ◽  
Primary Tumors ◽  
Treatment Algorithms ◽  
Common Causes

Objective This study was performed to determine the most common causes, locations, and treatments of metastasizing primary tumors through evaluation of patients with metastatic bone tumors who were admitted to our clinic. Methods In total, 96 patients with metastatic bone tumors who were admitted to our clinic from 2000 to 2016 were included in the study. Results The breast (30 patients, 31.3%) and lung (18 patients, 18.8%) were the most commonly metastasized primary organs. The femur was the most commonly metastasized bone. Conclusions Bone tumors in patients of advanced age are, unless otherwise proven, considered to be metastatic, and the development of specific diagnostic and treatment algorithms is needed. Clinicians should attempt to improve the general condition of patients with tumors exhibiting bone metastasis to increase the patients’ quality of life by providing early mobilization. Thus, appropriate patient selection and proper internal fixation are essential.

scholarly journals Dealing with Bone Metastases from Breast Cancer - A Pathological and Clinical Overview

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 25
Author(s):  
O. Munteanu ◽  
A. Dumitru ◽  
O. Bodean ◽  
L. Arsene ◽  
D. Voicu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Malignant Tumors ◽  
Cord Compression ◽  
Pathological Fractures ◽  
Future Directions ◽  
Skeletal Related Events ◽  
Frequent Site ◽  
Clinical Overview

Abstract From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.

scholarly journals Surgical treatment for pelvic bone metastases

2021 ◽  
Vol 22 (4) ◽  
pp. 72-76
Author(s):  
Artem V. Buharov ◽  
Vitali A. Derzhavin ◽  
Dmitrii A. Erin ◽  
Anna V. Yadrina ◽  
Mamed D. Aliev
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Drug Treatment ◽  
Bone Metastases ◽  
Radical Surgery ◽  
Palliative Surgery ◽  
Pelvic Bone ◽  
Multiple Metastases ◽  
Systemic Drug

Bone metastases are one of the important problems of modern orthopedic oncology. Because of the improvement of the methods of systemic drug treatment of malignant tumors, the overall duration of life expectancy of patients with generalized cancer, including bone metastases, can be up to 1218 months and more. Metastases, including pelvic bone metastases, reduce the quality of life of patients, not only causing pain syndrome (PS), but also significantly placing restrictions on patients movement, often leading to disability. The possibilities of surgical correction of modern oncoortopedia can prevent pathological fractures, reduce PS and, as a result, stabilize or improve the functional status of patients. The aim is to evaluate the results of treatment of patients with metastases of various solid tumors in pelvic bone. Materials and methods. The analysis of the treatment of 67 patients who underwent various types of surgery for pelvic ring metastases. The average age of patients was 55.5 years (from 23 to 75 years). 51 (76.12%) patients with multiple metastases underwent minimally invasive palliative surgery. Radical surgery was performed in16 (23.88%) patients with solitary mass. Results. The average blood loss during radical surgery was 1969 ml (from 150 to 4000 ml). The edges of resection during all surgeries are negative (R0). Six patients showed progression after the treatment of the disease. It was noted that 46 (90%) patients had a significant reduction in PS, up to complete disappearance, that allowed 42 (82%) patients to reduce the intake of analgesic drugs or completely abandon them, after minimally invasive palliative surgery. Conclusion. In case of solitary pelvic bone metastases is necessary to perform radical surgery to achieve maximum oncological and functional results. In patients with multiple metastases in order to reduce PS and improve the quality of life rationally should be performed minimally invasive surgery, this will allow to start systemic drug treatment as soon as possible.

scholarly journals Analysis of postoperative prognostic factors in patients with long bones metastatic lesions

2020 ◽  
Vol 101 (5) ◽  
pp. 685-690
Author(s):  
Jun Wang ◽  
N V Kharchenko ◽  
V Y Karpenko
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Bone Metastases ◽  
Bone Lesions ◽  
Long Bones ◽  
Body Parts ◽  
Limb Pain ◽  
Pathological Fractures ◽  
Metastatic Lesions

Currently, with the development of the concept of cancer treatment, the survival rate of patients has increased significantly, but the percentage of the frequency of various metastatic lesions remains high. The bones of the skeleton are one of the main parts of metastases. In cancer patients, bone metastases usually mean that the disease is at an advanced stage, and the prognosis is not good. These patients often suffer from many complications, including pain, decreased mobility, pathological fractures, etc. The quality of life of patients is seriously deteriorating. Therefore, the main goal of surgical treatment of patients with bone metastases is the earliest possible restoration the function of the affected limb, pain relief, prevention of pathological fractures and the improvement of the quality of life of patients after surgery. This literature review analyzes the incidence of bone metastases in patients, and the dependence of metastatic lesions of long tubular bones on localization incidence of bone metastases in different body parts. The domestic and foreign literature on the surgical treatment of patients with metastatic bone lesions was analyzed. The results of the analysis show that the features of surgical treatment are becoming the main factors influencing the prognosis in patients with metastatic lesions of the long bones.

Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP

2016 ◽  
Vol 55 (05) ◽  
pp. 188-195 ◽  
Author(s):  
Floor Overbeek ◽  
John de Klerk ◽  
Pieternel Pasker-de Jong ◽  
Alexandra van den Berk ◽  
Rob ter Heine ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Clinical Benefit ◽  
Response Rate ◽  
Clinical Care ◽  
Pain Response ◽  
Pain Palliation ◽  
Breast Cancer Patients ◽  
Routine Clinical Care ◽  
Painful Bone Metastases

Summary Aim: Rhenium-188-HEDP (188Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of 188Re-HEDP in routine clinical care. Patients and methods: Prostate or breast cancer patients with painful bone metastases receiving 188Re-HEDP as a routine clinical procedure were eligible for evaluation. Clinical benefit was assessed in terms of efficacy and toxicity. Pain palliation and QoL were monitored using the visual analogue scale (VAS), corrected for opioid intake, and the EORTC QLQ-C30 Global health status/QoL-scale. Thrombocyte and leukocyte nadirs were used to assess haematological toxicity. Results: 45 and 47 patients were evaluable for pain palliation and QoL, respectively. After a single injection of 188Re-HEDP, the overall pain response rate was 69% and mean VAS-scores decreased relevantly and significantly (p < 0.05). Repeated treatment resulted in similar pain response. The overall QoL response rate was 68% and mean Global health status/QoL-scores increased relevantly and significantly. Haematological side effects were mild and transient. Conclusion: The clinically relevant response on pain and quality of life and the limited adverse events prove clinical benefit of treatment with 188Re-HEDP and support its use in routine clinical care. Its effectiveness appears comparable to that of external beam radiotherapy.

ДИАГНОСТИКА ХРОНИЧЕСКИХ ИНДУЦИРОВАННЫХ КРАПИВНИЦ

2019 ◽  
pp. 5-13
Author(s):  
E.Yu. Borzova
Keyword(s):  
Quality Of Life ◽  
Biological Therapy ◽  
Treatment Algorithm ◽  
The Novel ◽  
International Guidelines ◽  
Systemic Reactions ◽  
Significant Impairment ◽  
Challenge Tests

Хронические индуцированные крапивницы имеют важное социальноэкономическое значение вследствие риска развития системных реакций и значительного снижения качества жизни пациентов. Диагностика хронических индуцированных крапивниц основывается на анамнестических данных и проведении провокационных тестов. Современный протокол ведения больных хронической крапивницей включает применение неседативных антигистаминных препаратов. Международные согласительные документы по лечению крапивницы рекомендуют 4кратное увеличение суточной дозы неседативных антигистаминных препаратов при их неэффективности в стандартных дозах. Данные метаанализа указывают на эффективность омализумаба при хронических индуцированных крапивницах. В перспективе ожидается расширение арсенала генноинженерной биологической терапии хронических индуцированных крапивниц.Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patients quality of life. The diagnosis of chronic inducible urticarias relies on the patients history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a firstline treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The metaanalysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.

ДИАГНОСТИКА ХРОНИЧЕСКИХ ИНДУЦИРОВАННЫХ КРАПИВНИЦ

2019 ◽  
Author(s):  
E.Yu. Borzova
Keyword(s):  
Biological Therapy ◽  
Meta Analysis ◽  
Treatment Algorithm ◽  
The Novel ◽  
First Line ◽  
Systemic Reactions ◽  
Significant Impairment ◽  
Challenge Tests ◽  
First Line Treatment

Хронические индуцированные крапивницы имеют важное социально-экономическое значение вследствие риска развития системных реакций и значительного снижения качества жизни пациентов. Диагностика хронических индуцированных крапивниц основывается на анамнестических данных и проведении провокационных тестов. Современный протокол ведения больных хронической крапивницей включает применение неседативных антигистаминных препаратов. Международные согласительные документы по лечению крапивницы рекомендуют 4-кратное увеличение суточной дозы неседативных антигистаминных препаратов при их неэффективности в стандартных дозах. Данные мета-анализа указывают на эффективность омализумаба при хронических индуцированных крапивницах. В перспективе ожидается расширение арсенала генно-инженерной биологической терапии хронических индуцированных крапивниц.Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patients quality of life. The diagnosis of chronic inducible urticarias relies on the patients history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a first-line treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The meta-analysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.

scholarly journals Recent Advances in Nanomedicine for the Diagnosis and Treatment of Prostate Cancer Bone Metastasis

Molecules ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 384
Author(s):  
Daniel E. Hagaman ◽  
Jossana A. Damasco ◽  
Joy Vanessa D. Perez ◽  
Raniv D. Rojo ◽  
Marites P. Melancon
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Advanced Prostate Cancer ◽  
Bone Fractures ◽  
Diagnosis And Treatment ◽  
Survival Times ◽  
Preclinical Research ◽  
Relieve Pain ◽  
Translational Models

Patients with advanced prostate cancer can develop painful and debilitating bone metastases. Currently available interventions for prostate cancer bone metastases, including chemotherapy, bisphosphonates, and radiopharmaceuticals, are only palliative. They can relieve pain, reduce complications (e.g., bone fractures), and improve quality of life, but they do not significantly improve survival times. Therefore, additional strategies to enhance the diagnosis and treatment of prostate cancer bone metastases are needed. Nanotechnology is a versatile platform that has been used to increase the specificity and therapeutic efficacy of various treatments for prostate cancer bone metastases. In this review, we summarize preclinical research that utilizes nanotechnology to develop novel diagnostic imaging tools, translational models, and therapies to combat prostate cancer bone metastases.

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