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Koob S, Kohlhof H, Randau TM, Wirtz DC. [Acetabular metastatic defect reconstruction using the modular revision support cup MRS-C]. Oper Orthop Traumatol 2024; 36:145-156. [PMID: 37921888 PMCID: PMC11014813 DOI: 10.1007/s00064-023-00834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 03/22/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE Stabilization of metastatic acetabular defects with a bone cement-augmented revision support cup for remobilization of oncological patients in advanced cancer stages. INDICATIONS Metastatic acetabular defects (Metastatic Acetabular Classification, MAC 2-4) in patients with a prognostic medium or long-term survival. CONTRAINDICATIONS Highly limited survival due to metastatic disease (< 6 weeks). Local bone or soft tissue infection. Primary bone tumor with curative treatment option. Advanced pelvic discontinuity. Recent wound compromising systemic therapy. SURGICAL TECHNIQUE Standard hip approach. Curettage of the metastatic defect and careful reaming of the acetabulum before insertion of the cup. Predrilling of the dome und flange screws before application of the bone cement through the center hole of the implant and filling of the acetabular defect. Complete insertion of the screws for compound osteosynthesis. Implant of a modular inlay or dual mobility system. POSTOPERATIVE MANAGEMENT Full weight bearing or mobilization with two crutches according to the level of pain. Adjuvant local radiation therapy after wound consolidation. Continuation of systemic therapy according to tumor board decision. RESULTS Between 2012 and 2019, we treated 14 patients with metastatic acetabular defects using the modular revision support cup "MRS-TITAN® Comfort", MRS-C, Peter Brehm GmbH, Weisendorf, Germany) at our institution. Mean Harris Hip Score improvement was 23.2 with a mean patient's survival of 9.7 months due to the reduced cancer-related prognosis; 13 of the 14 implants endured the patient's prognosis. One implant had to be removed due soft tissue defect-related periprosthetic joint infection.
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Affiliation(s)
- S Koob
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - H Kohlhof
- Unfall‑, Hand- und Orthopädische Chirurgie, St. Antonius Krankenhaus Köln, Köln, Deutschland
| | - T M Randau
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Vijayakumar G, Tang A, Vance D, Yoon RS, Sweeney K, Blank AT. Does Perioperative Radiation Affect Implant Survivorship of Primary Total Hip Arthroplasty in the Setting of Metastatic Bone Disease? Arthroplast Today 2024; 25:101296. [PMID: 38292148 PMCID: PMC10826139 DOI: 10.1016/j.artd.2023.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/30/2023] [Accepted: 11/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background Metastatic bone disease (MBD) commonly affects the hip and surgical intervention including total hip arthroplasty (THA) is often indicated to treat the joint and improve function. Patients with metastatic cancer often receive radiotherapy, and orthopaedic oncologists must consider surgical risks with operating on irradiated bone and soft tissue. We evaluated surgical outcomes and implant survival (IS) of titanium acetabular components and femoral components in patients treated for MBD in the setting of perioperative radiation. Methods This was a retrospective review of patients who underwent THA for MBD at 3 institutions between 2017 and 2021. Outcomes included rates of reoperation, complications, IS, and overall survival. Results Forty-six patients who received primary THA for MBD were included in the study. Twenty patients (43.5%) received perioperative radiation for MBD. Six postoperative complications including one superficial wound infection, 2 dislocations, 2 pathologic fractures, and one aseptic acetabular component loosening led to 5 reoperations. There were no significant differences in postoperative outcomes, reoperation after THA, and IS based on radiotherapy status. Conclusions To our knowledge, this is the first paper evaluating primary THA outcomes and IS between patients who receive perioperative radiation for MBD to the hip and those who do not. As surgical management is a crucial part of the treatment in alleviating pain and disability in patients with MBD, we continue to recommend THA for patients who received radiation at the operative site.
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Affiliation(s)
- Gayathri Vijayakumar
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Alex Tang
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, Jersey City, NJ, USA
| | - Dylan Vance
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Richard S. Yoon
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, Jersey City, NJ, USA
| | - Kyle Sweeney
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alan T. Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
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3
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Markowitz MI, Al-Hardan W, Constantinescu DS, Pretell-Mazzini J, Conway SA. Subtrochanteric nonunion after intramedullary nailing due to pathological fracture: proximal femoral replacement as a salvage approach. Eur J Orthop Surg Traumatol 2024; 34:167-173. [PMID: 37386190 DOI: 10.1007/s00590-023-03627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To assess proximal femoral replacement as a treatment solution for nonunion of pathologic subtrochanteric fractures after cephalomedullary nailing in patients with pathological fracture and previously irradiated bone. METHODS Retrospective review of five patients with pathological subtrochanteric femoral fractures that were treated with cephalomedullary nailing and developed a nonunion, which was revised with conversion to a proximal endoprosthetic replacement. RESULTS All five patients had previously been treated with radiation. One patient had the latest follow-up at 2 months postoperatively. At that time, the patient was walking with a walker for assistance, with no evidence of hardware failure or loosening on imaging. The remaining four patients had the latest follow-up ranging from 9 to 20 months after surgery. At their latest follow-up, three of the four patients were ambulatory with no pain, using only a cane for assistance with longer distances. The other patient demonstrated pain in his affected thigh, utilizing a walker for assistance with ambulation at latest follow-up, but not requiring further surgical interventions. There were no hardware failures or implant loosening through the follow-up period. None of the patients required revision, and there were no postoperative complications observed at their last follow-up. CONCLUSIONS In patients with pathological fractures in the subtrochanteric region that is treated with cephalomedullary nailing and developed a nonunion, treatment with conversion to a proximal femoral replacement with a mega prosthesis is a valuable treatment with good functional results and low risk for complications. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Moses I Markowitz
- University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Waleed Al-Hardan
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - David S Constantinescu
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Sheila A Conway
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
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Ceranka J, Wuts J, Chiabai O, Lecouvet F, Vandemeulebroucke J. Computer-aided diagnosis of skeletal metastases in multi-parametric whole-body MRI. Comput Methods Programs Biomed 2023; 242:107811. [PMID: 37742486 DOI: 10.1016/j.cmpb.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
The confident detection of metastatic bone disease is essential to improve patients' comfort and increase life expectancy. Multi-parametric magnetic resonance imaging (MRI) has been successfully used for monitoring of metastatic bone disease, allowing for comprehensive and holistic evaluation of the total tumour volume and treatment response assessment. The major challenges of radiological reading of whole-body MRI come from the amount of data to be reviewed and the scattered distribution of metastases, often of complex shapes. This makes bone lesion detection and quantification demanding for a radiologist and prone to error. Additionally, whole-body MRI are often corrupted with multiple spatial and intensity distortions, which further degrade the performance of image reading and image processing algorithms. In this work we propose a fully automated computer-aided diagnosis system for the detection and segmentation of metastatic bone disease using whole-body multi-parametric MRI. The system consists of an extensive image preprocessing pipeline aiming at enhancing the image quality, followed by a deep learning framework for detection and segmentation of metastatic bone disease. The system outperformed state-of-the-art methodologies, achieving a detection sensitivity of 63% with a mean of 6.44 false positives per image, and an average lesion Dice coefficient of 0.53. A provided ablation study performed to investigate the relative importance of image preprocessing shows that introduction of region of interest mask and spatial registration have a significant impact on detection and segmentation performance in whole-body MRI. The proposed computer-aided diagnosis system allows for automatic quantification of disease infiltration and could provide a valuable tool during radiological examination of whole-body MRI.
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Affiliation(s)
- Jakub Ceranka
- Vrije Universiteit Brussel, Department of Electronics and Informatics, Pleinlaan 2, Brussels, 1050, Belgium; imec, Kapeldreef 75, Leuven, B-3001, Belgium.
| | - Joris Wuts
- Vrije Universiteit Brussel, Department of Electronics and Informatics, Pleinlaan 2, Brussels, 1050, Belgium; imec, Kapeldreef 75, Leuven, B-3001, Belgium; Cliniques universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, Brussels, 1200, Belgium.
| | - Ophélye Chiabai
- Cliniques universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Frédéric Lecouvet
- Cliniques universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel, Department of Electronics and Informatics, Pleinlaan 2, Brussels, 1050, Belgium; imec, Kapeldreef 75, Leuven, B-3001, Belgium; Universitair Ziekenhuis Brussel, Department of Radiology, Laarbeeklaan 101, Brussels, 1090, Belgium
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5
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Maldonado LY, Bosques L, Cromer SJ, Azar SS, Yu EW, Burnett-Bowie SAM. Racial and Ethnic Disparities in Metabolic Bone Disease. Endocrinol Metab Clin North Am 2023; 52:629-641. [PMID: 37865478 DOI: 10.1016/j.ecl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Racial and ethnic disparities exist in the prevalence and management of osteoporosis, metastatic cancer, and sickle cell disease. Despite being the most common metabolic bone disease, osteoporosis remains underscreened and undertreated among Black women. Skeletal-related events in metastatic cancer include bone pain, pathologic fractures, and spinal cord compression. Disparities in screening for and treating skeletal-related events disproportionately affect Black patients. Metabolic bone disease contributes significantly to morbidity in sickle cell disease; however, clinical guidelines for screening and treatment do not currently exist. Clinical care recommendations are provided to raise awareness, close health care gaps, and guide future research efforts.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA; Department of Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Linette Bosques
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA
| | - Sara J Cromer
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sharl S Azar
- Hematology and Medical Oncology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 9-536, Boston, MA 02114, USA
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sherri-Ann M Burnett-Bowie
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA.
