What are the treatments for metastatic bone tumors?

The treatment of metastatic bone tumors should be based on the specific situation using radiotherapy, chemotherapy, biological therapy, traditional Chinese medicine treatment, and surgery if necessary. After the diagnosis of metastatic bone tumors is clear, comprehensive treatment methods should be used in a timely manner. The treatment of primary tumor lesions is the main part of the entire treatment.

1. For the treatment of metastatic bone tumors without complications, whether single or multiple bone metastases, the main treatment methods available are:

(1) Radiotherapy:

① Deep irradiation: In addition to 60Co, there are also linear accelerators, X-knife, γ-knife and electron accelerators, etc. The irradiation dose is selected according to the purpose of radiotherapy.

② Radionuclide therapy: The radionuclides commonly used in China are: 89Sr (89 Strontium), 153Sm-EDTMP (153 Samarium-ethylenediaminetetramethylenephosphate) and 131I.

(2) Hormone therapy: Orchiectomy and the use of estrogen are routine treatments for prostate cancer. Only 30% of cases are ineffective. Orchiectomy has no adverse reactions and can increase the 3-5 year survival rate by three times. Hormone therapy for breast cancer can significantly improve 20%-40% of patients. Commonly used drugs include estrogens, androgens, progesterone, antiestrogens, and estrogen synthesis inhibitors.

(3) Chemotherapy: Combination therapy with drugs used to treat primary cancer can have a certain effect. There are many chemotherapy drugs and regimens. Bone metastases caused by different primary cancers can be treated with different drugs and different regimens.

(4) Interventional therapy: The development and popularization of interventional therapy in recent years has not only greatly improved the therapeutic effect of primary malignant tumors, but also can treat metastases of multiple systems and organs and the serious complications caused by them and achieve certain results. An arterial catheter can be inserted into the blood supply artery of bone metastasis to selectively increase the concentration of anticancer drugs in the blood of the tumor area. For example, drug administration controlled by an infusion pump can prolong the duration of anticancer drug action on the tumor. At the end of drug administration, the blood supply artery of the tumor can be embolized as needed to block the blood supply to the tumor.

(5) Surgical treatment: If the metastasis is a single tumor, it can be surgically removed. For pathological fractures, the tumor can be removed and then internally fixed. This can alleviate the patient's pain and improve their quality of life. It is an effective treatment for metastatic bone tumors.

①Case selection: Surgery can also be an option for the treatment of metastatic bone tumors. The following conditions must be met: The primary tumor has not been found or the primary tumor has been completely removed. There are no metastatic tumors elsewhere. The bone metastasis is relatively localized and the soft tissue is not invaded, so it can be removed. The patient's general condition is good. The repair of bone metastasis after removal is not complicated.

②Surgical method: Simpler resection methods should be used as much as possible. For non-major bones, such as iliac wing, scapula, spinal accessory bones, ribs, etc., simple resection is performed. For the proximal femur, artificial femoral head replacement can be performed. For metastatic tumors with partial resection of the bone end, bone glue can be used for filling after resection.

(6) Treatment with traditional Chinese medicine: Traditional Chinese medicine considers tumors as a systemic disease and attributes the pathogenesis to qi stagnation and blood stasis, phlegm stagnation and toxic accumulation, heat toxic accumulation and weak vital energy. Traditional Chinese medicine uses syndrome differentiation and treatment according to different pathogenesis, and adopts the method of strengthening the body, replenishing the deficiency and eliminating the evil to carry out systemic treatment.

(7) Bisphosphonates: These drugs can inhibit the growth of tumor cells in bone tissue and prevent tumor damage to bones. They are inhibitors of osteoclasts and are used to treat bone dissolution, bone pain, hypercalcemia, and osteoporosis caused by bone metastases.

2. Treatment of metastatic bone tumors with complications

(1) Treatment of spinal metastases combined with paraplegia: Spinal metastases often occur in the vertebral body. The tumor expands into the spinal canal and compresses the spinal cord from the front, causing paraplegia.

(2) Treatment of bone metastases combined with pathological fractures: Different treatment methods should be selected according to different locations.

① Pathological fractures of diaphyseal bone metastases are more common in the femoral shaft. Closed intramedullary nail fixation can be performed to facilitate patient activities. It can also be used for humeral shaft fractures.

② Pathological fractures of bone ends, such as pathological fractures of femoral neck metastases, can be treated with femoral head resection and artificial femoral head replacement.

③ For pathological fractures caused by spinal metastases without paraplegia, percutaneous vertebroplasty can be used.

The above is an introduction to the treatment of metastatic bone tumors. In addition to the above treatments, radiotherapy or chemotherapy can also be performed in parallel, and sex hormone therapy can be used as appropriate depending on the situation of the primary cancer.

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