Bone metastases
Bone metastases
bone metastasesThe most common primary tumors whose cells spread to the bones are lung cancer, prostate cancer, breast cancer, and kidney cancer. These metastases can lead to bone destruction: osteolysis or osteocondensation, especially with prostate cancer.

A biopsy by a surgeon or interventional radiologist can be performed to analyze the anatomical pathology and determine the type of tumor. If there are up to 5 metastasized tumors, this is an oligometastatic stage, thus localized treatment can be performed either surgically or with cementoplasty performed by interventional radiologists, or stereotactic radiotherapy, which usually takes from 3 to 8 Gy and 5 sessions from 6 to 7 Gy, one session per day and three sessions per week.

Systemic therapy with chemotherapy or antihormonal therapy is often prescribed. For example, with prostate cancer in the case of metastatic prostate cancer in the bone, treatment with an LHRH analogue in combination with second-generation hormone therapy (abiraterone acetate) is proposed.

For hormone-dependent and HER2-negative breast cancer, anti-hormone therapy in combination with a CDk4 / 6 inhibitor can also be indicated. If there is a localized bone pain, palliative radiotherapy with an analgesic purpose (to reduce pain) aimed at metastases can be proposed: 3 schemes are possible, 1 session of 8 Gy, 5 sessions of 4 Gy and 10 sessions of 3 Gy. The pain may persist or worsen during treatment, this is a normal process. Anesthetic effect is achieved after one to three weeks.

To reduce bone resorption, two treatments are possible: Denosumab, an anti-rank ligand antibody used to inhibit osteoclasts (cells responsible for bone resorption) and Bisphosphonate. Before starting treatment, it is necessary to carry out phospho-calcium balance and an examination of the oral cavity with a panorama of the teeth (an adverse effect of osteonecrosis of the jaw is possible). An examination of the oral cavity will need to be done annually, once a year. Regular monitoring of phospho-calcium is also recommended because there is a high risk of hypocalcemia.

Also, once a month a blood test is performed for vitamin D with the addition of an ampoule of 100,000 UI in case of deficiency.

Calcium and Vitamin D supplements can also be given as a daily tablet if the calcium level is not very high. Vertebral metastasis can cause vertebral fracture, especially if the metastasis is osteolytic. The pain can be acute and localized at the level of the affected vertebra. A rupture of the spine, if the spinal cord or nerves are pinched, can cause neurological signs: muscle weakness, paresthesia, dysesthesia, incontinence or, conversely, retention of stool or urine, pain, as with ischemia.
In this case, emergency medical and possibly surgical care is indicated. High-dose corticosteroid therapy should be started immediately, the surgeon should give his opinion on emergency surgical decompression, as well as radiation therapy or cementoplasty.
 
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