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Leland CR, Morris CD, Forsberg JA, Levin AS. Functional outcomes after open reconstruction or nonoperative management of 81 pathologic acetabular fractures from metastatic bone disease. J Orthop 2023; 44:22-30. [PMID: 37654617 PMCID: PMC10466429 DOI: 10.1016/j.jor.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pathologic acetabular fracture secondary to skeletal metastasis may result in debilitating pain, inability to ambulate, and impaired quality of life, which may mark the first period of dependent care in cancer patients. Acetabular reconstruction may involve morbid procedures with increased complication rates. This study aimed to evaluate the evolution of pain, performance status, and ambulation following nonoperative management or open reconstruction of pathologic acetabular fractures. Methods A retrospective cohort of 2630 adult patients with osseous metastatic disease treated at a high-volume cancer center between 2005 and 2021 was screened for pathologic fractures of the acetabulum. The study outcomes were pain, performance status, and the ability to ambulate. We identified 78 patients (median age, 60 years; 37 female patients [46%]) with 81 fractures. Of these, treatment consisted of open reconstruction (n = 34) or nonoperative management alone (n = 47). The mean follow-up in surviving patients was 3.4 years. Results Open reconstruction was performed more frequently for displaced fractures (P < 0.01), Harrington class III or IV acetabula (P < 0.01), and patients with a performance status ≥3 at hospitalization (P = 0.00). Open reconstruction was associated with clinically meaningful improvements in pain (adjusted odds ratio [aOR], 8.3; 95% CI, 1.4-50.6; P = 0.02) and performance status (aOR, 10.9; 95% CI, 1.7-71.0; P = 0.01) at discharge and a restoration of ambulation (aOR, 7.5; 95% CI, 1.9-29.8; P < 0.01) at final follow-up. Conclusions In patients with pathologic acetabular fracture due to osseous metastatic disease, functional improvements in pain, performance status, and ambulation were observed following open acetabular reconstruction in carefully selected patients, with no impact on survival, while noninferior improvements were observed in patients receiving nonoperative management when considering their larger clinical context. Level of evidence Level III, therapeutic study.
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Affiliation(s)
- Christopher R. Leland
- Harvard Combined Orthopaedic Residency Program, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Division of Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carol D. Morris
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan A. Forsberg
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam S. Levin
- Division of Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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7
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Yanagisawa Y, Suzuki H, Gamada H, Yamazaki M. Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature. J Med Case Rep 2023; 17:257. [PMID: 37340320 DOI: 10.1186/s13256-023-03999-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Denosumab therapy is often used to reduce skeletal-related events in metastatic bone disease. On the other hand, there have been some instances of atypical femoral fracture in patients with metastatic bone disease treated with denosumab. In this case report, we describe a patient with metastatic bone disease due to breast cancer who had been using denosumab for 4 years to prevent skeletal-related events and suffered an atypical tibial fracture. CASE PRESENTATION We report here the case of an 82-year-old Japanese woman who had received yearly intravenous denosumab for 4 years and presented with a fracture fulfilling the criteria for an atypical fracture, except for being located at the tibial diaphysis. She was found to have stage 4 breast cancer with multiple bone metastases 4 years prior. She had difficulty walking due to her tibial pain and underwent surgical treatment. Four months after surgery, the tibial fracture site exhibited bone fusion. CONCLUSION In patients with long-term use of denosumab to prevent skeletal-related events in metastatic bone disease, it is important to be aware of shin and thigh pain and to examine for signs of atypical tibial fractures to pay attention to atypical femoral fractures.
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Affiliation(s)
- Yohei Yanagisawa
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hidefumi Suzuki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Ibrahim A, Vaidyanathan A, Primakov S, Belmans F, Bottari F, Refaee T, Lovinfosse P, Jadoul A, Derwael C, Hertel F, Woodruff HC, Zacho HD, Walsh S, Vos W, Occhipinti M, Hanin FX, Lambin P, Mottaghy FM, Hustinx R. Deep learning based identification of bone scintigraphies containing metastatic bone disease foci. Cancer Imaging 2023; 23:12. [PMID: 36698217 PMCID: PMC9875407 DOI: 10.1186/s40644-023-00524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Metastatic bone disease (MBD) is the most common form of metastases, most frequently deriving from prostate cancer. MBD is screened with bone scintigraphy (BS), which have high sensitivity but low specificity for the diagnosis of MBD, often requiring further investigations. Deep learning (DL) - a machine learning technique designed to mimic human neuronal interactions- has shown promise in the field of medical imaging analysis for different purposes, including segmentation and classification of lesions. In this study, we aim to develop a DL algorithm that can classify areas of increased uptake on bone scintigraphy scans. METHODS We collected 2365 BS from three European medical centres. The model was trained and validated on 1203 and 164 BS scans respectively. Furthermore we evaluated its performance on an external testing set composed of 998 BS scans. We further aimed to enhance the explainability of our developed algorithm, using activation maps. We compared the performance of our algorithm to that of 6 nuclear medicine physicians. RESULTS The developed DL based algorithm is able to detect MBD on BSs, with high specificity and sensitivity (0.80 and 0.82 respectively on the external test set), in a shorter time compared to the nuclear medicine physicians (2.5 min for AI and 30 min for nuclear medicine physicians to classify 134 BSs). Further prospective validation is required before the algorithm can be used in the clinic.
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Affiliation(s)
- Abdalla Ibrahim
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,grid.239585.00000 0001 2285 2675Department of Radiology and Nuclear Medicine, Columbia University Irving Medical Center, New York, United States ,grid.411374.40000 0000 8607 6858Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liege, Liege, Belgium ,grid.412301.50000 0000 8653 1507Department of Nuclear Medicine and Comprehensive diagnostic centre Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany
| | - Akshayaa Vaidyanathan
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,Radiomics (Oncoradiomics SA), Liege, Belgium
| | - Sergey Primakov
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,grid.239585.00000 0001 2285 2675Department of Radiology and Nuclear Medicine, Columbia University Irving Medical Center, New York, United States
| | | | | | - Turkey Refaee
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,grid.411831.e0000 0004 0398 1027Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Pierre Lovinfosse
- grid.411374.40000 0000 8607 6858Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liege, Liege, Belgium
| | - Alexandre Jadoul
- grid.411374.40000 0000 8607 6858Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liege, Liege, Belgium
| | - Celine Derwael
- grid.411374.40000 0000 8607 6858Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liege, Liege, Belgium
| | - Fabian Hertel
- grid.412301.50000 0000 8653 1507Department of Nuclear Medicine and Comprehensive diagnostic centre Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany
| | - Henry C. Woodruff
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,grid.239585.00000 0001 2285 2675Department of Radiology and Nuclear Medicine, Columbia University Irving Medical Center, New York, United States
| | - Helle D. Zacho
- grid.27530.330000 0004 0646 7349Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark ,grid.5117.20000 0001 0742 471XDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sean Walsh
- Radiomics (Oncoradiomics SA), Liege, Belgium
| | - Wim Vos
- Radiomics (Oncoradiomics SA), Liege, Belgium
| | | | - François-Xavier Hanin
- grid.7942.80000 0001 2294 713XDepartment of Nuclear Medicine, Universite´CatholiqueUniversite´Catholique de Louvain, CHU-UCL-Namur, Ottignies-Louvain-la-Neuve, Belgium
| | - Philippe Lambin
- grid.5012.60000 0001 0481 6099The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands ,grid.239585.00000 0001 2285 2675Department of Radiology and Nuclear Medicine, Columbia University Irving Medical Center, New York, United States
| | - Felix M. Mottaghy
- grid.239585.00000 0001 2285 2675Department of Radiology and Nuclear Medicine, Columbia University Irving Medical Center, New York, United States ,grid.412301.50000 0000 8653 1507Department of Nuclear Medicine and Comprehensive diagnostic centre Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany
| | - Roland Hustinx
- grid.411374.40000 0000 8607 6858Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liege, Liege, Belgium
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Thaler M, Manson TT, Holzapfel BM, Moskal J. Proximal femoral replacement using the direct anterior approach to the hip. Oper Orthop Traumatol 2022; 34:218-230. [PMID: 35641789 PMCID: PMC9197819 DOI: 10.1007/s00064-022-00770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/01/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Proximal femoral replacement (PFR) is a salvage procedure originally developed for reconstruction after resection of sarcomas and metastatic cancer. These techniques can also be adapted for the treatment of non-oncologic reconstruction for cases involving massive proximal bone loss. The direct anterior approach (DAA) is readily utilized for revision total hip arthroplasty (THA), but there have been few reports of its use for proximal femoral replacement. INDICATIONS Aseptic, septic femoral implant loosening, periprosthetic femoral fracture, oncologic lesions of the proximal femur. The most common indication for non-oncologic proximal femoral placement is a severe femoral defect Paprosky IIIB or IV. CONTRAINDICATIONS Infection. SURGICAL TECHNIQUE In contrast to conventional DAA approaches and extensions, we recommend starting the approach 3 cm lateral to the anterior superior iliac spine and performing a straight incision directed towards the fibular head. After identification and incision of the tensor fasciae lata proximally and the lateral mobilization of the iliotibial tract distally, the vastus lateralis muscle can be retracted medially as far as needed. Special care should be taken to avoid injuries to the branches of the femoral nerve innervating the vastus lateralis muscle. If required, the distal extension of the DAA can continue all the way to the knee to allow implantation of a total femoral replacement. The level of the femoral resection is detected with an x‑ray. In accordance with preoperative planning, the proximal femur is resected. Ream and broach the distal femoral fragment to the femoral canal. With trial implants in place, leg length, anteversion of the implant and hip stability are evaluated. It is crucial to provide robust reattachment of the abductor muscles to the PFR prosthesis. Mesh reinforcement can be used to reinforce the muscular attachment if necessary. POSTOPERATIVE MANAGEMENT We typically use no hip precautions other than to limit combined external rotation and extension for 6 weeks. In most cases, full weight bearing is possible after surgery. RESULTS A PFR was performed in 16 patients (mean age: 55.1 years; range 17-84 years) using an extension of the DAA. The indication was primary bone sarcoma in 7 patients, metastatic lesion in 6 patients and massive periprosthetic femoral bone loss in 3 patients. Complications related to the surgery occurred in 2 patients (both were dislocation). Overall, 1 patient required reoperation and 1 patient died because of his disease. Mean follow-up was 34.5 months.
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Affiliation(s)
- Martin Thaler
- Arthroplasty Center, Helios Klinikum Munich West, Steinerweg 5, 81241, Munich, Germany.
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, Greifswald, Germany.
| | - Theodore T Manson
- Department of Orthopaedic Surgery, University of Maryland, 21204, Baltimore, MD, USA
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Joseph Moskal
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Institute for Orthopedics and Neurosciences, 24014, Roanoke, VA, USA
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10
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Abstract
Bone is a common site of metastases, particularly in advanced breast and prostate cancer. Skeletal related events associated with bone metastases include pathologic fracture, need for surgery/radiation to bone and cord compression. These events cause significant morbidity and mortality. Bisphosphonates as well as denosumab act on the bone microenvironment and reduce the rate of skeletal related events by approximately 25%-40%. Hence, these therapies are an important adjunctive therapy in cancer care. Despite the established efficacy and recommendations for their use in many international guidelines, these bone modifying agents are underutilized. This review examines the currently available guidelines on bone modifying agents in metastatic bone disease and summarizes their efficacy, risk and comparative benefits.
