Dr. Achmad Basuki, Sp.

OT

SMF Orthopaedi, Dharmais cancer

center Hospital, Jakarta
 The most common cause of a destructive
lesion of skeletal in adult
 More than Primary sarcoma of the bone
 The skeleton is the third most common
target of metastatic cancer
 can be one of the earliest sites affected
 Which produces the greatest morbidity
- loss of functionality
- loss of quality of life
- decreased survival
 The role of the orthopedist are
- to establish or confirm diagnosis
- to evaluate for risk of fracture or
impending fracture
- to stabilize or other wish surgical
treatment pathological fracture
 The most common
Batson’s vertebra vein
site of bone
plexus metastasis
 Osteolytic
• Bone destruction is
mediated by osteoclasts
in patients with either
breast cancer or
multiple myeloma
 Osteoblastic
• Excess bone formation is
mediated by osteoblasts
in patients with either
prostate or breast cancer

Mundy GR. Nat Rev Cancer.

 PTHr P
Ca ++
STROMAL CELL/
OSTEOBLAST

Bone Re-absorption
RANK L
RANK r

Differentiation
Mature
PRECURSOR Osteoclast
OSTEOCLAST

PO 4
 Pathologic Fractures
8-30%

Decrease Quality Spinal cord

Bone pain of life and compression
50% Negative impact 5%
on survival

Hypercalcemia 10%
Diagnosis

treatment
 BONE PAIN

Bone scan

LESION Normal

X-Ray abnormal area

Biopsi
Normal

Benign Malignancy Metastasis CT or MRI

Normal Metastasis

Biopsi ?
Pain control

Inhibition of
osteolysis

Handling
complication
Non surgery

surgery
1. Pain Control

- Analgesics

- Radiation

- Chemotherapy
2. Inhibition of Osteolysis

- Bisphosphonates
 Bisphosphonates
have a strong • Bind to resorption sites
affinity for calcium
phosphate

Bisphosphonates • Direct effects on osteoclasts

inhibit bone • Indirect effects via other cells
resorption

Bisphosphonates • Recruitment of cells

decrease 4 • Adhesion to bone
parameters of • Lifespan of cells (increasing rates of apoptosis)
osteoclast function • Cellular activity
 indications :
goal :
- for diagnosis
Surgical 1. to provide
management local tumor -prophylactic
3. Handling  it has to control fixation of
complication benefit impending
2. immediate fractures
improving life weight
quality bearing & - stabilization
function of pathologic
fracture
General consideration
• Life expectancy at least 6 to 12 week consider for
surgical candidate
• Patient recovery time from surgery should not outlast
estimated time survival
• Provide immediately stable reconstruction
• Scoring assessment to predict the surgical candidate
Tomita K,
Kawahara N, Kobayashi T, Yoshida A, Murakami H,
Akamaru T. Surgical strategy for spinal
metastases. Spine. 2001;26:298-306.)
Walker MP, Yaszemski MJ, Kim CW, Talac R, Currier BL.
Metastatic
disease of the spine: evaluation and treatment. Clin Orthop
Relat Res. 2003;415 Suppl:S165-75.