Non-surgical management of musculoskeletal malignancy

The majority of patients with a musculoskeletal malignancy will have bone metastases from a distant primary tumour. This could be apparent at diagnosis or later in the course of the disease. Some primary tumour types are more likely than others to develop bone secondaries. This common clinical problem requires a multidisciplinary approach in order to reduce patient suffering and maintain quality of life. Almost all patients with metastatic bone disease will have incurable cancer and this needs to be acknowledged when considering treatment options. Conversely primary musculoskeletal cancers are relatively rare conditions and thus need to be managed by specialist centres. Multimodality, multiprofessional treatment is required which may last for many months and can be associated with considerable toxicity. Patients with localized disease can be cured but prognosis has to be guarded due to high rates of local recurrence and metastases for both primary bone and soft tissue sarcomas.