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Affiliation(s)
- Eric Schwartz
- Michigan Medicine: Rogel Cancer Center, United States of America.
| | - Zachery Reichert
- Michigan Medicine: Rogel Cancer Center, United States of America
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11
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Kendal JK, Heard BJ, Abbott AG, Moorman SW, Saini R, Puloski SKT, Monument MJ. Does surgical technique influence the burden of lung metastases in patients with pathologic long bone fractures? BMC Musculoskelet Disord 2022; 23:102. [PMID: 35101024 PMCID: PMC8802478 DOI: 10.1186/s12891-022-05067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study are to (1) determine whether fixation of metastatic long bone fractures with an intramedullary nail (IMN) influences the incidence of lung metastasis in comparison to arthroplasty or ORIF (Arthro/ORIF); and (2) assess this relationship in primary tumor types; and (3) to assess survival implications of lung metastasis after surgery. METHODS Retrospective cohort study investigating 184 patients (107 IMN, and 77 Arthro/ORIF) surgically treated for metastatic long bone fractures. Patients were required to have a single surgically treated impending or established pathologic fracture of a long bone, pre-operative lung imaging (lung radiograph or computed tomography) and post-operative lung imaging within 6 months of surgery. Primary cancer types included were breast (n = 70), lung (n = 43), prostate (n = 34), renal cell (n = 37). Statistical analyses were conducted using two-tailed Fisher's exact tests, and Kaplan-Meier survival analyses. RESULTS Patients treated with IMN and Arthro/ORIF developed new or progressive lung metastases following surgery at an incidence of 34 and 26%, respectively. Surgical method did not significantly influence lung metastasis (p = 0.33). Furthermore, an analysis of primary cancer subgroups did not yield any differences between IMN vs Arthro/ORIF. Median survival for the entire cohort was 11 months and 1-year overall survival was 42.7% (95% CI: 35.4-49.8). Regardless of fixation method, the presence of new or progressive lung metastatic disease at follow up imaging study was found to have a negative impact on patient survival (p < 0.001). CONCLUSIONS In this study, development or progression of metastatic lung disease was not affected by long bone stabilization strategy. IM manipulation of metastatic long bone fractures therefore may not result in a clinically relevant increase in metastatic lung burden. The results of this study also suggest that lung metastasis within 6 months of surgery for metastatic long bone lesions is negatively associated with patient survival. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Joseph K Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Bryan J Heard
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Annalise G Abbott
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Scott W Moorman
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Raghav Saini
- Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Shannon K T Puloski
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Michael J Monument
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada. .,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada. .,Foothills Medical Center, McCaig Tower, 3134 Hospital Drive N. W, Calgary, Alberta, Canada.
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12
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Abstract
AIMS The incidence of bone metastases is between 20% to 75% depending on the type of cancer. As treatment improves, the number of patients who need surgical intervention is increasing. Identifying patients with a shorter life expectancy would allow surgical intervention with more durable reconstructions to be targeted to those most likely to benefit. While previous scoring systems have focused on surgical and oncological factors, there is a need to consider comorbidities and the physiological state of the patient, as these will also affect outcome. The primary aim of this study was to create a scoring system to estimate survival time in patients with bony metastases and to determine which factors may adversely affect this. METHODS This was a retrospective study which included all patients who had presented for surgery with metastatic bone disease. The data collected included patient, surgical, and oncological variables. Univariable and multivariable analysis identified which factors were associated with a survival time of less than six months and less than one year. A model to predict survival based on these factors was developed using Cox regression. RESULTS A total of 164 patients were included with a median survival time of 1.6 years (interquartile range 0.5 to 3.1) after surgery. On multivariable analysis, a higher American Society of Anesthesiologists grade (p < 0.001), a high white cell count (p = 0.002), hyponatraemia (p = 0.001), a preoperative resting heart rate of > 100 bpm (p = 0.052), and the type of primary cancer (p = 0.026) remained significant predictors of reduced survival time. The predictive model developed showed good discrimination and calibration to predict both six- and 12-month survival in patients with metastatic bone disease. CONCLUSION In addition to surgical and oncological factors, the level of comorbidity and physiological state of the patient has a significant impact on survival in patients with metastatic bone disease. These factors should be considered when assessing the appropriateness of surgical intervention. This is the first study to examine other patient factors alongside surgical and oncological data to identify a relationship between these and survival. Cite this article: Bone Joint J 2021;103-B(11):1725-1730.
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Affiliation(s)
- Rachel Baumber
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Craig Gerrand
- Division of Orthopaedic Oncology & Specialist Hip and Knee Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Michael Cooper
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - William Aston
- Division of Orthopaedic Oncology & Specialist Hip and Knee Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK
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13
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Alfaro PA, Delgado J, Dumas A, Mesa C, Wevar O, Herrera C, Padilla F, Botello E. Comparison between different prognostic models to be used for metastatic bone disease on appendicular skeleton in a Chilean population. Eur J Orthop Surg Traumatol 2021; 31:1657-62. [PMID: 34677661 DOI: 10.1007/s00590-021-03153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several preoperation prognosis models used on the treatment of metastatic bone disease on appendicular skeleton have been devised. The purpose of this study was to compare the performance of different survival prognostic models on patients with metastatic bone disease in long bones in a Chilean population. METHODS This is a multicentric retrospective study. We retrospectively reviewed the medical records of 136 patients who were confirmed with metastatic bone disease of the appendicular skeleton and who were treated surgically from 2016 to 2019. The minimum follow-up time was 12 months. All patients were assessed using four appendicular metastatic bone disease scoring systems. A preoperative predicted survival time for all 136 patients was retrospectively calculated making use of the revised Katagiri, PathFx, Optimodel and IOR score model. RESULTS The PathFx model demonstrated an accuracy at predicting 3 (area under the curve [AUC] = 0.61) and 6-month (AUC = 0.65) survival time after surgical management. IOR score model demonstrated an accuracy at predicting 12-month survival time (AUC = 0.64). The survival rate reached the 44% in a year. The median survival time to death or last follow-up time was 14.9 months (SD ± 15). CONCLUSION PathFx score model demonstrated the highest accuracy at predicting a survival time of 3 and 6 months. IOR score model was the most accurate measure at predicting a survival time of 12-months. To our knowledge, this is the first study reporting a comparative analysis of metastatic bone disease with predicting models in a country located in Latin America. PathFx's and IOR score models are the ones to be used in the Chilean population as the predictive models in metastatic bone disease of the appendicular skeleton.
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14
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Sebghati J, Khalili P, Tsagkozis P. Surgical treatment of metastatic bone disease of the distal extremities. World J Orthop 2021; 12:743-750. [PMID: 34754830 PMCID: PMC8554352 DOI: 10.5312/wjo.v12.i10.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/16/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.
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Affiliation(s)
| | - Pendar Khalili
- Department of Orthopedics, Central Hospital in Karlstad, Karlstad 65230, Sweden
| | - Panagiotis Tsagkozis
- Department of Orthopedic Surgery, Karolinska University hospital, Solna 17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna 17176, Sweden
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15
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Tsukamoto S, Errani C, Kido A, Mavrogenis AF. What's new in the management of metastatic bone disease. Eur J Orthop Surg Traumatol 2021; 31:1547-55. [PMID: 34643811 DOI: 10.1007/s00590-021-03136-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022]
Abstract
Metastatic bone disease is a common complication of malignant tumours. As cancer treatment improves the overall survival of patients, the number of patients with bone metastases is expected to increase. The treatments for bone metastases include surgery, radiotherapy, and bone-modifying agents, with patients with a short expected prognosis requiring less invasive treatment. Patients with metastatic bone disease show greatly varying primary tumour histology, metastases sites and numbers, and comorbidities. Therefore, randomised clinical trials are indispensable to compare treatments for these patients. This editorial reviews recent findings on the diagnosis and prognosis prediction and discusses the current treatment of patients with metastatic bone disease.
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16
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McCabe FJ, Jadaan MM, Byrne F, Devitt AT, McCabe JP. Spinal metastasis: The rise of minimally invasive surgery. Surgeon 2021:S1479-666X(21)00140-2. [PMID: 34563452 DOI: 10.1016/j.surge.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival. METHODS This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days. RESULTS 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis. CONCLUSION This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need.
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17
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Kapoor S, Singh S, Bassett P, Gerrand C. Predicting length of stay after proximal femoral endoprosthetic replacement for oncological conditions. Surgeon 2021; 20:e236-e240. [PMID: 34446348 DOI: 10.1016/j.surge.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoprosthetic replacement of the proximal femur plays a vital role in managing metastatic and primary bone tumours1. Length of stay (LOS) has important resource implications but is driven by patient and disease factors over and above the procedure itself. The aim of this project was to identify factors that drive LOS in patients undergoing proximal femoral replacement (PFR). METHODS This was a retrospective analysis of clinical records from a single centre (RNOH). 144 cases were identified over a 4 year-period. These were divided into 3 diagnostic categories: primary bone tumour with chemotherapy, primary bone tumour without chemotherapy and metastatic bone disease. Several factors were considered that could influence the length of stay including age, ASA grade, gender, admission to the high dependency unit (HDU), diagnosis, saving the greater trochanter, pre-operative radiotherapy, admission with a fracture and return to theatre. RESULTS The median LOS for PFR was 15 days, with 79% admitted to HDU. LOS was almost doubled for patients returning to theatre (P = 0.04). Patients with ASA grades of 3 and 4 had a 75% longer LOS compared to those with grade 1. Additionally, a 10-year increase in age was associated with a 6-8% increase in LOS. Incorporating these factors produced a model which explained 27% of the variability of LOS. CONCLUSION Majority of the variables which were tested were significantly associated with LOS. However, factors other than those in our model drive length of stay. This analysis can support conversations with patients and service planning around LOS.
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Affiliation(s)
- Smriti Kapoor
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, United Kingdom.
| | - Saurabh Singh
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, United Kingdom.
| | - Paul Bassett
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, United Kingdom.
| | - Craig Gerrand
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, United Kingdom.
