Abstract
Over the past decades there has been an increase in the incidence of cancer worldwide. With the advancement in treatment, patient survival has improved in tandem with the increasing incidence. This, together with the availability of advanced modern diagnostic modalities, has resulted in more cases of metastatic bone disease being identified. Bone metastasis is an ongoing problem and has significant morbidity implications for patients affected. Multimodal treatment strategies are required in dealing with metastatic bone disease, which include both surgical and non-surgical treatment options. In the multidisciplinary team, orthopedic surgeons play an important role in improving the quality of life of cancer patients. Surgical intervention in this setting is aimed at pain relief, restoration of function and improvement in functional independence. In selected cases with resectable solitary metastasis, surgical treatment may be curative. With the advancement of surgical technique and improvement in implant design and manufacture, a vast array of surgical options are available in the modern orthopedic arena. In the majority of cases, limb salvage procedures have become the standard of care in the treatment of metastatic bone disease. Non-surgical adjuvant treatment also contributes significantly to the improvement of cancer patient care. A multidisciplinary approach in this setting is of paramount importance.
Highlights
The Scandinavian Skeletal Metastasis registry reported an 18% increase in the incidence of cancer over the past decade [1]
Through the advances of modern cancer treatment options, we see a general improvement in the longevity of cancer patients, and an increase in the risk of bone metastasis [7]
Gonzalez-Suarez et al published their study on the role of RANKL on RANK expressing tumor cells in mice. They demonstrated that the inhibition of RANKL in breast cancer had resulted in a decrease in associated lung metastasis [89]
Summary
The Scandinavian Skeletal Metastasis registry reported an 18% increase in the incidence of cancer over the past decade [1]. Through the advances of modern cancer treatment options, we see a general improvement in the longevity of cancer patients, and an increase in the risk of bone metastasis [7]. In the setting of metastatic disease, surgical treatment is aimed at alleviating pain, restoring functional independence, and improving the overall quality of life of patients [8]. Advanced implant technologies, including modern locking plates and intramedullary nails have provided treating surgeons with a more robust reconstructive option [10]. In the setting of metastatic bone disease construct fixation should be stable and strong enough to allow patients to immediately weight bear. In this regard, the modern implant repertoire allows individualization of treatment and a more predictable outcome
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