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Metastatic Bone Disease pp 223–233Cite as

Issues Facing the Established Metastatic Bone Disease Patient, Timing/Indications for Surgery

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Abstract

This chapter explores several challenges faced by clinicians when treating patients with established metastatic disease of bone. The goal is to review general principles and information from other disciplines as they relate to surgical decision making. The methodology and role of preoperative risk assessment in counseling patients with known metastatic disease is discussed. The difficult challenge of survival prognostication for metastatic cancer patients by even experienced practitioners is reviewed, and the impact of this uncertainty on shared surgical decision making between surgeon and patient is examined. The influence of disease location and severity, concurrent chemotherapy, and completed or planned radiation therapy upon surgical timing is reviewed with an emphasis on recent evidence and practical applications. The potential consequences of targeted cancer therapies upon surgical indications, techniques, and complications are discussed with analysis of current evidence and future prospects. The chapter concludes with a review of recent advances suggesting that surgical treatment of metastatic bone disease may aid the systemic treatment of cancer through immune modulation.

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Author information

Authors and Affiliations

  1. Division of Orthopedic Oncology, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA

    George T. Calvert MD, MBA

Authors
  1. George T. Calvert MD, MBA
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Corresponding author

Correspondence to George T. Calvert MD, MBA .

Editor information

Editors and Affiliations

  1. Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah, USA

    R. Lor Randall

Urgency Definitions

Urgency Definitions

Emergency:

  • Likely loss of life or limb if surgical intervention delayed more than 6 h.

  • Urgent: Surgical intervention required between 6–24 h to avoid loss of life or limb; limited clinical evaluation is usually possible.

  • Time Sensitive: Delay of surgery >1–6 weeks to allow for evaluation or significant changes in management will result in patient harm; most oncology cases fall into this category.

  • Elective: Procedure can be delayed for up to 1 year.

Risk Definitions

  • Low Risk: Risk of death or myocardial infarction is <1 %.

  • Elevated Risk: Risk of death or myocardial infarction is 1 % or greater.

  • Percent risk is determined by both the procedure and the patient’s risk factors.

  • Both the RCRI (below) and ACS NSQIP Risk Calculator may be used to calculate the risk.

Risks Addressed by the Guidelines

  • Coronary Artery Disease

  • Heart Failure

  • Cardiomyopathy

  • Valvular Heart Disease

  • Arrhythmias and Conduction Disorders

  • Pulmonary Vascular Disease

  • Adult Congenital Heart Disease

Revised Cardiac Risk Index (RCRI) Factors

  • High Risk Surgery

  • History of Ischemic Heart Disease

  • History of Heart Failure

  • History of Cerebrovascular Disease

  • Diabetes Mellitus Requiring Insulin

  • Serum Creatinine >2.0 mg/dl

  • 1 factor entails a death or myocardial infarction risk of 1 %

Activities Requiring >4 METS

  • Climb 2 Flights of Stairs

  • Walk 4 Blocks

  • Heavy House Work

  • Walk 4 mph on Level Ground

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Calvert, G.T. (2016). Issues Facing the Established Metastatic Bone Disease Patient, Timing/Indications for Surgery. In: Randall, R. (eds) Metastatic Bone Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5662-9_19

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  • DOI: https://doi.org/10.1007/978-1-4614-5662-9_19

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5661-2

  • Online ISBN: 978-1-4614-5662-9

  • eBook Packages: MedicineMedicine (R0)

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