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18
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Morris R, Shepherd K, Cribb G, Singh J, Tyrrell P, Cool P. Bone biopsy results in patients with a history of malignancy: a case series of 378 patients. Skeletal Radiol 2021; 50:1111-1116. [PMID: 33097964 DOI: 10.1007/s00256-020-03652-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the assessment of survival in the different outcome groups. MATERIALS AND METHODS This was a retrospective study of patients, with a previous malignancy and suspicious bone lesions, who underwent bone biopsy for final diagnosis between March 2010 and September 2019. Results of the biopsy were summarized into 3 groups: confirmed original malignancy, confirmed benign diagnosis, and confirmed new malignancy. Survival analysis of each group was also undertaken. RESULTS A total of 378 patients met the inclusion criteria (mean age 64 years, 216 females (57%)). In 250 cases (66%), the original malignancy was confirmed on the bone biopsy; in 128 cases, an alternative diagnosis was confirmed (benign diagnosis in 69 (18%)), and 59 had a new malignancy (16%). Survival was significantly greater for those in whom a benign diagnosis was confirmed (logrank test p = 0.0100). CONCLUSION This study shows that for patients presenting with a suspicious bone lesion, together with a history of malignancy, in a third of cases, the bone biopsy will confirm an alternative diagnosis of a benign lesion or a new malignancy. Survival of these patients will vary significantly depending on the biopsy outcome.
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Affiliation(s)
- Rhys Morris
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.
| | - Karen Shepherd
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Gillian Cribb
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Jaspreet Singh
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Prudencia Tyrrell
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Paul Cool
- Montgomery Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Keele University, Newcastle, Staffordshire, ST5 5BG, UK
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19
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Gusho CA, Clayton B, Mehta N, Colman MW, Gitelis S, Blank AT. Survival and outcomes of modular endoprosthetic reconstruction of the proximal femur for primary and non-primary bone tumors: Single institutional results. J Orthop 2021; 25:145-150. [PMID: 34025058 DOI: 10.1016/j.jor.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose This study assessed implant survival and dislocation following proximal femur tumor endoprosthetic replacement. Methods Thirty-eight procedures were performed between 2005 and 2019. The cumulative incidence of implant revision was calculated with death as a competing risk. Results The majority of endoprostheses were bipolar hemiarthroplasty (n = 33, 86.8%). The cumulative incidence of revision was 14.6% (95% CI, 3.2%-34.1%) at five years. Dislocation occurred in 7.9% (n = 3) of hips at a mean (SD) 44 ± 35.2 days. Conclusions Proximal femur tumor endoprosthetic replacement is a durable option that tends to outlive patients. Strict postoperative bracing may lower dislocation rates. Level of evidence III. Retrospective Study.
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Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bishir Clayton
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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20
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Downie S, Stillie A, Moran M, Sudlow C, Simpson H. Patient-reported assessment of outcome after surgery for bone metastases. Orthop Rev (Pavia) 2021; 13:9062. [PMID: 33953891 PMCID: PMC8077288 DOI: 10.4081/or.2021.9062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/20/2021] [Indexed: 12/14/2022] Open
Abstract
Regardless of prognosis, surgery is often considered in metastatic bone disease (MBD) as a palliative procedure to improve function and quality of life. Traditional focus on objective outcomes such as mortality is inappropriate in this group, and there is a drive to assess outcomes via patient-reported outcome measures (PROMs). This is an overview of current understanding of MBD outcomes and how this should influence future decision-making and research. The objectives of this review were to identify difficulties in measuring PROMs in the MBD patient population and explore alternatives to patientreported outcomes. We also provide an overview of current understanding of outcomes in MBD and how this should influence decision-making and direct research.
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Affiliation(s)
- Samantha Downie
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh
| | | | | | - Cathie Sudlow
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Hamish Simpson
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh
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21
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Zdravkovic A, Mickel M, Crevenna R. Successful application of focused extracorporeal shockwave therapy for plantar fasciitis in patients suffering from metastatic breast cancer. Support Care Cancer 2021; 29:4187-4190. [PMID: 33745042 PMCID: PMC8236439 DOI: 10.1007/s00520-021-06117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Focused extracorporeal shock wave therapy (fESWT) has been shown to be effective in a large number of musculoskeletal disorders. Until 2016, cancer was considered a contraindication for fESWT. The goal of this Commentary is to address the subject of fESWT in cancer patients and present a case of a successful application of fESWT in a breast cancer patient with metastatic bone disease, suffering from debilitating heel pain caused by plantar fasciitis. METHODS The subject of fESWT application in cancer patients is discussed using the example of a 75-year-old female with breast cancer and metastatic bone disease suffering from bilateral inferior heel pain, who was referred to our clinic with a tentative diagnosis of polyneuropathy. Patient history, clinical examination, electrodiagnostic testing, and radiological findings all indicated plantar fasciitis, rather than polyneuropathy. The possibility of metastatic bone lesions in the treatment area was excluded and the patient was thereupon treated with 5 weekly applications of low-energy fESWT. RESULTS The treatment lead to a reduction in pain of approximately 80% with no adverse events. CONCLUSION fESWT may be a viable treatment option for plantar fasciitis even in cancer patients, provided certain conditions are met.
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Affiliation(s)
- Andrej Zdravkovic
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Michael Mickel
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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22
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Ochi H, Takagi T, Baba T, Nozawa M, Kim SG, Sakamoto Y, Kato S, Homma Y, Kaneko K, Ishijima M. Total hip arthroplasty with reconstruction of acetabulum through direct anterior approach for metastatic bone disease of acetabulum combined with pathological proximal femoral neck fracture: A case report. Trauma Case Rep 2021; 32:100447. [PMID: 33732859 PMCID: PMC7937825 DOI: 10.1016/j.tcr.2021.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/26/2022] Open
Abstract
Most surgical treatment options for metastatic acetabular lesions involve variants of total hip arthroplasty (THA). However, these are technically complex reconstructions performed in very frail patients, and previous reports indicate complications such as dislocation, deep infection, aseptic loosening, and intraoperative death. A 73-year-old man presented to the emergency department at our hospital with right hip pain following a fall. He had undergone nephrectomy for the treatment of right kidney cancer at the age of 68 years. Four years after the nephrectomy, multiple lung metastases, pelvic bone metastases, and right femoral head and neck bone metastases were found. A radiograph of the hip joint showed a pathological proximal femoral fracture with a radiolucent lesion of the acetabulum. THA with acetabular reconstruction using a Kerboull-type (KT) plate through the direct anterior approach (DAA) was performed. After removal of the femoral head, curettage of the metastatic acetabular dome lesion was carefully performed under fluoroscopic guidance. After the KT plate was placed, cementation of the metastatic acetabular dome lesion was performed, and an optimally sized polyethylene liner was fixed with cement. A cemented stem was inserted after confirming the hip joint stability. At the 14-month follow-up, he could walk steadily without any complications and his modified Harris hip score was 100. The DAA conserves soft tissue because it is an intermuscular approach. Accordingly, postoperative recovery is fast and thus associated with a low dislocation rate and effective pain reduction. The acetabulum with metastatic disease was reconstructed using a KT plate for hip joint stability. Bone with metastatic disease that appears adequate at the time of THA may become incompetent after a few years. THA with acetabular reconstruction using a KT plate through the DAA was an effective treatment for metastatic bone disease of the acetabulum combined with pathological proximal femoral neck fracture.
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Affiliation(s)
- Hironori Ochi
- Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Tatsuya Takagi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masahiko Nozawa
- Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Sung-Gon Kim
- Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuko Sakamoto
- Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Suguru Kato
- Department of Orthopaedics Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Herget G, Saravi B, Schwarzkopf E, Wigand M, Südkamp N, Schmal H, Uhl M, Lang G. Clinicopathologic characteristics, metastasis-free survival, and skeletal-related events in 628 patients with skeletal metastases in a tertiary orthopedic and trauma center. World J Surg Oncol 2021; 19:62. [PMID: 33632256 PMCID: PMC7908692 DOI: 10.1186/s12957-021-02169-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Skeletal-related events (SREs) due to bone metastases (BM) significantly impact the morbidity and mortality of cancer patients. The present study sought to investigate clinicopathological characteristics, metastasis-free survival (MFS), and SREs in patients referred to a tertiary orthopedic and trauma center. Methods Data were retrieved from electronic health records (n=628). Survival curves were estimated utilizing the Kaplan–Meier method. The Cox regression model was used to determine factors influencing MFS based on estimated hazard ratios (HRs). Results Breast (55.8%) and lung (18.2%), and lung (32.9%) and prostate (16.8%) cancer were the most common cancer types in our cohort in women and men, respectively. Fifteen percent of patients presented with BM as the first manifestation of tumor disease, 23% had metastasis diagnosis on the same day of primary tumor diagnosis or within 3 months, and 62% developed BM at least 3 months after primary tumor diagnosis. Osteolytic BM were predominant (72.3%) and most commonly affecting the spine (23%). Overall median MFS was 45 months (32 (men) vs. 53 (women) months). MFS was shortest in the lung (median 15 months, 95% CI 8.05–19) and longest in breast cancer (median 82 months, 95% CI 65.29–94). Age (≥ 60 vs. < 60 years) and primary cancer grading of ≥2 vs. 1 revealed prognostic relevance. Conclusion Women with breast or lung cancer, men with lung or prostate cancer, age ≥60 years, male sex, and primary cancer grading ≥2 are associated with increased risk for MBD. Intensified follow-up programs may reduce the risk of SREs and associated morbidity and mortality.
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Affiliation(s)
- Georg Herget
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
| | - Eugenia Schwarzkopf
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Mara Wigand
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Norbert Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Orthopaedic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Markus Uhl
- Department of Radiology, Pediatric Radiology, and Interventional Radiology, St. Josefskrankenhaus, Sautierstraße 1, 79104, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
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Downie S, Stillie A, Moran M, Sudlow C, Simpson AHRW. A prospective longitudinal study investigating outcomes including patient-reported outcome measures after surgery for metastatic bone disease. Bone Jt Open 2021; 2:79-85. [PMID: 33573398 PMCID: PMC7925207 DOI: 10.1302/2633-1462.22.bjo-2020-0173.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aims Surgery is often indicated in patients with metastatic bone disease (MBD) to improve pain and maximize function. Few studies are available which report on clinically meaningful outcomes such as quality of life, function, and pain relief after surgery for MBD. This is the published protocol for the Bone Metastasis Audit — Patient Reported Outcomes (BoMA-PRO) multicentre MBD study. The primary objective is to ascertain patient-reported quality of life at three to 24 months post-surgery for MBD. Methods This will be a prospective, longitudinal study across six UK orthopaedic centres powered to identify the influence of ten patient variables on quality of life at three months after surgery for MBD. Adult patients managed for bone metastases will be screened by their treating consultant and posted out participant materials. If they opt in to participate, they will receive questionnaire packs at regular intervals from three to 24 months post-surgery and their electronic records will be screened until death or five years from recruitment. The primary outcome is quality of life as measured by the European Organisation for Research and the Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ) C30 questionnaire. The protocol has been approved by the Newcastle & North Tyneside 2 Research Ethics Committee (REC ref 19/NE/0303) and the study is funded by the Royal College of Physicians and Surgeons of Glasgow (RCPSG) and the Association for Cancer Surgery (BASO-ACS). Discussion This will be the first powered study internationally to investigate patient-reported outcomes after orthopaedic treatment for bone metastases. We will assess quality of life, function, and pain relief at three to 24 months post-surgery and identify which patient variables are significantly associated with a good outcome after MBD treatment. Cite this article: Bone Jt Open 2021;2(2):79–85.
