Management of bone metastases
Bone is a common site of metastasis for many solid malignancies, particularly lung, breast, prostate, thyroid, and kidney cancers. They represent a significant source of morbidity and can adversely affect function, quality of life, and survival. Direct effects of skeletal involvement by malignancy include severe pain, pathologic fractures, and neurologic symptoms from nerve root, spinal cord, or cauda equina compression. These can range from radicular pain and sensory deficits to ataxia, motor weakness progressing to paralysis, as well as bowel and bladder dysfunction. Management of patients with metastatic bone disease is multimodal and requires an integrated multidisciplinary approach. Factors influencing choice of treatment include severity of symptoms, disease extent, estimated life expectancy, skeletal stability/integrity, patient performance status as well as patient preferences. Therapeutic options include pharmacologic agents such as analgesics, osteoclast inhibitors and radiopharmaceuticals as well as non-pharmacologic approaches such as radiotherapy (conventionally fractionated radiotherapy or stereotactic radiation therapy), surgery, and systemic therapy. For patients with long bone or vertebral metastases, the decision-making process about whether to pursue surgical versus nonsurgical management can be complex and various scoring systems are utilized in clinical practice to aid this process.