Advertisement

How Expected Survival Influences the Choice of Surgical Procedure in Metastatic Bone Disease

  • Panagiotis Tsagozis
  • Jonathan Forsberg
  • Henrik C. F. Bauer
  • Rikard Wedin
Chapter

Abstract

Accurate estimation of expected survival is very helpful in the choice of patients that are good candidates for surgery, as well as in the choice of the surgical method and implant used. If we treat the short-time survivors and the long-time survivors with the same reconstruction, we will inevitably overtreat the short-time survivors and undertreat the long-time survivors. This translates to too extensive surgery and rehabilitation need in the short-time survivors. In this chapter we discuss our present general treatment recommendations based on prognosis.

Keywords

Skeletal metastasis Bone metastasis Survival Prognosis PATHFx Skeletal reconstruction Surgical treatment 

References

  1. 1.
    Hansen BH, Keller J, Laitinen M, Berg P, Skjeldal S, Trovik C, et al. The Scandinavian Sarcoma Group Skeletal Metastasis Register. Survival after surgery for bone metastases in the pelvis and extremities. Acta Orthop Scand Suppl. 2004;75:11–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Kirkinis MN, Lyne CJ, Wilson MD, Choong PFM. Metastatic bone disease: a review of survival, prognostic factors and outcomes following surgical treatment of the appendicular skeleton. Eur J Surg Oncol. 2016.  https://doi.org/10.1016/j.ejso.2016.03.036.
  3. 3.
    Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, Bergh P, et al. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol. 2013;22:132–8.  https://doi.org/10.1016/j.suronc.2013.02.008.CrossRefPubMedGoogle Scholar
  4. 4.
    Wedin R. Surgical treatment for pathologic fracture. Acta Orthop Scand Suppl. 2001;72:2p., 1–29.CrossRefPubMedGoogle Scholar
  5. 5.
    Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop. 1989;2003:S4–13.  https://doi.org/10.1097/01.blo.0000093045.56370.dd.CrossRefGoogle Scholar
  6. 6.
    Ratasvuori M, Wedin R, Hansen BH, Keller J, Trovik C, Zaikova O, et al. Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases. J Surg Oncol. 2014;110:360–5.  https://doi.org/10.1002/jso.23654.CrossRefPubMedGoogle Scholar
  7. 7.
    Fukushima H, Hozumi T, Goto T, Nihei K, Karasawa K, Nakanishi Y, et al. Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis. Clin Exp Metastasis. 2016;33:699–705.  https://doi.org/10.1007/s10585-016-9805-y.CrossRefPubMedGoogle Scholar
  8. 8.
    Wedin R, Bauer HC, Wersäll P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999;358:128–39.CrossRefGoogle Scholar
  9. 9.
    Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine. 1999;24:1943–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Bollen L, de Ruiter GCW, Pondaag W, Arts MP, Fiocco M, Hazen TJT, et al. Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases. Eur Spine J. 2013;22:1408–16.  https://doi.org/10.1007/s00586-013-2726-4.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lau D, Leach MR, Than KD, Ziewacz J, La Marca F, Park P. Independent predictors of complication following surgery for spinal metastasis. Eur Spine J. 2013;22:1402–7.  https://doi.org/10.1007/s00586-013-2706-8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Viganò A, Dorgan M, Bruera E, Suarez-Almazor ME. The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer. 1999;86:170–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C. How accurate are physicians’ clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol (R Coll Radiol). 2001;13:209–18.Google Scholar
  14. 14.
    Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66:143–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Forsberg JA, Eberhardt J, Boland PJ, Wedin R, Healey JH. Estimating survival in patients with operable skeletal metastases: an application of a Bayesian belief network. PLoS One. 2011;6:e19956.  https://doi.org/10.1371/journal.pone.0019956.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Forsberg JA, Wedin R, Bauer HCF, Hansen BH, Laitinen M, Trovik CS, et al. External validation of the Bayesian Estimated Tools for Survival (BETS) models in patients with surgically treated skeletal metastases. BMC Cancer. 2012;12:493.  https://doi.org/10.1186/1471-2407-12-493.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Piccioli A, Spinelli MS, Forsberg JA, Wedin R, Healey JH, Ippolito V, et al. How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations. BMC Cancer. 2015;15:424.  https://doi.org/10.1186/s12885-015-1396-5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ogura K, Gokita T, Shinoda Y, Kawano H, Takagi T, Ae K, Kawai A, Wedin R, Forsberg JA. Can a multivariate model for survival estimation in skeletal metastases (PATHFx) be externally validated using Japanese patients? Clin Orthop Relat Res. 2017;475(9):2263–70.  https://doi.org/10.1007/s11999-017-5389-3.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Wedin R, Hansen BH, Laitinen M, Trovik C, Zaikova O, Bergh P, et al. Complications and survival after surgical treatment of 214 metastatic lesions of the humerus. J Shoulder Elb Surg. 2012;21:1049–55.  https://doi.org/10.1016/j.jse.2011.06.019.CrossRefGoogle Scholar
  20. 20.
    Nelson DA, Barker ME, Hamlin BH. Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia. 1997;13:287–306.CrossRefPubMedGoogle Scholar
  21. 21.
    Stark A, Bauer HC. Reconstruction in metastatic destruction of the acetabulum. Support rings and arthroplasty in 12 patients. Acta Orthop Scand. 1996;67:435–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Weiss RJ, Wedin R. Surgery for skeletal metastases in lung cancer. Acta Orthop. 2011;82:96–101.  https://doi.org/10.3109/17453674.2011.552779.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Tsagozis P, Wedin R, Brosjö O, Bauer H. Reconstruction of metastatic acetabular defects using a modified Harrington procedure. Acta Orthop. 2015;86:690–4.  https://doi.org/10.3109/17453674.2015.1077308.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Weiss RJ, Ekström W, Hansen BH, Keller J, Laitinen M, Trovik C, et al. Pathological subtrochanteric fractures in 194 patients: a comparison of outcome after surgical treatment of pathological and non-pathological fractures. J Surg Oncol. 2013;107:498–504.  https://doi.org/10.1002/jso.23277.CrossRefPubMedGoogle Scholar
  25. 25.
    Bauer HC. Posterior decompression and stabilization for spinal metastases. Analysis of sixty-seven consecutive patients. J Bone Joint Surg Am. 1997;79:514–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Tibbs MK. Wound healing following radiation therapy: a review. Radiother Oncol J Eur Soc Ther Radiol Oncol. 1997;42:99–106.CrossRefGoogle Scholar
  27. 27.
    Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases: final results of the study by the Radiation Therapy Oncology Group. Cancer. 1982;50:893–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Panagiotis Tsagozis
    • 1
    • 2
  • Jonathan Forsberg
    • 2
    • 3
  • Henrik C. F. Bauer
    • 1
    • 2
  • Rikard Wedin
    • 1
    • 2
  1. 1.Department of OrthopaedicsKarolinska University HospitalStockholmSweden
  2. 2.Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
  3. 3.Orthopaedic Oncology, Orthopaedics, Walter Reed Department of SurgeryUniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations