Management of Metastasis Bone Disease
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Dr. Achmad Basuki, Sp. OT
SMF Orthopaedi, Dharmais cancer center Hospital, Jakarta
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The most common cause of a destructive lesion of skeletal in adult
More than Primary sarcoma of the boneThe skeleton is the third most common
target of metastatic cancer can be one of the earliest sites affectedWhich produces the greatest morbidity
- loss of functionality- loss of quality of life- decreased survival
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The role of the orthopedist are
- to establish or confirm diagnosis
- to evaluate for risk of fracture or
impending fracture
- to stabilize or other wish surgical
treatment pathological fracture
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Batson’s vertebra vein
plexus
The most common
site of bone
metastasis
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Osteolytic
• Bone destruction is
mediated by osteoclasts
in patients with either
breast cancer or
multiple myeloma
Osteoblastic
• Excess bone formation is
mediated by osteoblasts
in patients with either
prostate or breast cancer
Mundy GR. Nat Rev Cancer.
2002;8:584-593.
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STROMAL CELL/
OSTEOBLAST
PRECURSOR
OSTEOCLAST
PTHr PCa ++
PO 4
Mature
Osteoclast
Bone Re-absorption
Differentiation
RANK L
RANK r
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Pathologic Fractures
8-30%
Bone pain
50%
Spinal cord
compression
5%
Hypercalcemia 10%
Decrease Quality
of life and
Negative impact
on survival
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Diagnosis
treatment
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Bone scan
NormalLESION
X-Ray abnormal area
CT or MRI
MetastasisNormal
Biopsi ?
MetastasisBenign
Normal
Malignancy
Biopsi
BONE PAIN
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Pain control
Inhibition of osteolysis
Handling complication
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Non surgery
surgery
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1. Pain Control
- Analgesics
- Radiation
- Chemotherapy
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2. Inhibition of Osteolysis
- Bisphosphonates
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• Bind to resorption sites
Bisphosphonateshave a strong
affinity for calcium phosphate
• Direct effects on osteoclasts
• Indirect effects via other cells
Bisphosphonatesinhibit bone resorption
• Recruitment of cells
• Adhesion to bone
• Lifespan of cells (increasing rates of apoptosis)
• Cellular activity
Bisphosphonatesdecrease 4
parameters of osteoclast function
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3. Handling complication
Surgical management it has to
benefit improving life
quality
goal :
1. to provide local tumor control
2. immediate weight bearing & function
indications :
- for diagnosis
-prophylactic fixation of impending fractures
- stabilization of pathologic fracture
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General consideration
• Life expectancy at least 6 to 12 week consider for surgical candidate
• Patient recovery time from surgery should not outlast estimated time survival
• Provide immediately stable reconstruction
• Scoring assessment to predict the surgical candidate
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Tomita K,
Kawahara N, Kobayashi T, Yoshida A, Murakami H,
Akamaru T. Surgical strategy for spinal
metastases. Spine. 2001;26:298-306.)
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Walker MP, Yaszemski MJ, Kim CW, Talac R, Currier BL.
Metastatic
disease of the spine: evaluation and treatment. Clin Orthop
Relat Res. 2003;415 Suppl:S165-75.
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