Abstract
Simple SummaryMajor progress has been achieved in stage-IV bone metastatic patients to control over the disease progression, thereby resulting in longer survival. Self-autonomy and return to physical activity are now frequent. Thus, assessment of the strength of tumoral bone has becoming an issue, especially with the rapid variations of bone tumoral aspect (from lytic to sclerosing and vice versa), that we can observe on treatment. This review will explain the current available imaging techniques, the limits of the existing fracture risk scores in bone metastasis and the new numerical simulation technics arising in biomechanics.Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.
Highlights
Bones constitute one of the most common sites for metastasis
Knowing the loadings in specific daily activities would be of interest to define the range of variations of the loadings applied to metastatic bones
The high fracture risk of a bone metastasis becomes a changing and temporary condition for which multidisciplinary teams should aim at preserving locomotion by preventing pathologic fracture and treat pain
Summary
Bones constitute one of the most common sites for metastasis. The clinical cases submitted to our weekly bone metastasis multidisciplinary meetings highlight the benefits and challenges of modern therapies in all oncological specialties. We observe an increasing gap between the existing fracture bone scoring classifications and the current bone metastatic patient local and global prognosis enabled by new targeted therapies This topic is all the more important since these rapid bone changes may modify the care strategy, for example, choosing a temporary contention instead of orthopedic surgery, or opting for an aggressive eradicating treatment, such as stereotaxic radiotherapy on a regressive lesion initially considered as too large but related to potential neurological complications after relapse. All these points needed to be reviewed, from bedside to bench, in a single manuscript gathering all research fields and considering both bone locations (vertebrae and long bones) This challenge could be taken up with the contribution of a unique consortium, allowing a multidisciplinary approach, consisting of a bone metastasis physician (CBC), an osteoarticular radiologist (JBP), and fundamental expert research scientists in the pathophysiology of bone metastasis (PC) and bone biomechanics and numerical simulation (HF and DM). The progress made by the consortium has led to a new care strategy and conceptualization, as presented in the last figure of the review
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