Palliative Orthopaedic Surgery for Skeletal Metastases

2009 ◽  
Vol 05 (01) ◽  
pp. 30 ◽  
Author(s):  
Robert U Ashford ◽  
Keyword(s):  
Bone Pain ◽  
Multidisciplinary Approach ◽  
Pathological Fracture ◽  
Palliative Surgery ◽  
Skeletal Metastases ◽  
Endoprosthetic Replacement ◽  
Resultant Effect ◽  
Controversial Area ◽  
Cement Arthroplasty

Advances in oncological therapies have resulted in improved survival in patients with skeletal metastases. The resultant effect is that the skeletal metastases result in an increased incidence of pathological fracture and bone pain. This article focuses on the options available to the orthopaedic surgeon in the treatment of patients with skeletal metastases. It covers the controversial area of prophylactic fixation and the roles of conventional internal fixation, cement, arthroplasty and endoprosthetic replacement. The role of radiotherapy in the management of patients with surgically treated skeletal metastases is highlighted. Treatment for these patients is always individualised and should always be subject to a multidisciplinary approach. Despite the prognosis, satisfying results can be obtained that achieve the aims of palliative surgery, namely pain relief and maintenance of or improvement in function.

Management issues in bone pain

2021 ◽  
pp. 478-484
Author(s):  
Peter Hoskin
Keyword(s):  
Bone Metastases ◽  
Bone Pain ◽  
Weight Bearing ◽  
Neurological Complications ◽  
Skeletal Metastases ◽  
New Paradigm ◽  
Treatment Interventions ◽  
Important Approach ◽  
Sites Of Metastases

Bone is a common site of metastatic disease with common tumours, in particular, lung, breast, and prostate, frequently spreading to the skeleton. Particular problems may arise from skeletal metastases; pain is a common problem in over 75% of patients and pathological fracture can be catastrophic in terms of mobility and integrity of the spinal canal. The function of the skeleton results in specific challenges when dealing with bone pain, with most patients having multiple sites of metastases, many having variable pain intensity in relation to movement and weight bearing, and more difficult cases progressing to develop neurological complications. Prevention of bone metastases and skeletal damage is an important approach and pain management requires optimization of medication and radiotherapy. Pathological fractures present a specific challenge, best treated surgically and with the role of radiotherapy still poorly defined. A new paradigm has emerged with the recognition that, in some patients, bone metastases may represent an oligometastatic state in which ablative treatment such as stereotactic radiotherapy can result in a prolonged disease-free interval and deferred toxic systemic treatment interventions.

scholarly journals [177Lu]Lu-DOTA-ZOL bone pain palliation in patients with skeletal metastases from various cancers: efficacy and safety results

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Madhav Prasad Yadav ◽  
Sanjana Ballal ◽  
Marian Meckel ◽  
Frank Roesch ◽  
Chandrasekhar Bal
Keyword(s):  
Overall Survival ◽  
Pain Assessment ◽  
Bone Pain ◽  
Performance Status ◽  
Response Assessment ◽  
Assessment Criteria ◽  
Skeletal Metastases ◽  
Efficacy And Safety ◽  
Pain Palliation ◽  
Global Pain

Abstract Background [177Lu]Lu-DOTA-ZOL has shown promising results from the dosimetry and preclinical aspects, but data on its role in the clinical efficacy are limited. The objective of this study is to evaluate the efficacy and safety of [177Lu]Lu-DOTA-ZOL as a bone pain palliation agent in patients experiencing pain due to skeletal metastases from various cancers. Methods In total, 40 patients experiencing bone pain due to skeletal metastases were enrolled in this study. The patients were treated with a mean cumulative dose of 2.1 ± 0.6 GBq (1.3–2.7 GBq) [177Lu]Lu-DOTA-ZOL in a median follow-up duration of 10 months (IQR 8–14 months). The primary outcome endpoint was response assessment according to the visual analogue score (VAS). Secondary endpoints included analgesic score (AS), global pain assessment score, Eastern Cooperative Oncology Group Assessment performance status (ECOG), Karnofsky performance status, overall survival, and safety assessment by the National Cancer Institute’s Common Toxicity Criteria V5.0. Results In total, 40 patients (15 males and 25 females) with a mean age of 46.6 ± 15.08 years (range 24–78 years) were treated with either 1 (N = 15) or 2 (N = 25) cycles of [177Lu]Lu-DOTA-ZOL. According to the VAS response assessment criteria, complete, partial, and minimal responses were observed in 11 (27.5%), 20 (50%), and 5 patients (12.5%), respectively with an overall response rate of 90%. Global pain assessment criteria revealed complete, partial, minimal, and no response in 2 (5%), 25 (62.5%), 9 (22.5%), and 4 (10%) patients, respectively. Twenty-eight patients died and the estimated median overall survival was 13 months (95% CI 10–14 months). A significant improvement was observed in the VAS, AS, and ECOG status when compared to baseline. None of the patients experienced grade III/IV haematological, kidney, or hepatotoxicity due to [177Lu]Lu-DOTA-ZOL therapy. Conclusion [177Lu]Lu-DOTA-ZOL shows promising results and is an effective radiopharmaceutical in the treatment of bone pain due to skeletal metastases from various cancers.

