The Surgical Treatment of Pelvic Bone Metastases

Abstract

Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient's prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases.

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

“…Given the lack of long-term follow-up data, we believe that PIGSF is best suited for fracture consolidation in high-risk, non-surgical candidates with short life expectancy. Conversely, surgery is favoured for low-risk patients with isolated solitary bone metastasis and good prognosis, since it offers potentially curative resection and optimal biomechanical reconstruction [10,13,15,34]. Patients between these extremes should ideally be treated with cytoreduction followed by stabilisation-either via limited surgical resection and reconstruction; or using percutaneous thermal ablation with PIGSF/cementoplasty [10,35].…”

“…Therapeutic or prophylactic fixation is therefore essential to optimise outcome, and is typically performed via surgery [10][11][12][13][14][15]. However, invasive procedures may be unsuitable for high-risk patients with complex (especially pelvic) lesions, and may result in significant complications and prolonged post-operative recovery [15,16].…”

Pelvis metastazları

“…[7] Birinci ve üçüncü bölgedeki lezyonlar ise osteolitik karakterde olsalar bile, pelvik halkanın mekanik stabilitesine etki etmeyen lezyonlar olarak sınıflandırılabilir. [18] Lezyonların yerleşimlerinin tespiti, tedavi planlaması için çok önemlidir. Rutin pelvis direkt grafileri, lezyonların kesin sınırlarını tespit etmekte yetersiz kalabilmektedir.…”

“…Asetabuloplastide kemik çimentosunun eklem içine kaçması, radyofrekans ablasyon ve kriyoterapi işlemlerinde ise damar sinir yapılarına 1 cm'den yakın olan lezyonlarda damar sinir hasarları, bu tekniklerin komplikasyonları arasında sayılabilir. [18] uygulanamamaktadır. Bu lezyonların cerrahisinde, tümör dokusunun küretajı sonrası defekt hâlâ Tip 2 ise antiprotrüzyo kafesler, mediyal duvara meş uygulaması veya pubis ve iskion kollarına gönderilen Steinman pinleri ile kombine edilen çimento rekonstrüksiyonu ve çimentolu asetabular komponent uygulanabilir.…”

Differential osteogenic potential of human adipose‐derived stem cells co‐cultured with human osteoblasts on polymeric microfiber scaffolds

“…Reconstruction of critical sized bone defects represents a daily challenge in traumatology, degenerative diseases, fracture treatment, and resolving bone loss after cancer surgery, all of which may at present require bone grafting . Currently, the transplantation of freshly isolated autologous bone is considered to be the gold standard, although it bears substantial drawbacks like limited graft availability and significant donor‐site morbidity . To overcome these problems, bone tissue engineering may be a promising alternative.…”