1,721,252 research outputs found
Physiopathology of minimally invasive surgery in hip arthroplasty. Histochemical, immunological and endocrinological aspects
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Surgical treatment for pelvic bone metastases.
No full textThe pelvis is the second most common site of bone metastases after the spine. Pain, bone destruction causing mechanical instability and pathological fractures are the most common manifestations. Traditional treatments for pelvic bone metastases include surgery and external beam radiation therapy. If bone destruction is limited, analgesics, radiation therapy, hormonal therapy, chemotherapy, embolization, bisphosphonates and minimally invasive techniques such as radiofrequency ablation, osteoplasty and cryosurgery can be considered [6]. Lesions of the hemipelvis not directly involving the hip joint, pathological fractures sustained through an area of the pelvis other than the acetabulum and avulsion fractures of the anterior superior/inferior iliac spines, iliac crest and pubic rami seldom require surgical stabilization and reconstruction because pelvic stability is maintained. By contrast, diffuse involvement of the pelvis, impending or existing pelvic discontinuity and bony destruction of the periacetabular area warrants surgical treatment [4,7–10]. The use of poly(methyl methacrylate) to bridge large defects and suspend an acetabular component, conventional total hip replacement, massive allograft or saddle megaprosthetic reconstruction are likely to fail because of the deficient bone and the progressive osteolytic disease [1]
Metastatic spread to bone: the role of Chemotherapy.
No full textCancer metastasis includes tumor cell intravasation, transport and immune evasion within the circulatory system, arrest at a secondary site, extravasation and finally, colonization and growth [1]. However, cancer metastasis remains poorly understood in terms of clinical outcome, pathology and tissue specificity of different tumor types. The predilection of some cancers to target and proliferate in bone is also unclear (Figure 2.1). Less than 1% of cancer cells entering the blood circulation successfully generate metastatic foci [2]. Consequently, there are few successful treatments that directly target metastatic cancer; identifying effective therapeutic targets for this stage of cancer and prognostic factors to identify those patients prone to develop local and distant progressive disease is challenging [2]
Metastatic spread to bone: The role of chemotherapy
No full textCancer metastasis includes tumor cell intravasation, transport and immune evasion within the circulatory system, arrest at a secondary site, extravasation and finally, colonization and growth [1]. However, cancer metastasis remains poorly understood in terms of clinical outcome, pathology and tissue specificity of different tumor types. The predilection of some cancers to target and proliferate in bone is also unclear (Figure 2.1). Less than 1% of cancer cells entering the blood circulation successfully generate metastatic foci [2]. Consequently, there are few successful treatments that directly target metastatic cancer; identifying effective therapeutic targets for this stage of cancer and prognostic factors to identify those patients prone to develop local and distant progressive disease is challenging [2].Genetic profiling of tumors has revealed important regulators of the metastatic process and suggested novel targets for cancer therapeutics. Targeting the tumor cell alone is not sufficient; multimodality therapy against tumor cells, their growth factors and the essential accessory cells with which cancer cells interact is imperative. In the bone marrow and within the tumor stroma, two niches constitute highly specific, physiologically defined sites; the vascular and stromal niche. A high preponderance of tumor cells is found in the bone marrow of patients with malignancy, even in the absence of overt distant metastases. Bisphosphonates inhibit normal and pathologic osteoclast-mediated bone resorption. Denosumab inhibits the maturation of osteoclasts by binding to RANKL, protecting the bone from degradation
Surgical treatment for metastatic pathological fractures.
No full textPathological fractures of the long bones occur in 10–29% of patients with bone metastases. The occurrence of these fractures may alter management and prognosis, decrease quality of life and jeopardize survival [1–4]. The fracture hematoma may contaminate the adjacent soft tissue, nerves, vessels and joint, and damage to the microcirculation may favor distant hematogenous dissemination of the tumor [5]
Palliative treatments: electrochemotherapy and thermoablation.
No full textMetastatic disease is a major cause of pain and decreased quality of life in patients with cancer. Autopsy studies have shown that up to 85% of patients who die from breast, prostate or lung cancer have histological evidence of bone metastases at the time of death. In Europe, the number of new cases of bone metastases per year is approximately 1 in 100,000. Worsening of patients’ quality of life is due to associated symptoms such as intractable pain, pathological fractures, spinal cord compression, hypercalcemia and reduction of movement and performance status
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