BMC Musculoskeletal Disorders | |
Analysis of orthopedic surgery of bone metastases in breast cancer patients | |
Matthias F Pietschmann1  Hans Roland Dürr1  Volkmar Jansson1  Joachim Stemmler2  Marcus Schlemmer2  Bernd Wegener1  | |
[1] Orthopedic Oncology, Department of Orthopedic Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, D-81377, München, Gemany;Medical Clinic III, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377, Munich, Germany | |
关键词: Surgical treatment of bone metastases; Bone metastases; Breast cancer; | |
Others : 1134412 DOI : 10.1186/1471-2474-13-232 |
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received in 2012-01-02, accepted in 2012-11-22, 发布年份 2012 | |
【 摘 要 】
Background
Breast cancer is the most common malignancy and the second leading cause of death in women. Because bone metastases are a common finding in patients with breast cancer, they are of major clinical concern.
Methods
In 115 consecutive patients with bone metastases secondary to breast cancer, 132 surgical procedures were performed. Medical records and imaging procedures were reviewed for age, treatment of the primary tumor, clinical symptoms, surgical treatment, complications, and survival.
Results
The overall survival of patients with metastatic breast cancer was dependent on the site and the amount of the metastases. Age was not a prognostic factor for survival. If the result of the orthopaedic surgery was a wide resection (R0) survival was significantly better than in the R1 (marginal resection – tumor resection in sane tissue) or R2 (intralesional resection) situation. Concerning the orthopaedic procedures there was no survival difference.
Conclusion
In conclusion a wide (R0) resection and the absence of pathological fracture and visceral metastases were predictive for longer survival in univariate analysis. Age and the type of orthopaedic surgery had no impact on survival in multivariate analysis. The resection margins lost significance. The standard of care for patients with metastatic breast cancer to the bone requires a multidisciplinary approach.
【 授权许可】
2012 Wegener et al.; licensee BioMed Central Ltd.
【 预 览 】
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【 参考文献 】
- [1]Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ: Cancer statistics, 2007. CA Cancer J Clin 2007, 57(1):43-66.
- [2]Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer statistics, 2008. CA Cancer J Clin 2008, 8:71-96.
- [3]Lee YT: Breast carcinoma: pattern of metastases at autopsy. J Surg Oncol 1983, 23(3):175-180.
- [4]Sherry MM, Greco FA, Johnson DH, Hainsworth JD: Metastatic breast cancer confined to the skeletal system. An indolent disease. Am J Med 1986, 81(3):381-386.
- [5]Mundy GR: Metastases to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer 2002, 2(8):584-593.
- [6]Wedin R, Bauer HC, Rutqvist LE: Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients. Cancer 2001, 92(2):257-262.
- [7]Choi BS, Robins HI: Primary disease resection in metastatic breast cancer improves survival. J Clin Oncol 2007, 25(5):603-604.
- [8]Jubelirer SJ, Wilson R, Summers L, Richardson S: Prognostic factors determining survival in breast cancer patients presenting with metastatic disease. W V Med J 1990, 86(1):7-9.
- [9]Ripamonti C, Fulfaro F: Malignant bone pain: pathophysiology and treatments. Curr Rev Pain 2000, 4(3):187-196.
- [10]Gainford MC, Dranitsaris G, Clemons M: Systemic treatment from bone metastases in breast cancer: is it all that it`s cracked up to be? J Clin Oncol 2005, 23(21):4802-4803.
- [11]Randall RL, Aoki SK, Olson PR, Bott SI: Complications of cemented long-stem hip arthroplasties in metastatic bone disease. Clin Orthop Relat Res 2006, 443:287-295.
- [12]Layman R, Olson K, van Poznak C: Bisphosphonates for breast cancer:questions ansered, questions remaining. Hematol Oncol Clin North Am 2007, 21(2):341-367.
- [13]Rosen LS, Gordon DH, Dugan W Jr, Major P, Eisenberg PD, Provencher L, Kaminski M, Simeone J, Seaman J, Chen BL, Coleman RE: Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast carcinoma patients with at least one osteolytic lesion. Cancer 2004, 100:36-43.
- [14]Chow E, Harris K, Fan G, Tsao M, Sze WM: Palliative radiotherapy trials for bone metastases: a systemic review. J Clin Oncol 2007, 25:1423-1436.
- [15]Cumming D, Cumming J, Vince A, Benson R: Metastatic bone disease: the requirement for improvement in a multidisciplinary approach. Int Orthop 2009, 33(2):493-496.
- [16]Snyder BD, Cordio MA, Nazarian A, Kwak SD, Chang DJ, Entezari V, Zurakowski D, Parker LM: Noninvasive prediction of fracture risk in patients with metastatic cancer to the spine. Clin Cancer Res 2009, 15(24):7676-7683.
- [17]Weber KL, Randall RL, Grossmann S: Management of lower-extremity bone metastases. J Bone Joint Surg Am 2006, 88(Suppl 4):11-19.
- [18]Selek H, Başarir K, Yildiz Y, Sağlik Y: Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur. J Arthroplasty 2007, 23(1):112-117.
- [19]Eckardt JJ, Kabo JM, Kelly CM, Ward WG Sr, Cannon CP: Endoprosthetic reconstructions for bone metastases. Clin Orthop Relat Res 2003, 415(Suppl):254-262.
- [20]Dürr HR, Müller PE, Lenz T, Baur A, Jansson V, Refior HJ: Surgical treatment of bone metastases in patients with breast cancer. Clin Orthop Relat Res 2002, 396:191-196.
- [21]Marulanda GA, Mont MA, Lucci A, Letson GD, Khakpour N: Orthopedic surgery implications of breast cancer. Expert Rev Anticancer Ther 2009, 8(6):949-956.
- [22]Narazaki DK, de Alverga Neto CC, Baptista AM, Caiero MT, de Camargo OP: Prognostic factors in pathologic fractures secondary to metastatic tumors. Clinics (Sao Paulo) 2006, 61(4):313-320.
- [23]Di Martino A, Vincenzi B, Denaro L, Barnaba SA, Papalia R, Santini D, Tonini G, Denaro V: 'Internal bracing' surgery in the management of solid tumor metastases of the thoracic and lumbar spine. Oncol Rep 2009, 21(2):431-435.
- [24]Bauer HC: Indications for surgical treatment of spinal metastases. Ortop Traumatol Rehabil 2003, 5(2):164-166.
- [25]Shehadi JA, Sciubba DM, Suk I, Suki D, Maldaun MV, McCutcheon IE, Nader R, Theriault R, Rhines LD, Gokaslan ZL: Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients. Eur Spine J 2007, 16(8):1179-1192.
- [26]McArthur N, Kasperk C, Baier M, Tanner M, Gritzbach B, Schoierer O, Rothfischer W, Krohmer G, Hillmeier J, Kock HJ, Meeder PJ, Huber FX: 1150 kyphoplasties over 7 years: indications, techniques, and intraoperative complications. Orthopedics 2009, 32(2):90.
- [27]Bauer HC, Wedin R: Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand 1995, 66:143-146.