Factors Affecting Life Expectancy After Bone Metastasis in Adults - Results of a 5-year Prospective Study

Postoperative Complications of Intramedullary Nailing for Impending and Pathologic Fractures of the Humerus Due to Bone Metastases-A Systematic Review of the Literature

Intramedullary nailing (IMN) is a common option for managing impending or pathologic fractures of the humerus secondary to metastatic disease. We sought to assess the (1) early complications, (2) failure rates and mechanisms, and (3) functional outcomes. A systematic review using the PubMed, Embase, and Cochrane databases was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The study was registered on PROSERO (CRD42023406905). The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Studies describing postoperative outcomes of patients with impending or pathologic fractures of the humerus treated with IMN were included. Implant failure was classified into mechanical and nonmechanical causes. Functional outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) score. Overall, 41 studies comprising 1431 patients were included. Early complications occurred in 5.5% of patients, with 2.8% of patients having systemic complications. The overall implant failure rate was 4.9%, and the mean MSTS score at the last follow-up was 79.9%. IMN was associated with good postoperative functional outcomes and low implant failure rates. Systemic complications were the most common type of early complication, and tumor progression was the main cause of implant failure. LEVEL OF EVIDENCE: III.

Pattern and Outcome of Metastatic Malignant Lesions to the Jaws: A Systematic Review of 594 Cases

The jaws are affected secondarily by metastasis from a distant site. Metastatic lesions of jaws are very rare and constitute about 1% of all the malignancies occurring in the jaw, and the pattern of metastasis differs by age and sex. The objective of this review was to analyze the pattern of metastatic jaw lesions and its outcome. This was a systematic review of cases of metastatic jaw lesions published between 1950 and 2022. An electronic search of PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar was performed. Only case reports or case series with histopathological results demonstrating metastasis to the jaws were included. The main outcomes included demographics, primary site, metastatic site, clinical manifestations, and patient survival. Descriptive and multivariate analysis and a Kaplan-Meier survival curve were performed. A total of 450 articles were selected with a total of 594 cases. The mean age of the patients was 54.31 (SD = 19.49) years with a median age of 58 (IQR = 47-68) years. There were slightly more females (N = 299, 50.3%) with a male-to-female ratio of 1:1.01. The most common malignant lesion to metastasize to the jaws was adenocarcinoma (N = 230, 38.7%). In females, the frequent sites of the primary lesion were the breast (N = 99, 33.1%), thyroid (N = 52, 17.4%), and lungs (N = 27, 9.0%), whereas in males they were the lung (N = 57, 19.3%) the prostate (N = 41, 13.9%), liver (N = 36, 12.2%), and kidney (N = 28, 9.5%). The frequently reported clinical symptoms include jaw swelling (N = 460, 77.4%), pain (N = 250, 42.1%), paresthesia (N = 117, 29.8%), and trismus (N = 72, 12.1%). Regarding the outcome, 65.3% had succumbed to the disease at the time of publication of their cases. The survival of patients with metastatic jaw lesions did not depend on the demographics of the patient, the primary site, and the treatment of the primary lesion. Metastasis to the jaw bone is very rare and its prognosis is poor. Females and the elderly are more affected. The most common primary malignant lesion is adenocarcinoma. Most of the clinicians misdiagnosed the metastatic jaw lesion on initial presentation. Factors determining the survival of patients with metastatic jaw lesions could not be ascertained.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-05120-w.

How the bone microenvironment shapes the pre-metastatic niche and metastasis

The bone is a frequent metastatic site, with changes in the mineralized bone and the bone marrow milieu that can also prime other sites for metastasis by educating progenitor cells to support metastatic spread. Stromal and immune populations cooperatively maintain the organizationally complex bone niches and are dysregulated in the presence of a distant primary tumor and metastatic disease. Interrogating the bone niches that facilitate metastatic spread using innovative technologies holds the potential to aid in preventing metastasis in and mediated by the bone. Here, we review recent advances in bone niche biology and its adaptations in the context of cancer.

Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease

Management of periacetabular metastatic bone disease (MBD) is challenging, specifically if associated with bone loss or fracture. The aim of this study was to evaluate the complications and outcomes after undergoing peri-acetabular reconstruction using an 'ice-cream cone' pedestal cup endoprostheses for the most severe cases of (impending) pathological acetabular fractures. Fifty cases with severe periacetabular disease were identified. Acetabular defects were classified using the Metastatic Acetabular Classification (MAC). Pre- and post-operative mobility was assessed using the Eastern Cooperative Oncology Group (ECOG) Performance Status. Pain levels were assessed using a verbal rating scale. Surgical complications and patient survival were analysed; the Prognostic Immune Nutritional Index (PINI) was applied retrospectively to survival. There were 32 females and 18 males with a median age of 65 (41-88). Median post-operative follow-up was 16 months (IQR 5.5-28.5 months). Thirty-nine had complete, and 11, impending pathological fractures. The observed five-year survival was 19%, with a median survival of 16 months (IQR 5.8-42.5 months). Significantly worse survival was observed with PINI scores < 3.0 (p = 0.003). Excluding three perioperative deaths, 13 complications occurred in 12 patients: Implant failure in six patients (four aseptic loosening, one dislocation and one infection). At the final follow-up, mobility and pain levels were improved in 85% and 100%, respectively. Reconstruction of significant pelvic MBD with the 'ice-cream cone' reduces pain and improves mobility. Whilst the mortality rate is high, it remains a reasonable option for bed-bound, immobile patients. We advocate the use of an 'ice-cream cone' prosthesis for selected patients balancing the reported risks with the observed benefits.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-024-01917-x.

Bridging the Gap in Understanding Bone Metastasis: A Multifaceted Perspective

The treatment of patients with advanced cancer poses clinical problems due to the complications that arise as the disease progresses. Bone metastases are a common problem that cancer patients may face, and currently, there are no effective drugs to treat these individuals. Prostate, breast, and lung cancers often spread to the bone, causing significant and disabling health conditions. The bone is a highly active and dynamic tissue and is considered a favorable environment for the growth of cancer. The role of osteoblasts and osteoclasts in the process of bone remodeling and the way in which their interactions change during the progression of metastasis is critical to understanding the pathophysiology of this disease. These interactions create a self-perpetuating loop that stimulates the growth of metastatic cells in the bone. The metabolic reprogramming of both cancer cells and cells in the bone microenvironment has serious implications for the development and progression of metastasis. Insight into the process of bone remodeling and the systemic elements that regulate this process, as well as the cellular changes that occur during the progression of bone metastases, is critical to the discovery of a cure for this disease. It is crucial to explore different therapeutic options that focus specifically on malignancy in the bone microenvironment in order to effectively treat this disease. This review will focus on the bone remodeling process and the effects of metabolic disorders as well as systemic factors like hormones and cytokines on the development of bone metastases. We will also examine the various therapeutic alternatives available today and the upcoming advances in novel treatments.