Metastatic Bone Disease: Review of Spectrum of Bony Involvement, Treatment, Survival and Outcome referred to a Tertiary Orthopaedic Hospital

Congress:

ESSR 2017

Poster Number:

P-0305

Type:

Scientific Poster

Keywords:

Bones, Oncology, Nuclear medicine, Nuclear medicine conventional, MR, CT, Outcomes analysis, Surgery, Treatment effects, Multidisciplinary cancer care, Metastases, Neoplasia

Authors:

T. M. Bansal, D. Dalili, N. Khandwalla, M. George, Z. Shah, M. J. Bankes, A. Isaac; London/UK

DOI:

10.1594/essr2017/P-0305

DOI-Link:

https://dx.doi.org/10.1594/essr2017/P-0305

$Fig. 69: Mirel's score - derived from Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–264 References: Danoob Dalili$

Fig. 69: Mirel's score - derived from Mirels H. Metastatic disease in long bones: a...

Fig. 66: Primary Diagnoses

Fig. 67: Referring specialities

Fig. 68: Site of metastasis

$Fig. 39: Patient G - Breast lytic mets: pathological fracture AP femur radiograph References: Amanda Isaac$

Fig. 39: Patient G - Breast lytic mets: pathological fracture AP femur radiograph

Fig. 13: Patient B - Cholangiocarcinoma metastasis lesser trochanter 3 months later:...

Fig. 21: Patient C - Lymphoma metastasis: large destructive lesion in the left...

Fig. 15: Patient B - Cholangiocarcinoma metastasis lesser trochanter: post femoral nail...

Fig. 31: Patient F - Bladder ca : Whole body bone scan demonstrating multiple sites of...

Fig. 70: GSTT dedicated bone metastasis pathyway

Purpose

To review all the appendicular metastatic bone disease referrals requiring specialist input for the management of long bone pathological fractures. A dedicated referral pathway (Fig. 70) for patients with bony metastasis was introduced at Guys’ and St Thomas Hospital in 2009. By forming a specialist multidisciplinary team, the aim was to facilitate prompt, consultant-led decision-making and intervention for patients atrisk of pathological long bone fractures.

Methods and Materials

We reviewed all the appendicular metastatic bone disease referrals received by our institution from January 2009- January 2017. Patient demographics, co-morbidities, extent of skeletal involvement, treatment, predicted survival of the patient, survival and outcomes following surgical and non-surgical treatment were collected and analysed.

Results

184 patients were referred from seven different specialties (Male: Female: 98:86), mean age of 64 years.(Fig. 67) 16 different types of primary cancer were identified, the most common being breast in 26% (46/184).(Fig. 66) The femur was the most common site of metastasis (149/183) with per-trochanteric lesions in 81% of patients. (Fig. 68) 49 patients underwent surgical intervention (1 in 4 referrals), with cephalon-medullary nailing being the most commonly performed procedure (26/49). Patients in the surgical group were younger, with a higher Mirel’s score (Fig....

Conclusion

We believe an Orthopaedic led metastasis service is required in every major cancer centre to expedite care of patients with acute or impending fracture. In our 8 year experience, we have identified that the majority of metastases are centered around the hip joint and therefore, a specialist hip surgeon should lead the service. An MDT approach is vital to provide high quality care for these complex patients.

References

Heindel-W, et al. The diagnostic imaging of bone metastases. Dtsch Arztebl Int 2014; 111: 741-778 Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64. 13. Jawad MU, Scully SP. In brief: classifications in brief: mirels’ classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res. 2010;468(10):2825- 2827. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative...

Personal Information

Mr Mohit Bansal Specialist Registrar Orthopaedic Surgeon, Guy's & St Thomas' NHS Foundation Trust, London, UK Dr Danoob Dalili Specialist Registrar Clinical Radiology, Imperial College Healthcare, London, UK Research fellow, Guy's & St Thomas' NHS Foundation Trust, London, UK Nasha Khandwalla Physician Associate, Guy's & St Thomas' NHS Foundation Trust, London, UK Mr Marc George Consultant Orthopaedic Hip Surgeon, Guy's & St Thomas' NHS Foundation Trust, London, UK Mr Zameer Shah Consultant Orthopaedic Hip Surgeon, Guy's & St Thomas' NHS Foundation Trust, London, UK Mr...