Facilitating Change in Anorexia Nervosa: The Role of Occupational Therapy

1992 ◽  
Vol 55 (9) ◽  
pp. 334-339 ◽  
Author(s):  
Priscilla Harries
Keyword(s):  
Anorexia Nervosa ◽  
Occupational Therapy ◽  
Multidisciplinary Approach ◽  
Projective Art

Patients with anorexia nervosa benefit from a multidisciplinary approach. This article gives a brief description of, first, the illness and its treatment and, secondly, the occupational therapy techniques used at the Maudsley Unit. It then demonstrates the progress of patients through examples of projective art.

scholarly journals Nutritional Optic Neuropathies: State of the Art and Emerging Evidences

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2653
Author(s):  
Matilde Roda ◽  
Natalie di Geronimo ◽  
Marco Pellegrini ◽  
Costantino Schiavi
Keyword(s):  
Bariatric Surgery ◽  
Optic Neuropathy ◽  
Multidisciplinary Approach ◽  
State Of The Art ◽  
Signs And Symptoms ◽  
Therapeutic Strategies ◽  
Scientific Interest ◽  
Optic Nerve Atrophy ◽  
Prompt Diagnosis

Nutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach.

scholarly journals The Role of Purinergic Receptors in Cancer-Induced Bone Pain

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Sarah Falk ◽  
Maria Uldall ◽  
Anne-Marie Heegaard
Keyword(s):  
Inflammatory Pain ◽  
Bone Pain ◽  
Purinergic Receptors ◽  
Sensory Information ◽  
Cellular Mechanisms ◽  
Pain State ◽  
Current Therapies ◽  
Peripheral Site

Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular mechanisms underlying cancer-induced bone pain including the involvement of ATP and the purinergic receptors in the progression of the pain state. In nociception, ATP acts as an extracellular messenger to transmit sensory information both at the peripheral site of tissue damage and in the spinal cord. Several of the purinergic receptors have been shown to be important for the development and maintenance of neuropathic and inflammatory pain, and studies have demonstrated the importance of both peripheral and central mechanisms. We here provide an overview of the current literature on the role of purinergic receptors in cancer-induced bone pain with emphasis on some of the difficulties related to studying this complex pain state.

Human Absorbed Dose Evaluation of [177Lu]Lu-IBA as a Bone Palliative Candidate

2021 ◽  
Author(s):  
Hassan Ranjbar ◽  
Zahra Pourhabib
Keyword(s):  
Radiochemical Purity ◽  
Palliative Therapy ◽  
Absorbed Dose ◽  
Skeletal Metastases ◽  
Clinical Pharmacokinetics ◽  
Thermal Neutron Irradiation ◽  
Biodistribution Data ◽  
Biological Studies ◽  
Significant Uptake

AbstractThe role of lutetium-177 among bone-seeking radionuclides in targeted therapy is noteworthy. The clinical pharmacokinetics of ibandronate (IBA) indicates that this bisphonate has powerful bone mineral affinity. The aim of this study was to evaluate of [177Lu]Lu-IBA efficacy as a new compound.The [177Lu]Lu-IBA was prepared by radiolabeling of IBA ligand to 177LuCl3 that was obtained by thermal neutron irradiation of enriched Lu2O3 sample. Produced [177Lu]Lu-IBA with high radiochemical purity was administered intravenously to mice. Biodistribution data were collected at 1, 4, 24, 48 h and 7 d post injections. With calculating accumulated activities in each organ and extrapolating mouse’s organs to human’s organs by the RADAR method and using OLINDA/EXM software the injected dose in various human organs was achieved.[177Lu]Lu-IBA was produced with radiochemical purity nearly 96 %. Its biodistribution data showed the high uptake and durability in the skeletal tissues without significant uptake in other major organs.The results showed that [177Lu]Lu-IBA has considerably good properties as a bone-seeking radiopharmaceutical and therefore can be a candidate for bone pain palliative therapy in skeletal metastases; however, further biological studies are still needed.

Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery

2019 ◽  
Vol 45 (3) ◽  
pp. 389-393 ◽  
Author(s):  
Nadine L. de Boer ◽  
Jan A.W. Hagemans ◽  
Bob T.A. Schultze ◽  
Alexandra R.M. Brandt-Kerkhof ◽  
Eva V.E. Madsen ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Palliative Surgery ◽  
Malignant Obstruction
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