Management of long bone metastases: recommendations from the Italian Orthopaedic Society bone metastasis study group

Abstract

The purpose of this article is to outline the current approach to patients affected by metastasis to the long bones and to present a clinical and surgical algorithm available for clinicians and for future research. A modern approach to patients affected by long bone metastasis in fact requires a multidisciplinary contest where oncologists, radiotherapists, surgeons and physical therapists cooperate with a shared vision, in order to provide the best possible integrated treatments available. The authors of this article constitute the Bone Metastasis Study Group of the Italian Orthopaedic Society (SIOT): a national group of orthopedic tumor surgeons who are dedicated to studying the approach, techniques and outcomes of surgery for metastatic tumours of the musculoskeletal system.

Keywords::

• algorithm
• appendicular skeleton
• bone metastasis
• long bones
• palliative therapy
• recommendations
• surgery

Acknowledgements

We acknowledge Prof. Roberta Aronica for English revision of the current manuscript. We acknowledge that Dr DA Campanacci is the senior author of the current manuscript. We thank Dr Ibrahim for revision of these guidelines.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Recent research might improve our ability to estimate patient survival, thus improving the chance to better tailor surgery in patients affected by metastasis to the bone.

• All the skeletal related events, even if asymptomatic, are in charge of the orthopedic surgeon and the medical oncologist with expertise in musculoskeletal oncology.

• In lesions at the metaepyphisis, the management is oriented towards therapeutic surgery with tumor excision and reconstruction with arthroplasty or plate and cement; osteosynthesis alone is performed in patients with expected poor prognosis.

• In lesions at the diaphysis, in case of good prognosis and when the expected response to adjuvant therapy is poor, a therapeutic surgery with tumor excision and reconstruction with osteosynthesis and cement or intercalary implants is proposed; conversely, in patients with poor prognosis or with a good expected response to nonsurgical therapies, the osteosynthesis alone with a locked nail (femur, tibia or humerus) or a plate fixation at the forearm is planned.

• In patients unsuitable to surgery, minimally invasive therapies may contribute to pain control for lesions nonresponding to nonsurgical therapies.

• The Italian Orthopaedic Society Bone Metastasis Study Group designed an algorithm for the medical and surgical treatment of long bone metastases.

Notes