Surgical treatment of tibial metastases: Retrospective, multicenter, observational study of 25 patients

Bonnevialle, P.; Descamps, Jules; Niglis, Lucas; Baron, Marie Le; Falguieres, Julie; Mericq, Olivier; Fabre, Thierry; Reina, Nicolas; Sailhan, Frédéric

doi:10.1016/j.otsr.2019.07.017

Cited by 10 publications

(13 citation statements)

References 43 publications

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“…Despite the fact that clear cell RCC is the most common type of metastatic RCC, sarcomatoid, papillary, and collecting duct type of RCC are associated with higher CSM [ 3 ]. Studies have shown the median survival time after diagnosis of skeletal metastasis in RCC to be 12 months [ 5 ], 15.8 months [ 7 ], and 32 months [ 8 ]. Furthermore, the number of bone metastases is inversely associated with overall survival (OS).…”

Section: Discussionmentioning

confidence: 99%

Metastatic Lesion of the Tibia from Renal Cell Carcinoma

Młodożeniec

Balawender

Zasadny

2021

Case Reports in Oncological Medicine

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Introduction. Renal cell carcinoma is responsible for 3% of all cancers, with the highest incidence occurring in Western countries. Additionally, in patients with osseous metastasis, only 3% occur within the tibia. Rarely, a patient presents with a primary complaint of lower limb pain in advanced metastatic renal cell carcinoma. Case Presentation. The patient arrived at the emergency department with a primary complaint of left ankle pain. Ankle X-rays demonstrated a lytic lesion involving the medial malleolus with possible metastatic disease. CT scan confirmed a tumor within the right kidney. The patient was treated with a laparoscopic radical nephrectomy with histopathologic confirmation of clear cell renal cell carcinoma. Biopsy was then performed of the tibial lesion, confirming metastatic clear cell renal cell carcinoma. The tibial lesion was treated with local radiotherapy, and because of the progression of the tibia lesion, a decision was made to amputate the leg. Additionally, the patient was enrolled to sunitinib treatment and was disease free at one year of follow-up. 13 months after diagnosis of cancer, she was suffering a major stroke of the brain that caused her to die. Conclusion. The treatment of patients with osseous metastases of renal cell cancer depends on the number of metastases, location of metastases, and overall health of the patient. We performed an overview of available literature and provided a summary regarding the use of cytoreductive nephrectomy, local therapy, target therapy, and bone-targeting agents in the treatment of metastatic renal cell cancer.

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Section: Discussionmentioning

confidence: 99%

Metastatic Lesion of the Tibia from Renal Cell Carcinoma

Młodożeniec

Balawender

Zasadny

2021

Case Reports in Oncological Medicine

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“…The somewhat higher occurrence of MBD involving the tibia has resulted in better data. The primary tumors giving rise to bone metastases in the tibia are breast and prostate cancer in women and men respectively, with lung, kidney and colorectal cancers also being represented independent of sex[ 8 , 23 , 45 ]. The most common site of metastases in the tibia is the proximal metaphyseal region, followed by the diaphysis[ 21 , 23 ] .…”

Section: Acrometastases Of Lower Extremitymentioning

confidence: 99%

“…However, if the lesion is highly destructive and affecting the joint, endoprosthetic reconstruction with a medial gastrocnemius flap can be considered in patients with good prognosis[ 28 ]. Closed IM nailing, sometimes with the addition of curettage, and generally followed by radiation therapy, is the preferred method of choice when metastases are located in the diaphysis[ 8 ]. IM nail devices typically allow immediate weight bearing, and postoperative radiation therapy is not contraindicated, which is of great importance to the patient (Figure 2 ).…”

Section: Acrometastases Of Lower Extremitymentioning

confidence: 99%

“…CT scans could be helpful in situations when there is cortical destruction and mineralization[ 7 ], and they support the diagnosis process by differentiating benign and malignant tumors[ 6 ]. Moreover, CT scanning with 2D frontal-sagittal reconstructions has been proposed as a method for improving the performance of fracture prediction in impending fractures[ 8 ]. Although CT scans are proposed as the second step in the diagnosis process, they are most often the primary technique for detecting MBD, as they are part of the routine staging protocol when diagnosing all kinds of cancer[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of metastatic bone disease of the distal extremities

Sebghati¹,

Khalili²,

Tsagozis³

2021

WJO

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Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.

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“…11 In the literature, there are quite a few publications presenting distal tibial metastasis. 6,9,[12][13][14][15][16] Futani et al 6 presented a case of intra-articular distal tibial metastasis caused by duodenal cancer at the age of 52 years. They performed talocalcaneal fusion on the patient with intramedullary nails and methylmethacrylate.…”

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confidence: 99%

Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization

Başdelioğlu¹,

Civi²

2021

Journal of the American Podiatric Medical Association

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Metastasis of the distal tibia is quite rare. In this article, we present the case of a 58-year-old woman with distal tibial metastasis located in the posterior malleous caused by breast cancer. She had left ankle pain and nonweightbearing status that had been ongoing for 2 months and showed progression. The patient's Mirels score was 10. Limb salvage surgery was performed by removing the metastatic lesion by posterior ankle incision followed by applying a double plate from the posterior and the medial side of the distal tibia, and the defect was reconstructed with methylmethacrylate. Consequently, good stability was achieved. Radiotherapy consisting of 10 fractions (2000 cGy total) was applied to the distal tibia at postoperative week 3. There were no complications after surgery. No recurrence was observed at the 18-month follow-up of the patient. The Musculoskeletal Tumor Society Score at the 18-month control of the patient was 86%. Use of curettage of the metastatic mass, double-plate application, and defect reconstruction with methylmethacrylate is an effective method for distal tibia metastases located in the posterior malleolus.

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Surgical treatment of tibial metastases: Retrospective, multicenter, observational study of 25 patients

Cited by 10 publications

References 43 publications

Metastatic Lesion of the Tibia from Renal Cell Carcinoma

Metastatic Lesion of the Tibia from Renal Cell Carcinoma

Surgical treatment of metastatic bone disease of the distal extremities

Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization

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