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Can surgical management of bone metastases improve quality of life among women with gynecologic cancer?

Ji T, Eskander R, Wang Y, Sun K, Hoang BH, Guo W - World J Surg Oncol (2014)

Bottom Line: Patients were followed for an average period of 13.8 months (range, 2 to 34 months).The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery.The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.

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Affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China. bonetumor@163.com.

ABSTRACT

Background: The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival.

Methods: Eighteen patients underwent surgical procedures for the treatment of bone metastases secondary to gynecologic cancer between September 2003 and April 2012. The primary cancer sites included the uterus (n = 10), the cervix (n = 5), and an ovary (n = 3). Patients were followed for an average period of 13.8 months (range, 2 to 34 months). A visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status were evaluated both pre- and postoperatively.

Results: The median survival time following diagnosis of bone metastasis was 10.0 months. The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery. The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.

Conclusions: The prognosis of gynecological cancer patients with bone metastasis is poor. Some patients had improvement in their quality of life after surgical intervention for bone metastases; however, novel integrated treatment modalities should be investigated.

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Representative case showed pathological fracture in femoral neck of patient number 17. The preoperative X ray showed the pathological fracture (A).A proximal femoral endoprosthesis was used to reconstruct the bone defect (B). Histological appearance (C) of the lesion featuring infiltration by poorly differentiated squamous carcinoma cells (hematoxylin and eosin (H&E) stain, ×200). Immunohistochemically, the tumor was positive for 34βE12 +, CK5/6 + and p63 +.
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Figure 3: Representative case showed pathological fracture in femoral neck of patient number 17. The preoperative X ray showed the pathological fracture (A).A proximal femoral endoprosthesis was used to reconstruct the bone defect (B). Histological appearance (C) of the lesion featuring infiltration by poorly differentiated squamous carcinoma cells (hematoxylin and eosin (H&E) stain, ×200). Immunohistochemically, the tumor was positive for 34βE12 +, CK5/6 + and p63 +.

Mentions: Intralesional curettage can decrease rates of local recurrence, avoiding the need for extensive resection and reconstruction. More aggressive local and systemic treatment is advocated for improved local control [28]. Additionally, current systemic treatments and improvements in supportive care have translated into prolonged survival following management of bone metastases. These factors have compelled more aggressive operative procedures, although indications remain controversial. En bloc resection may be more appropriate when advanced disease precludes internal fixation, or when the metastatic disease is limited to a solitary bony deposit. Five patients received en bloc resection in the current study, three of which were for proximal femoral lesions (Figure 3). Outcomes of internal fixation for this site are often unfavorable, with high nonunion rate (65%), high local recurrence rate (48%), and high implant failure rate (23%) [31-33]. Use of endoprostheses demonstrates a lower mechanical failure rate and a higher rate of implant survivorship [31].


Can surgical management of bone metastases improve quality of life among women with gynecologic cancer?

Ji T, Eskander R, Wang Y, Sun K, Hoang BH, Guo W - World J Surg Oncol (2014)

Representative case showed pathological fracture in femoral neck of patient number 17. The preoperative X ray showed the pathological fracture (A).A proximal femoral endoprosthesis was used to reconstruct the bone defect (B). Histological appearance (C) of the lesion featuring infiltration by poorly differentiated squamous carcinoma cells (hematoxylin and eosin (H&E) stain, ×200). Immunohistochemically, the tumor was positive for 34βE12 +, CK5/6 + and p63 +.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125343&req=5

Figure 3: Representative case showed pathological fracture in femoral neck of patient number 17. The preoperative X ray showed the pathological fracture (A).A proximal femoral endoprosthesis was used to reconstruct the bone defect (B). Histological appearance (C) of the lesion featuring infiltration by poorly differentiated squamous carcinoma cells (hematoxylin and eosin (H&E) stain, ×200). Immunohistochemically, the tumor was positive for 34βE12 +, CK5/6 + and p63 +.
Mentions: Intralesional curettage can decrease rates of local recurrence, avoiding the need for extensive resection and reconstruction. More aggressive local and systemic treatment is advocated for improved local control [28]. Additionally, current systemic treatments and improvements in supportive care have translated into prolonged survival following management of bone metastases. These factors have compelled more aggressive operative procedures, although indications remain controversial. En bloc resection may be more appropriate when advanced disease precludes internal fixation, or when the metastatic disease is limited to a solitary bony deposit. Five patients received en bloc resection in the current study, three of which were for proximal femoral lesions (Figure 3). Outcomes of internal fixation for this site are often unfavorable, with high nonunion rate (65%), high local recurrence rate (48%), and high implant failure rate (23%) [31-33]. Use of endoprostheses demonstrates a lower mechanical failure rate and a higher rate of implant survivorship [31].

Bottom Line: Patients were followed for an average period of 13.8 months (range, 2 to 34 months).The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery.The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China. bonetumor@163.com.

ABSTRACT

Background: The evaluation, counseling, and management of gynecologic patients with bone metastasis remain a challenge for clinicians. In order to critically evaluate the role of surgery, we retrospectively analyzed the records of 18 patients surgically treated for metastatic gynecologic tumors of bone, focusing on quality of life, local tumor control, and survival.

Methods: Eighteen patients underwent surgical procedures for the treatment of bone metastases secondary to gynecologic cancer between September 2003 and April 2012. The primary cancer sites included the uterus (n = 10), the cervix (n = 5), and an ovary (n = 3). Patients were followed for an average period of 13.8 months (range, 2 to 34 months). A visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status were evaluated both pre- and postoperatively.

Results: The median survival time following diagnosis of bone metastasis was 10.0 months. The mean VAS score was 5.8 preoperatively compared with 2.1, 3 months after surgery. The mean pre and postoperative ECOG performance status grades were 3.1 and 2.3, respectively.

Conclusions: The prognosis of gynecological cancer patients with bone metastasis is poor. Some patients had improvement in their quality of life after surgical intervention for bone metastases; however, novel integrated treatment modalities should be investigated.

Show MeSH
Related in: MedlinePlus