Surgical Therapy of Bone Metastases

The treatment of patients with cancer epitomizes the importance of using a collaborative team approach to optimize patient care. Physician team members most commonly are radiation oncologists, general surgeons, surgical oncologists, thoracic surgeons, neurosurgeons, and orthopedic surgeons. When patients are receiving chemotherapy, their medical oncologist frequently takes responsibility for coordinating care among the various team members and initiating consultations with necessary providers. When patients develop bone metastases or chemotherapy-induced bone loss (CTIBL), the orthopedic surgeon may be able to improve the patient's quality of life greatly. Procedures orthopedists perform most commonly include open reduction and internal fixations and arthroplasties (joint replacement surgery). Less invasive procedures currently being tested include stereotactic radiosurgery, radiofrequency ablation (RFA), and percutaneous cementoplasty. By understanding the options available to patients with skeletal complications of malignancy, the medical oncologist can discuss issues with patients and make appropriate referrals for diagnosis and treatment. Additionally, with a greater understanding of the surgical procedures available, the medical oncologist will be better able to assist in preparing the patient for surgery.