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Cancers
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Surgical Treatment of Bone Metastases
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Surgical Treatment of Bone Metastases

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 11177

Special Issue Editor

Prof. Dr. Michael Mørk Petersen

E-Mail Website
Guest Editor
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University of Copenhagen, 10. DK-1165 Copenhagen, Denmark
Interests: orthopedic oncology; bone sarcomas; soft tissue sarcomas; bone metastases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Bone metastases are common occurrences in many cancers and are especially common in lung, breast, kidney, and prostate cancer. Bone metastases can cause painful and debilitating bony lesions or pathological fractures, and when located in the spine, even spinal cord or nerve root damage leading to paralysis can occur. Surgical treatment of bone metastases is often a major surgery (e.g., spinal surgery or joint replacement surgery) performed on patients with a poor performance status and a high mortality. However, this surgery is often advantageous for the patients with respect to pain relief and function, but it can only very seldom be considered curative. Therefore, the selection of the right patients for bone metastasis surgery and selection of the surgical technique is extremely important in this patient group.

The intention of this Special Issue is to highlight all aspects of bone metastasis surgery research performed on all types of cancer patients, including patients suffering from hematologic malignancies.

Potential topics of interest, among others, for this Special Issue are surgical technique and selection of implants, patient survival, prediction of survival, surgical complications, implant survival, functional results, quality of life, and health economics.

Prof. Dr. Michael Mørk Petersen
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • metastatic bone disease
  • bone metastasis
  • pathological fractures
  • surgical treatment
  • patients survival
  • implant survival
  • functional results
  • surgical technique

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Published Papers (6 papers)

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Editorial

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2 pages, 155 KiB  
Editorial
Surgical Treatment of Metastatic Bone Disease—When Decisions at End-of-Life Really Makes the Difference
by Michala Skovlund Sørensen and Michael Mørk Petersen
Cancers 2021, 13(11), 2581; https://doi.org/10.3390/cancers13112581 - 25 May 2021
Cited by 1 | Viewed by 1488
Abstract
The current era within the field of surgical treatment of metastatic bone disease (MBD) is best described as the beginning of a paradigm shift [...] Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)

