Abstract
Metastatic bone disease (MBD) is common—it is detected in up to 65–75% of patients with breast or prostate cancer, in over 35% of patients with lung cancer; and almost all patients with symptomatic multiple myeloma have focal lesions or a diffuse bone marrow infiltration. Metastatic bone disease can cause a variety of symptoms and is often associated with a poorer prognosis, with high social and health-care costs. Population-based cohort studies confirm significantly increased health-care utilization costs in patients presenting with cancer with MBD compared with those without MBD. The prolonged survival of patients with bone metastasis thanks to advances in therapy presents an opportunity for better treatments for this patient cohort. Early and accurate diagnosis of bone metastases is therefore crucial. The patterns and presentation of MBD are quite heterogeneous and necessitate good knowledge of the possibilities and limitations of each imaging modality. Here, we review the state-of-the-art imaging techniques, assess the need for evidence-based and cost-effective patient care pathways, and advocate multidisciplinary management based on collaborations between orthopedic surgeons, pathologists, oncologists, radiotherapists, and radiologists aimed at improving patient outcomes. Radiologists play a key role in this multidisciplinary approach to decision-making through correlating the tumor entity, the tumor biology, the impact on the surrounding tissues and progression, as well as the overall condition of the patient. This approach helps to choose the best patient-tailored imaging plan advocating a “choose wisely” strategy throughout the initial diagnosis, minimally invasive treatment procedures, as well as follow-up care plans.
Highlights
Bone metastases are common, can cause a variety of symptoms, and are often associated with a poorer prognosis
Metastatic bone disease (MBD) itself is not visible on radiographs unless the tumor is mineralized or leads to a clear osteolysis as in myeloma [28] focal lesions, which is depicted when more than 50% of the bone substance has vanished [29]
The ASCO recommends that cancer-directed therapy not be used for patients with solid tumors with the following characteristics: low performance status (3 or 4), no benefit from prior evidencebased interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti-cancer treatment
Summary
Can cause a variety of symptoms, and are often associated with a poorer prognosis. Over 1.9 billion dollars was spent on managing MBD in prostate cancer patients in the United States in 2004 [6] Such costs have increased over time owing to the prolonged survival and development of more innovative treatments that can be offered to the patient when compared with previous decades. It is important to develop agreed upon local pathways for referral of these patients and to communicate this information widely across their local clinical settings This facilitates discussions between various disciplines and expedites a patient-specific tailored management plan, with potential cost and time savings. Advances in imaging have increased the sensitivity and specificity of detecting bone lesions, increasing the positive predicative value of imaging With these advances, expectations of patients and carers with regard to medical care and health-care professionals have increased
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