Concepts and surgical treatment of metastatic bone disease

This chapter focuses on treatment that affects the neoplastic process as well as the bone microenvironment. It discusses the molecular events related to metastatic bone disease and summarizes the use of bisphosphonate or anti-RANKL therapy as well as surgical stabilization in these settings. Colonization and growth of tumor cells in the bone can be thought of as occurring in three phases: colonization, dormancy, and expansion. Radium-223 dichloride is a radiopharmaceutical approved for use in the treatment of prostate cancer bone metastasis. As patients with bone metastasis are unlikely to be surgically cured, the primary focus of orthopedic oncologists is to improve quality of life. The goals of surgical treatment of patients with bone metastasis are to improve function and decrease pain. In selected patients, minimally invasive procedures provide an alternative to surgery and can produce long-lasting pain relief.