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Affiliation(s)
- Samantha Downie
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh, UK
| | - Alison Stillie
- Department of Clinical Oncology, Western General Hospital, Edinburgh, UK
| | - Matthew Moran
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh, UK
| | - Catherine Sudlow
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK
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Kiran M, Alsousou J, Dalal N, Ralte P, Kumar G, Kapoor B. Is a single dose of preoperative antibiotic therapy effective for patients treated with megaendoprosthesis after metastatic bone tumour resection? Musculoskelet Surg 2021; 106:187-193. [PMID: 33400185 DOI: 10.1007/s12306-020-00692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Purpose The timing and number of doses of antibiotics required for megaendoprosthetic replacement (MPR) in metastatic bone disease (MBD) is a matter of debate. The aim of our study is to present the results of a prospective cohort of MPR for MBD receiving a single dose of antibiotic at induction of anaesthesia. METHODS All patients who underwent primary MPR in MBD were included in this prospective study. All penicillin-sensitive patients received one dose of cefuroxime 1.5gm intravenous at induction. In penicillin-allergic patients, teicoplanin 1.2gm and ciprofloxacin 500 mg intravenous was administered. The patients were followed up in the wound clinic and the specialist MBD clinic at 2 weeks, 3 months, 6 months and then annually. Data collected included demographics, primary tumours, surgical procedures, complications and duration of follow-up. All calculations were performed using SPSS® 25(IBM, USA). A p value ≤ 0.05 was considered to be significant. RESULTS There were 51 patients with a mean age of 65.4 years. Procedures included proximal femoral replacement (35), distal femoral replacement (7), proximal humeral replacement (4), distal humeral replacement (3) and total femoral replacement (2). Thirty-seven patients received cefuroxime, and fourteen patients received teicoplanin and ciprofloxacin at induction of anaesthesia. The deep infection rate was 1.9%. Thirty-seven patients died with a median survival of 10 months (1 to 51 months). Mean follow-up was 18.9 months (1 to 70 months). CONCLUSION Single dose of preoperative antibiotics at anaesthetic induction seems to be safe and effective for preoperative prophylaxis in orthopaedic oncology.
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Affiliation(s)
- M Kiran
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
| | - J Alsousou
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - N Dalal
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - P Ralte
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - G Kumar
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - B Kapoor
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
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Errani C, Cosentino M, Ciani G, Ferra L, Alfaro PA, Bordini B, Donati DM. C-reactive protein and tumour diagnosis predict survival in patients treated surgically for long bone metastases. Int Orthop 2021; 45:1337-46. [PMID: 33392682 DOI: 10.1007/s00264-020-04921-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Surgical options for long bone metastases include intramedullary nail fixation or prosthetic reconstruction. Patients with a short life expectancy may benefit from less invasive surgery such as intramedullary nail fixation, while patients with a long life expectancy could be treated with more invasive surgery such as prosthetic reconstruction. The purpose of our study was to analyze the survival of patients treated surgically for long bone metastases, determining the prognostic factors affecting survival and analyzing the surgical complications and reoperation rates. Based on our results, we developed a prognostic score that helps to choose the best treatment for these patients. In addition, we compared the performance of our prognostic score with other previous prognostic models. METHOD We investigated prospectively potential clinical and laboratory prognostic factors in 159 patients with metastatic bone disease who underwent surgery with intramedullary nail fixation or prosthetic reconstruction. Clinical data were collected, recording the following data: age and sex of patients, primary tumour and time of diagnosis, number (single or multiple) and presentation (synchronous or metachronous) of bone metastases, presence of visceral metastases. The following laboratory data were analyzed: hemoglobin, leukocyte counts, lymphocyte counts, platelets count, alkaline phosphatase, and C-reactive protein. RESULTS Our study showed that pathological C-reactive protein and primary tumour diagnosis were significant negative independent prognostic factors at 12-month survival. Based on our results, we created a score using C-reactive protein and primary tumour diagnosis, creating three different prognostic groups: (A) good prognosis primary tumour and physiological CRP with probability of survival at 12 months of 88.9 [80.1-98.5]; (B) bad prognosis primary tumour and physiological CRP or good prognosis primary tumour and pathological CRP with a probability of survival at 12 months of 56.7 [45.4-70.7]; (C) bad prognosis primary tumour and pathological CRP with a probability of survival at 12 months of 12.5 [5.0-28.3]. Using ROC multiple analysis, our score (AUC = 0.816) was the most accurate in predicting a 12-month survival compared to previous prognostic models. DISCUSSION Patients treated surgically for long bone metastases with a life expectancy over 12 months should be treated with more durable reconstruction, while patients with a life expectancy less than 12 months should be treated with less invasive surgery. The diagnosis of primary cancer and C-reactive protein are two very simple data which every orthopaedic surgeon in any community hospital can easily rely on for any decision-making in the surgical treatment of a complex patient as with a patient with skeletal metastases. CONCLUSION Our prognostic score based on only two simple variables (C-reactive protein and primary tumour diagnosis) was able to predict the 12-month survival of patients treated surgically for long bone metastases and could be helpful in choosing the best treatment for these patients.
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McCabe FJ, Jadaan DY, Jadaan MM, McCabe JP. The rise of metastatic bone disease in Ireland. Clin Exp Metastasis 2020; 37:693-702. [PMID: 33099723 DOI: 10.1007/s10585-020-10059-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
To describe the expected rise of metastatic bone disease in Ireland, the relative primary types, and the locations of spread within the skeleton. This was a population-based epidemiological study using cancer registry data. We included patients with known metastatic cancer to bone, within 1 year of the primary diagnosis, during the years 1994 to 2012 inclusive. Our main outcome measures were age-specific, gender-specific and age-standardised incidence rates of bone metastasis, primary types and metastatic location within the skeleton. There were 14,495 recognised cases of bone metastasis in Ireland, 1994-2012 inclusive. Cases consistently rose over the time period, with 108% case increase and 51% age-standardised incidence rise. Annual percentage change increased across both genders and over all age groups. Most of this rise was not due to demographic population change. Breast, prostate and lung accounted for the majority of primary types. GI cancers were the fourth most common primary type. There were proportional increases in breast and lung, with proportional decreases in prostate. The spine was the major metastatic site. Bone metastasis is a significant and rising healthcare concern in Ireland. This rise is disproportionate to demographic changes. Breast, prostate and lung cancers account for the majority. GI cancers are implicated in an unexpectedly high number of cases. Spine is the most common location of bony metastasis, especially at presentation. Prudent healthcare planning is necessitated to prepare for the growing consequences of bone metastasis in cancer patients.
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Barton KI, Hazenbiller O, Freeman G, Kashluba K, Ball M, Aboutaha A, Puloski SKT, Monument MJ. Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals. Support Care Cancer 2021; 29:1111-9. [PMID: 32607597 DOI: 10.1007/s00520-020-05595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of research examining how surgical decision-making for metastatic bone disease (MBD) can be optimized to improve quality of life (QOL) and functional outcomes, while accurately aligning with patient goals and expectations. The objective of this study was to survey and interview patients with MBD and support persons (PS), physicians, and allied health care providers (HCP) with the goal of identifying (1) important surgical issues related to MBD management, (2) discordance in perioperative expectations, and (3) perceived measures of success in the surgical management of MBD. METHODS Utilizing a custom survey developed by HCP and patients with MBD, participants were asked to (1) identify important issues related to MBD management, (2) rank perceived measures of success, and (3) answer open-ended questions pertaining to the management of MBD. RESULTS From the survey, increased life expectancy, minimizing disease progression, removal of local tumour, timely surgery after diagnosis, increased length of hospitalization, and physiotherapy access were all identified as significant discordant goals between PS and physicians/HCP. Conversely, there was an agreement between physicians and HCP who considered improved QOL and functional outcomes as most important goals. Structured homogenous-group workshops identified the need for (1) improved discussions of prognosis, surgical options, expectations, timelines, and resources, (2) the use of a care team "quarterback", and (3) an increased use of multi-disciplinary treatment planning. CONCLUSIONS We feel this data highlights the importance of improved communication and coordination in treating patients with MBD. Further research evaluating how surgical techniques influence survival and disease progression in MBD is highly relevant and important to patients.
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Prabowo Y, Asril E, Wikanjaya R. Functional outcome of operative treatment for pelvic metastatic bone disease from primary thyroid cancer: A case series. Int J Surg Case Rep 2020; 66:288-297. [PMID: 31891891 PMCID: PMC6938941 DOI: 10.1016/j.ijscr.2019.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/22/2019] [Accepted: 11/30/2019] [Indexed: 12/01/2022] Open
Abstract
70 % of all malignant bone tumors are metastatic in origin. Functional outcome of MBD surgical management rarely described in literature. SF-36 and MSTS can be used to measure the functional outcome of MBD surgery. Surgery remains a good choice of therapy for MBD of pelvic.
Background Metastatic bone disease (MBD) is the most common malignancy of bone. It is estimated that 70 % of all malignant bone tumors are due to metastasis. The functional outcome from pelvic MBD surgical management has been rarely described in the literature contrary to that of the long bones. Method We reported three patients that underwent pelvic resection surgery due to pelvic MBD. All of the primary tumors were thyroid cancer. We measure the functional outcome using SF-36 and MSTS (musculoskeletal tumor society) scores after a one-year follow-up. Result The SF-36 scoring result was that all of the patients had a remarkable improvement in terms of pain (77.5 %, 100 %, and 100 %). All of the patients also still had proper social functioning (75 %, 100 %, and 100 %) and good emotional well-being (72 %, 92 %, and 88 %). According to the MSTS, the second and third case had an excellent functional outcome; however the first case had poor functional outcome Conclusion Surgery remains the choice of therapy for pelvic MBD that results in alleviation of pain and quality of life improvement.