Research

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8 pages, 1199 KiB  
Article
Carbon Instrumentation in Patients with Metastatic Spinal Cord Compression
by Søren Schmidt Morgen, Emma Benedikte Alfthan Madsen, Anders Skive Weiland, Benny Dahl and Martin Gehrchen
Cancers 2024, 16(4), 736; https://doi.org/10.3390/cancers16040736 - 9 Feb 2024
Viewed by 968
Abstract
Recently carbon spinal implants have been introduced in the treatment of patients with metastatic spinal cord compression (MSCC). This is expected to decrease the deflection of radiation and improve diagnostic imaging and radiotherapy when compared to titanium implants. The aim of this study [...] Read more.
Recently carbon spinal implants have been introduced in the treatment of patients with metastatic spinal cord compression (MSCC). This is expected to decrease the deflection of radiation and improve diagnostic imaging and radiotherapy when compared to titanium implants. The aim of this study was to determine the safety and effectiveness of spinal carbon instrumentation (CI) in patients with MSCC in a large cohort study. A total of 163 patients received instrumentation between 1 January 2017 and 31 December 2021. A total of 80 were stabilized with CI and 83 with TI. The outcome measures were surgical revision, postsurgical survival, peri-operative bleeding, and surgery time. The peri-operative blood loss in the CI-group was significantly lower than that in the TI-group: 450mL vs. 630mL, (p = 0.02). There were no significant differences between the groups in mean survival (CI 9.9) vs. (TI 12.9) months (p = 0.39), or the number of patients needing a revision (CI 6) vs. (TI 10), (p = 0.39). The median duration of surgery was 121 min, (p = 0.99) with no significant difference between the two groups. Surgical treatment with CI for MSCC is safe and an equally sufficient treatment when compared to TI. Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)
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10 pages, 1137 KiB  
Article
Survival Prediction in Patients Treated Surgically for Metastases of the Appendicular Skeleton—An External Validation of 2013-SPRING Model
by Maria Anna Smolle, Ewald Musser, Marko Bergovec, Joerg Friesenbichler, Christine Linda Wibmer, Lukas Leitner, Michala Skovlund Sørensen, Michael Mørk Petersen, Iva Brcic, Joanna Szkandera, Susanne Scheipl and Andreas Leithner
Cancers 2022, 14(14), 3521; https://doi.org/10.3390/cancers14143521 - 20 Jul 2022
Cited by 2 | Viewed by 1349
Abstract
Introduction: The aim of this study was to externally validate the 2013-SPRING model, a survival prediction tool for patients treated surgically for bone metastases in a retrospective patient cohort from a single institution. Moreover, subgroup analyses on patients treated with (A) endoprostheses or [...] Read more.
Introduction: The aim of this study was to externally validate the 2013-SPRING model, a survival prediction tool for patients treated surgically for bone metastases in a retrospective patient cohort from a single institution. Moreover, subgroup analyses on patients treated with (A) endoprostheses or (B) osteosynthesis, as well as (C) upper limb and (D) lower limb metastases, were performed. Methods: Altogether, 303 cancer patients (mean age: 67.6 ± 11.1 years; 140 males (46.2%)) with bone metastases to the extremities, treated surgically between March 2000 and June 2018 at a single tertiary sarcoma centre, were retrospectively included. Median follow-up amounted to 6.3 (interquartile range (IQR): 2.3–21.8) months, with all patients followed-up for at least one year or until death. The 2013-SPRING model was applied to assess the prognostication accuracy at 3, 6 and 12 months. Models were validated with area under the curve receiver operator characteristic (AUC ROC; the higher the better), as well as Brier score. Results: Of the 303 patients, 141 had been treated with osteosynthesis (46.5%), and the remaining 162 patients with endoprosthesis (53.5%). Sixty-five (21.5%) metastases were located in the upper limbs, and two hundred and thirty-eight (78.5%) in the lower limbs. Using the 2013-SPRING model for the entire cohort, the accuracy of risk of death prediction at 3, 6 and 12 months, determined by the AUC ROC, was 0.782 (95% CI: 0.729–0.843), 0.810 (95% CI: 0.763–0.858) and 0.802 (95% CI: 0.751–0.854), respectively. Corresponding Brier scores were 0.170, 0.178 and 0.169 at 3, 6 and 12 months. In the subgroup analyses, predictive accuracy of the 2013-SPRING model was likewise encouraging, albeit being slightly higher in the osteosynthesis subgroup as compared with the endoprosthesis subgroup, and also higher in the upper limb in comparison to the lower limb metastasis subgroup. Conclusions: The current validation study of the 2013-SPRING model shows that this model is clinically relevant to use in an external cohort, also after stratification for surgical procedure and metastasis location. Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)
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16 pages, 1135 KiB  
Article
Surgical Treatment of Metastatic Bone Disease in the Appendicular Skeleton: A Population-Based Study
by Thea Hovgaard Ladegaard, Celine Lykke Sørensen, Rasmus Nielsen, Anders Troelsen, Dhergam Ahmed Ali Al-Mousawi, Rikke Bielefeldt, Michael Mørk Petersen and Michala Skovlund Sørensen
Cancers 2022, 14(5), 1258; https://doi.org/10.3390/cancers14051258 - 28 Feb 2022
Cited by 3 | Viewed by 2144
Abstract
Background: Population-based studies of patients with bone metastases in the appendicular skeleton (aBM) requiring surgery for complete or impending fracture are rare. In this epidemiologically-based observational study we created a large population-based cohort of patients treated for aBM, aiming to: (1) monitor [...] Read more.
Background: Population-based studies of patients with bone metastases in the appendicular skeleton (aBM) requiring surgery for complete or impending fracture are rare. In this epidemiologically-based observational study we created a large population-based cohort of patients treated for aBM, aiming to: (1) monitor possible time-related changes of the incidence of surgical treatment of aBM-lesions, (2) examine differences in the population and care of patients treated at different treatment centers and (3) examine if findings from a previous pilot study regarding absence of a suitable biopsy of the lesions representing debut of cancer or a relapse has improved the awareness of aBM and hereby increased the focus on regular tumor biopsies and follow-up imaging of cancer patients. Methods: We examined a population-based cohort consisting of all patients treated for aBM 2014–2019. Procedures were performed at five secondary surgical centers (SSC) or one tertiary referral Musculoskeletal Tumor Center (MTC). Patients were followed until end of study (30 September 2021) or death. No patients were lost to follow-up. Results: Four-hundred-fifty-seven patients (493 primary aBM-lesions, 482 procedures) were included. Annual incidence of aBM-surgery was 46 aBM-lesions/million. MTC-patients had a significant better preoperative status than SSC-patients considering factors known for survival. Patients with complete fracture experienced longer surgical delay when treated at MTC compared to SSC: 4 (1–9) and 1 (1–3) days (p < 0.001), respectively. Overall survival for the entire cohort was 37% and 11% at 1 and 5 years (MTC and SSC 1 and 5 year respectively: 44% and 15% vs. 29% and 5%, p < 0.001). In patients with debut or relapse of cancer, 8% and 9% had insufficient biopsies, and 21% and 12% had no biopsy, respectively. Comparison showed no change over time. Conclusions: The current study highlights the low awareness on treating aBM at SSC and emphasizes the importance of caution in interpretation of studies not representing an entire population, thus introducing selection bias. Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)
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11 pages, 1637 KiB  
Article
Pretreatment Plasma IL-6 and YKL-40 and Overall Survival after Surgery for Metastatic Bone Disease of the Extremities
by Michala Skovlund Sørensen, Thomas Colding-Rasmussen, Peter Frederik Horstmann, Klaus Hindsø, Christian Dehlendorff, Julia Sidenius Johansen and Michael Mørk Petersen
Cancers 2021, 13(11), 2833; https://doi.org/10.3390/cancers13112833 - 7 Jun 2021
Cited by 2 | Viewed by 2219
Abstract
Background: Plasma IL-6 and YKL-40 are prognostic biomarkers for OS in patients with different types of solid tumors, but they have not been studied in patients before surgery of metastatic bone disease (MBD) of the extremities. The aim was to evaluate the prognostic [...] Read more.
Background: Plasma IL-6 and YKL-40 are prognostic biomarkers for OS in patients with different types of solid tumors, but they have not been studied in patients before surgery of metastatic bone disease (MBD) of the extremities. The aim was to evaluate the prognostic value of plasma IL-6 and YKL-40 in patients undergoing surgery for MBD of the extremities. Patients and Methods: A prospective study included all patients undergoing surgery for MBD in the extremities at a tertiary referral center during the period 2014–2018. Preoperative blood samples from index surgery were included. IL-6 and YKL-40 concentrations in plasma were determined by commercial ELISA. A total of 232 patients (median age 66 years, IQR 58–74; female 51%) were included. Results: Cox regression analysis was performed to identify independent prognostic factors for OS. IL-6 correlated with YKL-40 (rho = 0.46, p < 0.01). In univariate analysis (log2 continuous variable) IL-6 (HR = 1.26, 95% CI 1.16–1.37), CRP (HR = 1.20, 95% CI 1.12–1.29) and YKL-40 (HR = 1.25, 95% CI 1.15–1.37) were associated with short OS. In multivariable analysis, adjusted for known risk factors for survival, only log2(IL-6) was independently associated with OS (HR = 1.24, 95% CI 1.08–1.43), whereas CRP and YKL-40 were not. Conclusion: High preoperative plasma IL-6 is an independent biomarker of short OS in patients undergoing surgery for MBD. Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)
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Review

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12 pages, 701 KiB  
Review
The Role of Post-Operative Radiotherapy for Non-Spine Bone Metastases (NSBMs)
by Sherif Ramadan, Andrew J. Arifin and Timothy K. Nguyen
Cancers 2023, 15(13), 3315; https://doi.org/10.3390/cancers15133315 - 23 Jun 2023
Viewed by 1769
Abstract
Non-spine bone metastases (NSBMs) can cause significant morbidity and deterioration in the quality of life of cancer patients. This paper reviews the role of post-operative radiotherapy (PORT) in the management of NSBMs and provides suggestions for clinical practice based on the best available [...] Read more.
Non-spine bone metastases (NSBMs) can cause significant morbidity and deterioration in the quality of life of cancer patients. This paper reviews the role of post-operative radiotherapy (PORT) in the management of NSBMs and provides suggestions for clinical practice based on the best available evidence. We identified six retrospective studies and several reviews that examined PORT for NSBMs. These studies suggest that PORT reduces local recurrence rates and provides effective pain relief. Based on the literature, PORT was typically delivered as 20 Gy in 5 fractions or 30 Gy in 10 fractions within 5 weeks of surgery. Complete coverage of the surgical hardware is an important consideration when designing an appropriate radiation plan and leads to improved local control. Furthermore, the integration of PORT in a multidisciplinary team with input from radiation oncologists and orthopedic surgeons is beneficial. A multimodal approach including PORT should be considered for an NSBM that requires surgery. However, phase III studies are needed to answer many remaining questions and optimize the management of NSBMs. Full article
(This article belongs to the Special Issue Surgical Treatment of Bone Metastases)
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