وصف
Surgical management of bone metastases plays a crucial role in improving the quality of life for patients with advanced cancers. The primary goals of surgery are pain relief, stabilization of fractures, and restoration of function. Advances in surgical techniques now emphasize minimally invasive approaches, enhancing recovery times and reducing complications. Recent updates include the use of cementoplasty, advanced fixation methods, and intraoperative imaging to improve precision and outcomes. Multidisciplinary care, including orthopedic surgeons, oncologists, and radiologists, is essential for optimizing treatment strategies based on the patient’s overall health and cancer stage.
ملخص
- Orthopedic oncologists address musculoskeletal oncology, often encountering skeletal metastasis as a primary concern. Their surgical perspective complements medical oncology in managing these patients, who frequently present with pathological fractures, back pain, or spinal issues.
- Early detection of skeletal metastasis is vital. A significant portion of patients remain unaware of the spread of cancer for nearly a year, highlighting the need for enhanced screening programs to reduce the disease burden.
- Patient evaluation involves determining the presence of a primary cancer history, assessing bone condition (lytic, sclerotic, or fractured), and recognizing cases with unknown primary sources. Treatment strategies diverge based on these classifications, requiring individualized approaches.
- Diagnostic procedures include thorough history, physical examination, X-rays, bone scans, and CT scans. Biopsies are essential for solid lesions or when the primary source is unidentified, ideally performed within a specialized center. Multidisciplinary tumor board discussions are crucial for informed decision-making.
- Treatment strategies depend on spinal canal involvement. If compromised, decompression and stabilization precede sampling. In uncomplicated cases, biopsy and staging take priority. Curative intent is prioritized when appropriate, contrasting with palliative approaches for advanced disease.
- Surgery aims to alleviate pain, address pathological fractures, and manage complications. While non-surgical options exist, surgery often improves quality of life, especially when fractures struggle to heal with chemotherapy alone. Scoring systems like Mirels and the category scoring system aid in determining surgical candidacy.
- Surgical options range from internal fixation and cementing to resections and replacements. Resections are considered for solitary or oligometastatic disease originating from kidney, thyroid, breast, rectum, or lung cancers. Replacements, particularly around the hip, offer improved function compared to internal fixation for pathological fractures.
- Surgical pearls emphasize personalized approaches based on prognosis and avoiding compromise surgeries. Embolization plays a role in reducing vascularity, while denosumab is utilized in certain situations. Minimally invasive techniques like cementoplasty, kyphoplasty, cryotherapy, and radiofrequency ablation offer palliative benefits.
- Careful consideration is required to avoid overly aggressive interventions in patients with unfavorable prognostic factors, like high category scores or multiple lesions from unknown primaries. Bracing, radiotherapy, bisphosphonates, and supportive care are viable alternatives in such cases.
- Future directions involve refining criteria for impending fractures, utilizing denosumab, exploring anti-angiogenic agents, and advancing cryotherapy techniques. These efforts aim to improve outcomes and quality of life for patients with bone metastasis.
نموذج شهادة
حول المتحدثين
Dr. Srimanth B. S
Lead Consultant, Orthopaedic Oncology, Manipal Hospitals, Bengaluru
الإفصاح المالي
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