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Affiliation(s)
- Yogi Prabowo
- Consultant of Orthopaedic Oncology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Elfikri Asril
- Resident of Orthopaedic Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Rio Wikanjaya
- Resident of Orthopaedic Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Alexandraki KI, Pizanias M, Uri I, Thomas D, Page T, Kolomodi D, Low CS, Adesanya O, Tsoli M, Gross DJ, Randeva H, Srirajaskanthan R, Grozinsky-Glasberg S, Kaltsas G, Weickert MO. The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice. Endocrine 2019; 64:690-701. [PMID: 30635793 DOI: 10.1007/s12020-019-01838-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To study the evolution and optimal management of metastatic bone disease (mBD) in patients with neuroendocrine neoplasms (NENs). METHODS Seventy-four patients were recruited from four NEN centers in this observational multicenter study. RESULTS Pancreas and small bowel were the most common primaries (30 and 27%, respectively). Almost all gastrointestinal (GI)-NENs were grades 1 and 2, whereas bronchopulmonary-thymic were atypical carcinoids. Thirty-two (43%) patients had synchronous metastatic bone disease (mBD) and three patients reported bone-specific symptoms; metachronous mBD developed at a median of 35 (range: 4-395) months. Thirty-six (86%) of patients with metachronous mBD had stage IV disease at diagnosis. Somatostatin receptor functional imaging and computed tomography were the modalities mostly used for mBD identification. Fifty-two patients received assessable bone-related therapy (bisphosphonates, denosumab, local radiotherapy, and radionuclide treatment). Improvement in mBD was seen in 5, stable disease in 22, and deterioration in 25 patients. The presence of synchronous mBD and the negative outcome of bone-related therapy negatively affected overall survival (OS). In the multivariate analysis, the stronger predictor of OS was the outcome of bone-related therapy (HR: 4.753; 95% CI: 1.589-14.213). Bisphosphonates therapy was the mostly used bone-specific treatment but its monthly administration did not affect OS. At last follow-up, 39 patients were alive with OS 50 (14-463) months. CONCLUSIONS Early investigation for mBD offers a prognostic marker of patients with NENs, since synchronous mBD has a negative impact on survival. The outcome of bone-related therapy affects OS but the monthly administration of bisphosphonates did not show a benefit over less intense schemes.
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Affiliation(s)
- Krystallenia I Alexandraki
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece.
| | - Michail Pizanias
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK
| | - Inbal Uri
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Dimitrios Thomas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Tristan Page
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Denise Kolomodi
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Chen Sheng Low
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Olu Adesanya
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marina Tsoli
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Harpal Randeva
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
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Meares C, Badran A, Dewar D. Prediction of survival after surgical management of femoral metastatic bone disease - A comparison of prognostic models. J Bone Oncol 2019; 15:100225. [PMID: 30847272 PMCID: PMC6389683 DOI: 10.1016/j.jbo.2019.100225] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Operative fixation for femoral metastatic bone disease is based on the principles of reducing pain and restoring function. Recent literature has proposed a number of prognostic models for appendicular metastatic bone disease. The aim of this study was to compare the accuracy of proposed soring systems in the setting of femoral metastatic bone disease in order to provide surgeons with information to determine the most appropriate scoring system in this setting. Methods A retrospective cohort analysis of patients who underwent surgical management of femoral metastatic bone disease at a single institution were included. A pre-operative predicted survival for all 114 patients was retrospectively calculated utilising the revised Katagiri model, PathFx model, SSG score, Janssen nomogram, OPTModel and SPRING 13 nomogram. Univariate and multivariate Cox regression proportional hazard models were constructed to assess the role of prognostic variables in the patient group. Area under the receiver characteristics and Brier scores were calculated for each prognostic model from comparison of predicted survival and actual survival of patients to quantify the accuracy of each model. Results For the femoral metastatic bone disease patients treated with surgical fixation, multivariate analysis demonstrated a number of pre-operative factors associated with survival in femoral metastatic bone disease, consistent with established literature. The OPTIModel demonstrated the highest accuracy at predicting 12-month (Area Under the Curve [AUC] = 0.79) and 24-month (AUC = 0.77) survival after surgical management. PathFx model was the most accurate at predicting 3-month survival (AUC = 0.70) and 6-month (AUC = 0.70) survival. The PathFx model was successfully externally validated in the femoral patient dataset for all time periods. Conclusions Among six prognostic models assessed in the setting of femoral metastatic bone disease, the present study observed the most accurate model for 3-month, 6-month, 12-month and 24-month survival. The results of this study may be utilised by the treating surgical team to determine the most accurate model for the required time period and therefore improve decision-making in the care of patients with femoral metastatic bone disease.
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Affiliation(s)
- Charles Meares
- The Bone and Joint Institute, Royal Newcastle Centre and John Hunter Hospital, Newcastle, Australia
| | | | - David Dewar
- The Bone and Joint Institute, Royal Newcastle Centre and John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Infante M, Fabi A, Cognetti F, Gorini S, Caprio M, Fabbri A. RANKL/RANK/OPG system beyond bone remodeling: involvement in breast cancer and clinical perspectives. J Exp Clin Cancer Res 2019; 38:12. [PMID: 30621730 PMCID: PMC6325760 DOI: 10.1186/s13046-018-1001-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
RANKL/RANK/OPG system consists of three essential signaling molecules: i) the receptor activator of nuclear factor (NF)-kB-ligand (RANKL), ii) the receptor activator of NF-kB (RANK), and iii) the soluble decoy receptor osteoprotegerin (OPG). Although this system is critical for the regulation of osteoclast differentiation/activation and calcium release from the skeleton, different studies have elucidated its specific role in mammary gland physiology and hormone-driven epithelial proliferation during pregnancy. Of note, several data suggest that progesterone induces mammary RANKL expression in mice and humans. In turn, RANKL controls cell proliferation in breast epithelium under physiological conditions typically associated with higher serum progesterone levels, such as luteal phase of the menstrual cycle and pregnancy. Hence, RANKL/RANK system can be regarded as a major downstream mediator of progesterone-driven mammary epithelial cells proliferation, potentially contributing to breast cancer initiation and progression. Expression of RANKL, RANK, and OPG has been detected in breast cancer cell lines and in human primary breast cancers. To date, dysregulation of RANKL/RANK/OPG system at the skeletal level has been widely documented in the context of metastatic bone disease. In fact, RANKL inhibition through the RANKL-blocking human monoclonal antibody denosumab represents a well-established therapeutic option to prevent skeletal-related events in metastatic bone disease and adjuvant therapy-induced bone loss in breast cancer. On the other hand, the exact role of OPG in breast tumorigenesis is still unclear. This review focuses on molecular mechanisms linking RANKL/RANK/OPG system to mammary tumorigenesis, highlighting pre-clinical and clinical evidence for the potential efficacy of RANKL inhibition as a prevention strategy and adjuvant therapy in breast cancer settings.
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Affiliation(s)
- Marco Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Via San Nemesio, 21, 00145, Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - Stefania Gorini
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Via San Nemesio, 21, 00145, Rome, Italy.
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Wisanuyotin T, Sirichativapee W, Sumnanoont C, Paholpak P, Laupattarakasem P, Sukhonthamarn K, Kosuwon W. Prognostic and risk factors in patients with metastatic bone disease of an upper extremity. J Bone Oncol. 2018;13:71-75. [PMID: 30591860 PMCID: PMC6303409 DOI: 10.1016/j.jbo.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to evaluate survival of metastatic bone disease of an upper extremity, and to identify the prognostic factors that influence survival. Methods Patients with metastatic bone disease of an upper extremity between 2008 and 2015 were reviewed from the database of a tertiary university hospital. Results Of 102 patients, 48 males and 54 females with a median age of 61 (range, 28–82 years), the humerus (64.7%), clavicle (13.7%), and scapula (12.7%) were the common sites for bone metastasis of an upper extremity. Fifty-nine (57.8%) presented with pathologic fracture. No history of cancer was found in 76.5% of patients. The mean onset of metastatic bone disease after the first diagnosis of primary cancer was 4.74 ± 14.07 months (range, 0–84 months). Lung (31.4%) was the most common primary cancer followed by liver (14.7%), breast (12.7%), thyroid (7.8%), and renal (3.9%). Eighty-two cases (80.39%) died from the disease such that the median survival was 4.08 months (95% CI 2.57–6.17). The significant risk factors were the type of primary tumor (P < 0.001, HR = 4.44; 95% CI, 1.99–9.90) and ECOG performance status (P = 0.021, HR = 2.11, 95% CI 1.12–3.99). Conclusions Patients with metastatic bone disease of an upper extremity have a limited life expectancy. The type of primary tumor and ECOG performance status were the important prognostic factors that influenced overall survival. Our data help in the management of patients, families, and doctors, so as to avoid over- or under-treatment.
