Abstract
BackgroundThe evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival.MethodsEighteen patients underwent surgical procedures for the treatment of bone metastases secondary to gynecologic cancer between September 2003 and April 2012. The primary cancer sites included the uterus (n = 10), the cervix (n = 5), and an ovary (n = 3). Patients were followed for an average period of 13.8 months (range, 2 to 34 months). A visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status were evaluated both pre- and postoperatively.ResultsThe median survival time following diagnosis of bone metastasis was 10.0 months. The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery. The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.ConclusionsThe prognosis of gynecological cancer patients with bone metastasis is poor. Some patients had improvement in their quality of life after surgical intervention for bone metastases; however, novel integrated treatment modalities should be investigated.
Highlights
The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians
In order to minimize the impact of cancer recurrence on the primary outcome of pain improvement and performance status, we focused the analysis on immediate pre-operative assessment and that occurring in the initial 3 months after surgical intervention
At completion of data collection, 15 patients were dead of primary disease, and 2 patients were alive without evidence of disease recurrence
Summary
The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival. Patients with bone metastasis have advanced stage disease, and the utility of surgical intervention is unclear. Some advocate minimal intervention and aggressive pain control, while others support more aggressive surgical intervention due to the unresponsiveness of these metastatic lesions to chemotherapy, radiotherapy and other noninvasive measures. The established indications for surgery include impending or existing pathological fractures, spinal cord compression, and pain, especially for patients who became resistant to radiotherapy [9,10]
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