Management of long-bone metastases: a surgical perspective

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Bone metastases are frequently encountered in the management of cancer. The incidence of such events is increasing in the geriatric population and most often they can be managed conservatively. Surgery is sometimes unavoidable to address some of these lesions and will represent a significant challenge for both the patient and the medical team. Patients presenting with bone metastases are a heterogeneous group. Some present late in the course of their disease after failing all treatment modalities whereas others present without a known diagnosis of cancer. In addition, some metastatic cancers are responsive to treatment and prolonged survival may be expected (e.g., myeloma, breast prostate, kidney and thyroid) as compared with others where therapeutic options are limited with concomitant decrease in life expectancy (e.g., lung, bladder and pancreas). Patients will benefit if physicians can recognize lesions at risk of fracture or already fractured, and understand the advantages and the limitations of surgery. Patient selection and the type of procedure performed are of outmost importance. Chances for a satisfactory functional outcome and survival rates following surgery should be known in order to avoid unnecessary procedures that may be associated with significant rates of complication. Appropriate surgical intervention for bone metastases can provide the elderly cancer patient with meaningful palliation and contribute to their overall quality of life.

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