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Kendal JK, Abbott A, Kooner S, Johal H, Puloski SKT, Monument MJ. A scoping review on the surgical management of metastatic bone disease of the extremities. BMC Musculoskelet Disord 2018; 19:279. [PMID: 30081884 PMCID: PMC6080518 DOI: 10.1186/s12891-018-2210-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/27/2018] [Indexed: 12/19/2022] Open
Abstract
Background Management of metastatic bone disease of the extremities (MBD-E) is challenging, and surgical directions pose significant implications for overall patient morbidity and mortality. Recent literature reviews on the surgical management of MBD-E present a paucity of high-level evidence and global inconsistencies in study design. In order to steer productive research, a scoping review was performed to map and assess critical knowledge gaps. Methods The Arksey and O’Malley framework for scoping studies was followed. A comprehensive literature search identified a large body of literature pertaining to the surgical management of MBD-E. Study data and meta-data was extracted and presented using descriptive analytics and a thematic framework. Literature gaps were identified and analyzed. Results Three hundred eighty five studies from 1969 to 2017 were included. Studies were categorized into 11 separate themes, with the majority (63%) falling into the “surgical fixation strategies” theme, followed by “complications” at 7% and “prognosis and survival” at 6.2%. Less than 3% of studies were categorized in “patient related outcomes” or “epidemiology” themes. 89% of studies were retrospective and only 6 studies were of level 1 or 2 evidence. We identified a temporal increase in publication by decade, and all studies published on interventional radiology techniques or economic analyses were published after 2007 or 2009, respectively. 64.9% of studies were published in Europe and 20.3% were published in North America. Average patient age was 62 (± 5.2 years), and breast was the most common primary tumour (28%), followed by lung (17%) and kidney (15%). In terms of surgical location, 75% of operations involved the femur, followed by the humerus at 22% and tibia at 3%. Conclusions We present a descriptive overview of the current published literature on the surgical management of MBD-E. Critical knowledge gaps have been identified through the development of a thematic framework. Consolidation of literary gaps must involve bolstered efforts towards patient and family-engaged research initiatives and assessment of patient-related surgical outcomes. Multi-disciplinary engagement in developing prospective research will also help guide evidence-based personalized practice for these patients. By building on existing comprehensive patient databases and registries, knowledge on survival and prognostic parameters can be greatly improved. Electronic supplementary material The online version of this article (10.1186/s12891-018-2210-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joseph K Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Annalise Abbott
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sahil Kooner
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Herman Johal
- Centre for Evidence Based Orthopaedics, Departments of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West Hamilton, Hamilton, ON, L8S 4K1, Canada
| | - Shannon K T Puloski
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Michael J Monument
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Eggermont F, Derikx LC, Verdonschot N, van der Geest ICM, de Jong MAA, Snyers A, van der Linden YM, Tanck E. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?: Towards computational modelling in daily clinical practice. Bone Joint Res 2018; 7:430-439. [PMID: 30034797 PMCID: PMC6035356 DOI: 10.1302/2046-3758.76.bjr-2017-0325.r2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. METHODS A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians. RESULTS In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments. CONCLUSION FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines.Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430-439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.
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Affiliation(s)
- F. Eggermont
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - L. C. Derikx
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - N. Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands and Laboratory of Biomechanical Engineering, Enschede, The Netherlands
| | - I. C. M. van der Geest
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - M. A. A. de Jong
- Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
| | - A. Snyers
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Y. M. van der Linden
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - E. Tanck
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Summers AR, Philipp T, Mikula JD, Gundle KR. The role of postoperative radiation and coordination of care in patients with metastatic bone disease of the appendicular skeleton. Orthop Rev (Pavia) 2017; 9:7261. [PMID: 29564074 PMCID: PMC5850070 DOI: 10.4081/or.2017.7261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/30/2017] [Indexed: 11/29/2022] Open
Abstract
Metastatic bone disease affects approximately 300,000 people in the United States, and the burden is rising. These patients experience significant morbidity and decreased survival. The management of these patients requires coordinated care among a multidisciplinary team of physicians, including orthopaedic surgeons. This article reviews the role of radiation therapy after orthopaedic stabilization of impending or realized pathologic extremity fractures. Orthopaedic surgeons have an opportunity to benefit patients with metastatic bone disease by referring them for consideration of post-operative radiation therapy. Further research into rates of referral and the effect on clinical outcomes in this population is needed.
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Affiliation(s)
- Andrew R. Summers
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Travis Philipp
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Jacob D. Mikula
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Kenneth R. Gundle
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR
- Operative Care Division, Portland Veterans Administration Medical Center, Portland, OR, USA
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Rabasseda X. A report from the American Society for Bone and Mineral Research 2014 Annual Meeting (September 12-15 - Houston, Texas, USA). Drugs Today (Barc) 2017; 50:691-702. [PMID: 25374967 DOI: 10.1358/dot.2014.50.10.2235851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the weather was very Texas-unlike, with fog, clouds and even intense rain, the George R. Brown Convention Center in Houston was the site for this year's annual meeting of the American Society for Bone and Mineral Research, where investigators from across the world came to present the latest findings in bone science. Four days of oral and poster presentations encompassing over 1,500 papers discussing a great variety of subjects including preclinical and clinical research aimed at improving the treatment of bone diseases such as osteoporosis and other forms of bone frailty.
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Filippiadis D, Mavrogenis AF, Mazioti A, Palialexis K, Megaloikonomos PD, Papagelopoulos PJ, Kelekis A. Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment. Eur J Orthop Surg Traumatol 2017; 27:729-736. [PMID: 28597402 DOI: 10.1007/s00590-017-1986-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 01/20/2023]
Abstract
Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Alexis Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
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Body JJ, Gatta F, De Cock E, Tao S, Kritikou P, Wimberger P, Mebis J, Peeters M, Pedrazzoli P, Caraceni A, Adamo V, Hechmati G. An observational time and motion study of denosumab subcutaneous injection and zoledronic acid intravenous infusion in patients with metastatic bone disease: results from three European countries. Support Care Cancer 2017; 25:2823-32. [PMID: 28429148 DOI: 10.1007/s00520-017-3697-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/31/2017] [Indexed: 11/12/2022]
Abstract
Purpose Denosumab (administered via subcutaneous injection) demonstrated superior efficacy versus the intravenously administered zoledronic acid in the prevention of skeletal-related events in an integrated analysis of three head-to-head phase III trials in patients with bone metastases secondary to solid tumors. To date, no studies have evaluated treatment administration duration endpoints of these two agents. Methods A multinational, multi-site, observational time and motion study conducted in 10 day oncology units (DOUs) across Belgium, Germany, and Italy. Observations of process time included task time and active healthcare professional (HCP) time for pre-defined tasks. Patient time measurements included entering/exiting the DOU, treatment room, and treatment chair or examination table. Results A total of 189 patients were enrolled (82 received zoledronic acid and 107 received denosumab) and 238 observations were recorded (104 for zoledronic acid and 134 for denosumab). Mean total task time was reduced by 81% when denosumab was used versus zoledronic acid (8.4 versus 44.2 min; p < 0.0001; pooled analysis across all countries). Pooled estimates for active HCP time were 12.2 min for zoledronic acid and 6.9 min for denosumab (44% reduction; p < 0.0001). Conclusions In the countries studied, using denosumab compared with zoledronic acid reduced total task time and active HCP time. Thus, HCPs have more time to dedicate to other patients or care activities. An ability to increase the volume of appointments within DOUs could reduce waiting lists in sites operating at full capacity and increase overall productivity and efficiency in hospital processes. Electronic supplementary material The online version of this article (doi:10.1007/s00520-017-3697-5) contains supplementary material, which is available to authorized users.
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Yang SP, Kim TWB, Boland PJ, Farooki A. Retrospective Review of Atypical Femoral Fracture in Metastatic Bone Disease Patients Receiving Denosumab Therapy. Oncologist 2017; 22:438-444. [PMID: 28275116 DOI: 10.1634/theoncologist.2016-0192] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/02/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Denosumab therapy is used to reduce skeletal-related events in metastatic bone disease (MBD). There have been reports of atypical femoral fracture (AFF) in osteoporotic patients treated with denosumab but none in the context of higher dose and more frequent denosumab therapy for MBD. The goal of this study was to assess the incidence of AFF in MBD. PATIENTS AND METHODS We conducted a retrospective review of 253 patients who received a minimum of 12 doses of denosumab at 120 mg each for MBD. To identify patients with asymptomatic atypical stress reactions in the lateral subtrochanteric femur (which precede fractures), we reviewed the skeletal images of 66 patients who had received at least 21 doses of denosumab for AFF features. RESULTS These patients received a median of 17 doses, with a median treatment duration of 23 months. There was 1 case of undiagnosed clinical AFF detected after chart review and 2 cases of subclinical atypical femoral stress reaction observed on imaging review after 23 doses of denosumab over 33 months, 28 doses over 27 months, and 21 doses over 21 months, respectively. Scout computed tomography films showed diffuse cortical thickening of diaphysis with localized periosteal reaction of lateral femoral cortex. Bone scan and magnetic resonance imaging scan of 2 patients with stress reactions confirmed the diagnosis. CONCLUSION The incidence of clinical AFF in this context is 0.4% (1/253; 95% confidence interval [CI] 0.1%-2.2%), and the incidence of atypical femoral stress reaction based on imaging review is 4.5% (3/66; 95% CI 1.6%-12.5%). Clinicians should be aware of the clinical prodrome (which may or may not be present) and antecedent imaging changes associated with AFF. The Oncologist 2017;22:438-444Implications for Practice: Among patients with metastatic bone disease treated with denosumab, cases of clinical and subclinical atypical femoral fracture (AFF) are rare. The one detected case of clinical fracture went unrecognized despite prodromic symptoms. Clinicians should be aware of (a) the potential prodrome of anterior thigh/groin pain and (b) subclinical imaging changes in the lateral femur, both of which may precede clinical AFF.
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Affiliation(s)
- Samantha Peiling Yang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tae Won B Kim
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Orthopedic Oncology Division, Department of Orthopedic Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Patrick J Boland
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Azeez Farooki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging 2017; 98:483-489. [PMID: 28126418 DOI: 10.1016/j.diii.2016.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/28/2016] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. MATERIALS AND METHODS The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years±13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score≥8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. RESULTS No patients treated with RPOC had a fracture during a mean follow-up time of 382 days±274 (SD) (range: 11-815 days). RPOC was performed under general (n=10) or locoregional (n=2) anesthesia. The average duration of the procedure was 95min±17 (SD) (range: 73-121min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4days ±3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n=7), VAS score decreased from 6.8±1.2 (SD) (range: 5-9) before treatment, to 2.3±1.1 (SD) (range: 1-4) one month later. CONCLUSION Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.
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Affiliation(s)
- E Mavrovi
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France.
| | - J-B Pialat
- Department of Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - H Beji
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - A-C Kalenderian
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - G Vaz
- Department of Oncologic Surgery, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - B Richioud
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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Liska F, Schmitz P, Harrasser N, Prodinger P, Rechl H, von Eisenhart-Rothe R. [Metastatic disease in long bones : Review of surgical treatment options]. Unfallchirurg 2016; 121:37-46. [PMID: 27904933 DOI: 10.1007/s00113-016-0282-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surgery in metastatic bone disease is currently the most frequent type of surgery in orthopedic oncology. Improved survival rates and an increasing incidence of bone metastasis have led to an increase in complications caused by metastatic disease, such as pathological fractures or hardware failure after operative treatment. Although surgery of metastatic lesions remains a palliative therapy concept, because of sufficient therapy for the primary carcinomas, tumor-specific-oriented follow-up protocols and a variation in the prognosis for the individual entities, an individually adapted treatment strategy is necessary. Depending on the life expectancy, more aggressive surgical procedures with the goal of adequate local tumor control have come into focus. Therefore, prognosis-tailored treatment requires an experienced team and should be performed in a multidisciplinary tumor center. The current article provides an overview of recent therapy concepts for the surgical treatment including endoprosthetic reconstruction, internal fixation with either intramedullary nailing or plate fixation devices, often augmented with bone cement.
