Can surgical management of bone metastases improve quality of life among women with gynecologic cancer?

World Journal of Surgical Oncology

Wei Guo⁴  Bang H Hoang¹  Kunkun Sun³  Yifei Wang⁴  Ramez Eskander²  Tao Ji¹ 

[1] Department of Orthopaedic Surgery and Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA 92868, USA;Department of Obsterics and Gynecology, Division of Gynecologic Oncology, University of California Irvine Medical Center, Orange, CA 92868, USA;Department of Pathology, People’s Hospital, Peking University, Beijing 100044, China;Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing 100044, China

关键词: palliative treatment;    quality of life;    surgery;    bone metastasis;    gynecological cancer;   

Others  :  1148383
DOI  :  10.1186/1477-7819-12-250

 received in 2014-01-30, accepted in 2014-07-20,  发布年份 2014

【 摘 要 】

Background

The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival.

Methods

Eighteen patients underwent surgical procedures for the treatment of bone metastases secondary to gynecologic cancer between September 2003 and April 2012. The primary cancer sites included the uterus (n = 10), the cervix (n = 5), and an ovary (n = 3). Patients were followed for an average period of 13.8 months (range, 2 to 34 months). A visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status were evaluated both pre- and postoperatively.

Results

The median survival time following diagnosis of bone metastasis was 10.0 months. The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery. The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.

Conclusions

The prognosis of gynecological cancer patients with bone metastasis is poor. Some patients had improvement in their quality of life after surgical intervention for bone metastases; however, novel integrated treatment modalities should be investigated.

【 授权许可】

   
2014 Ji et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 2012, 62:10-29.
• [2]Fulcher AS, O’Sullivan SG, Segreti EM, Kavanagh BD: Recurrent cervical carcinoma: typical and atypical manifestations. Radiographics 1999, 19:S103-S116. quiz S264-105
• [3]Abdul-Karim FW, Kida M, Wentz WB, Carter JR, Sorensen K, Macfee M, Zika J, Makley JT: Bone metastasis from gynecologic carcinomas: a clinicopathologic study. Gynecol Oncol 1990, 39:108-114.
• [4]Rose PG, Piver MS, Tsukada Y, Lau T: Patterns of metastasis in uterine sarcoma. An Autopsy Study. Cancer 1989, 63:935-938.
• [5]Cormio G, Rossi C, Cazzolla A, Resta L, Loverro G, Greco P, Selvaggi L: Distant metastases in ovarian carcinoma. Int J Gynecol Cancer 2003, 13:125-129.
• [6]Thanapprapasr D, Nartthanarung A, Likittanasombut P, Na Ayudhya NI, Charakorn C, Udomsubpayakul U, Subhadarbandhu T, Wilailak S: Bone metastasis in cervical cancer patients over a 10-year period. Int J Gynecol Cancer 2010, 20:373-378.
• [7]Matsuyama T, Tsukamoto N, Imachi M, Nakano H: Bone metastasis from cervix cancer. Gynecol Oncol 1989, 32:72-75.
• [8]Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF: Impact of surgical intervention on quality of life in patients with spinal metastases. Spine (Phila Pa 1976) 2006, 31:2849-2856.
• [9]Hoshi M, Takada J, Ieguchi M, Takahashi S, Nakamura H: Prognostic factors for patients with solitary bone metastasis. Int J Clin Oncol 2013, 18:164-169.
• [10]Nathan SS, Healey JH, Mellano D, Hoang B, Lewis I, Morris CD, Athanasian EA, Boland PJ: Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. J Clin Oncol 2005, 23:6072-6082.
• [11]Tjalma WA, Somville J: Fibula metastasis as the presenting feature of vaginal cancer. Eur J Gynaecol Oncol 2011, 32:114-116.
• [12]Jiang GQ, Gao YN, Gao M, Zheng H, Yan X, Wang W, An N, Cao K: Clinicopathological features and treatment of extremity bone metastasis in patients with endometrial carcinoma: a case report and review. Chin Med J (Engl) 2011, 124:622-626.
• [13]Corrado G, Santaguida S, Zannoni G, Scambia G, Ferrandina G: Femur metastasis in carcinoma of the uterine cervix: a rare entity. Arch Gynecol Obstet 2010, 281:963-965.
• [14]Chen YL, Hsiao SM, Lin MC, Lin HH: Bone metastasis as the initial presentation in one case of ovarian cancer with two components of endometrioid adenocarcinoma and adenosarcoma. Taiwan J Obstet Gynecol 2009, 48:298-301.
• [15]Du ZY, Zang J, Tang XD, Guo W: Experts’ agreement on therapy for bone metastases. Orthop Surg 2010, 2:241-253.
• [16]Blecharz P, Urbanski K, Mucha-Malecka A, Malecki K, Reinfuss M, Jakubowicz J, Skotnicki P: Hematogenous metastases in patients with Stage I or II endometrial carcinoma. Strahlenther Onkol 2011, 187:806-811.
• [17]Chang KH, Lee JP, Ryu HS: Rare case of stage IA epithelial ovarian cancer with bone as the first site of recurrent metastasis. Int J Gynecol Cancer 2006, 16(Suppl 1):322-326.
• [18]Vizzielli G, Fanfani F, Costantini B, Gallotta V, Scambia G, Fagotti A: External hemipelvectomy as treatment for solitary coxofemoral metastasis from endometrial carcinoma: case report and review of the literature. J Obstet Gynaecol Res 2012, 38:892-898.
• [19]Ratanatharathorn V, Powers WE, Steverson N, Han I, Ahmad K, Grimm J: Bone metastasis from cervical cancer. Cancer 1994, 73:2372-2379.
• [20]Ishibashi M, Fujiwaki R, Nakayama I, Miura H, Sawada K: Endometrial carcinosarcoma presenting as a tibial metastasis. Int J Clin Oncol 2007, 12:305-308.
• [21]Sahinler I, Erkal H, Akyazici E, Atkovar G, Okkan S: Endometrial carcinoma and an unusual presentation of bone metastasis: a case report. Gynecol Oncol 2001, 82:216-218.
• [22]Loizzi V, Cormio G, Cuccovillo A, Fattizzi N, Selvaggi L: Two cases of endometrial cancer diagnosis associated with bone metastasis. Gynecol Obstet Invest 2006, 61:49-52.
• [23]Kumar R, Gupta R, Khullar S, Padhy AK, Julka PK, Malhotra A: Bone scanning for bone metastasis in carcinoma cervix. J Assoc Physicians India 2000, 48:808-810.
• [24]Sugiura H, Yamada K, Sugiura T, Hida T, Mitsudomi T: Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res 2008, 466:729-736.
• [25]Lin CC, Chen PQ, Chen WJ, Chen LH: Prognosis of operative treatment for metastatic hepatocellular carcinoma of the spine. Clin Orthop Relat Res 2006, 444:209-215.
• [26]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.
• [27]Khan FA, Rose PS, Yanagisawa M, Lewallen DG, Sim FH: Surgical technique: Porous tantalum reconstruction for destructive nonprimary periacetabular tumors. Clin Orthop Relat Res 2012, 470:594-601.
• [28]Ji T, Guo W, Yang RL, Tang S, Sun X: Clinical outcome and quality of life after surgery for peri-acetabular metastases. J Bone Joint Surg (Br) 2011, 93:1104-1110.
• [29]Coleman RE: Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 2006, 12:6243s-6249s.
• [30]Coleman RE: Skeletal complications of malignancy. Cancer 1997, 80:1588-1594.
• [31]Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR: Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res 2012, 470:684-691.
• [32]Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC: Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res 1990, 251:213-219.
• [33]Gainor BJ, Buchert P: Fracture healing in metastatic bone disease. Clin Orthop Relat Res 1983, 178:297-302.