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Affiliation(s)
- Franz Liska
- Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Philipp Schmitz
- Abteilung Orthopädie und Unfallchirurgie, Klinikum Fürstenfeldbruck, Dachauer Str. 33, 82256, Fürstenfeldbruck, Deutschland
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
| | - Peter Prodinger
- Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
| | - Hans Rechl
- Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
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Piggott RP, Waters PS, Kerin MJ. The influence of breast cancer subtype on bone metastases development and survival in women with metastatic breast cancer. Ir J Med Sci 2016; 186:97-102. [PMID: 27734241 DOI: 10.1007/s11845-016-1512-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tumour metastatic disease reflects a complex interplay between tumour characteristics and local host factors. This complex relationship may have an influence on the development of metastatic disease and patient survival. Multiple factors of the primary tumour influence the development of metastases and survival in patients. Breast cancer subtype has been shown to influence patient prognosis and response to therapy. AIM The aim of our study was to correlate breast cancer subtype with bony metastatic disease and patient survival. METHODS All women undergoing breast cancer surgery in a single institution in Ireland between January 1990 and July 2012 were included in the study. A prospectively maintained database was reviewed and expanded retrospectively. Univariate and multivariate analysis was carried out. RESULTS Database interrogation identified 238 patients for inclusion. Patient demographics, tumour characteristics and survival data were analyzed. Average follow-up of patients was 57.6 months (range 1-272 months). Multivariate analysis identified oestrogen receptor positivity and presence of metastatic disease elsewhere as significant factors influencing the development of bone metastases. Breast cancer subtype did not influence the bone metastases development (p = 0.99). Breast cancer subtype influenced patients' overall survival (p < 0.001), bone disease-free survival (p < 0.001) and survival with bone disease (p < 0.001). Subtype did not influence distant disease-free survival. CONCLUSION Breast cancer subtype influences patients' overall survival, with luminal A and B subtypes associated with the best outcome. Bone metastases remain the most common form of breast cancer metastases but are not influenced by breast cancer subtype.
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Affiliation(s)
- R P Piggott
- Department of Surgery, Galway University Hospital, Galway, Ireland.
| | - P S Waters
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Galway University Hospital, Galway, Ireland
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Errani C, Mavrogenis AF, Cevolani L, Spinelli S, Piccioli A, Maccauro G, Baldini N, Donati D. Treatment for long bone metastases based on a systematic literature review. Eur J Orthop Surg Traumatol. 2017;27:205-211. [PMID: 27650452 DOI: 10.1007/s00590-016-1857-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 09/09/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To provide treatment guidelines for patients with long bone metastatic disease based on a systematic review of the literature and to propose an algorithm to guide orthopedic surgeons in decision-making for these patients. MATERIALS AND METHODS We performed a computerized literature search in MEDLINE, EMBASE and Scopus for studies on patients with long bone metastases. We used the key words "long bones", "metastasis" and "treatment" for published studies that evaluated any treatment for long bone metastases. The articles found were then studied to determine the accuracy of surgical treatments for long bone metastases in every anatomic location, regardless of cancer type, stage and grade of the oncologic disease. Guidelines inferred from this literature review were collected, and an algorithm was proposed. RESULTS There was no clear evidence to support excision of a long bone metastatic lesion at the same surgical setting with internal fixation or prosthetic reconstruction. However, en bloc resection of an isolated bone metastasis may have a beneficial effect on survival. The life expectancy of the patients should be considered for any surgical treatment. Internal fixation preferably with reconstruction nails is indicated for meta-diaphyseal lesions; their rate of mechanical failure and complications ranges from 2 to 22 %. Prosthetic reconstruction is indicated for extensive lytic lesions or pathologic fractures in a meta-epiphyseal locations; their rate of mechanical failure and complications ranges from 3.7 to 35 %. Most of the internal fixation-related complications occur more than 1 year after treatment, in contrast to prosthetic reconstruction-related complications that may occur earlier. CONCLUSIONS Intramedullary nail fixation or prosthetic reconstruction should be chosen on the basis of the location of the lesion, the extent of bone destruction and the stability of the construct to outlast the expected life of the patient. Implant-related complication is similar but may occur earlier with prosthetic reconstructions.
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Jehn CF, Diel IJ, Overkamp F, Kurth A, Schaefer R, Miller K, Lüftner D. Management of Metastatic Bone Disease Algorithms for Diagnostics and Treatment. Anticancer Res 2016; 36:2631-2637. [PMID: 27272771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bone is a frequent site of metastases in advanced cancer and is associated with significant skeletal morbidity. Current treatment options are aimed at preserving and improving functional independence and quality of life. MATERIALS AND METHODS A review of current literature focusing on diagnostic tools and treatment approaches of bone metastasis in advanced cancer was performed and conclusions were incorporated into diagnostic and treatment algorithms. RESULTS Radiologic imaging has added valuable tools for screening and diagnostics of bone metastasis. Clinical management of skeletal metastasis includes improved pain management, introduction of bone modifying agents and advancements in surgical and radiation therapy. We propose three algorithms enhancing the sensitivity of diagnostics and improving multidisciplinary management of vertebral and non-vertebral bone metastasis. CONCLUSION Bone metastases are an expression of a systemic disease. Treatment options include highly specialized modalities yet need to be tailored to individual needs. Algorithms help standardize treatment procedures and can improve treatment outcome in a multidisciplinary setting.
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Affiliation(s)
- Christian F Jehn
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité, Berlin, Germany
| | - Ingo J Diel
- Practice for Medical Oncology and Gynaecology am Rosengarten, Mannheim, Germany
| | | | - Andreas Kurth
- THEMISTOCLES GLUCK Hospital Ratingen, Ratingen, Germany
| | | | - Kurt Miller
- Department of Urology, University Hospital Charité, Berlin, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité, Berlin, Germany
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Wallace AN, Huang AJ, Vaswani D, Chang RO, Jennings JW. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note. Skeletal Radiol 2016; 45:401-5. [PMID: 26408315 DOI: 10.1007/s00256-015-2263-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/20/2015] [Accepted: 09/06/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. MATERIALS AND METHODS The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. RESULTS During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). CONCLUSIONS Palliative percutaneous acetabular radiofrequency ablation and cementoplasty can be feasibly performed from an anterior approach using a navigational ablation probe and ultrahigh viscosity cement instilled under CT-fluoroscopic guidance.
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Owosho AA, Blanchard A, Levi L, Kadempour A, Rosenberg H, Yom SK, Farooki A, Fornier M, Huryn JM, Estilo CL. Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients. J Craniomaxillofac Surg 2015; 44:265-70. [PMID: 26782845 DOI: 10.1016/j.jcms.2015.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022] Open
Abstract
This case series describes the course of osteonecrosis of the jaw (ONJ) in thirteen patients with metastatic bone tumors treated solely with denosumab. Patients on denosumab may be more prone to developing ONJ even without a risk/precipitating factor and they may develop ONJ early in their denosumab therapy. The outcomes of ONJ in ten patients following a period of denosumab discontinuation after the onset of ONJ were: 3 had complete resolution of symptoms, 4 patients' ONJ progressed, 2 patients' ONJ was unchanged and in 1 patient there was partial ONJ resolution. The role of drug discontinuation prior to an invasive dental procedure or after the onset of ONJ still remains debatable.
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Affiliation(s)
- Adepitan A Owosho
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ariel Blanchard
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lauren Levi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Arvin Kadempour
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Haley Rosenberg
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - SaeHee K Yom
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Azeez Farooki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Monica Fornier
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Joseph M Huryn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Cherry L Estilo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Chillà A, Bianconi D, Geetha N, Dorda A, Poettler M, Unseld M, Sykoutri D, Redlich K, Zielinski CC, Prager GW. Effects of cilengitide in osteoclast maturation and behavior. Exp Cell Res 2015; 337:68-75. [PMID: 26209605 DOI: 10.1016/j.yexcr.2015.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone metastasis is a common burden in many types of cancer and has a severe impact on the quality of life in patients. Hence, specific therapeutic strategies inhibiting tumor induced osteolysis are urgently needed. In this study, we aimed to interfere with integrin adhesion receptors, which are central players of the bone resorption process. For this purpose, we used cilengitide, a cyclic RGD peptide, which blocks integrin αVβ3 and αVβ5-ligand binding. Our results revealed that cilengitide blocked osteoclast maturation in a dose-dependent manner. In detail, pre-osteoclasts treated with cilengitide exhibited reduced cell spreading, cell migration and cell adhesion on RGD-containing matrix proteins, which are ligands of integrin αV. The activation of the most upstream signal transduction molecules of the integrin receptor-initiated pathway, FAK and c-Src, were consistently blocked by cilengitide. First evidence suggests that cilengitide might interfere with metastatic bone disease in vivo and this study describes a potential underlying mechanism of the inhibitory effect of cilengitide on αV-integrin expressing pre-osteoclasts by blocking integrin ligand binding and interfering with osteoclast maturation and cell behavior. In conclusion, our findings suggest that cilengitide, which interferes with αV-integrins on osteoclasts, may represent a novel therapeutic strategy in the treatment of malignant bone disease.
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Abstract
Objectives Guidelines for the management of patients with metastatic bone
disease (MBD) have been available to the orthopaedic community for
more than a decade, with little improvement in service provision
to this increasingly large patient group. Improvements in adjuvant
and neo-adjuvant treatments have increased both the number and overall
survival of patients living with MBD. As a consequence the incidence
of complications of MBD presenting to surgeons has increased and
is set to increase further. The British Orthopaedic Oncology Society
(BOOS) are to publish more revised detailed guidelines on what represents
‘best practice’ in managing patients with MBD. This article is designed
to coincide with and publicise new BOOS guidelines and once again
champion the cause of patients with MBD. Methods A series of short cases highlight common errors frequently being
made in managing patients with MBD despite the availability of guidelines. Results Despite guidelines for the management of patients with MBD being
available for more than a decade basic errors in management continue
to be made, affecting patient survival and quality of life. Conclusions It is hoped that by publicising the new BOOS guidelines the management
of patients with MBD will improve over the next decade, significantly
more than it has over the last decade.
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Affiliation(s)
- P Harvie
- Nuffield Orthopaedic Centre, WindmillRoad, Headington, OxfordOX3 7LD, UK
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