Öz
Amaç: Bu çalışmanın amacı ürolojik malignitelere bağlı semptomatik kemik metastazlarının cerrahi tedavisinin etkinliğini ve lokal kontrol elde edilebilirliğini değerlendirmektir.Çalışma planı: Bu çalışma 2002 ve 2013 yılları arasında ürolojik maliğniteye bağlı kemik metastazlarından ölen hastaların incelendiği retrospektif gözlemsel bir çalışmadır. Ürolojik malignitelere bağlı kaybedilen kemik metastazlı 70 hastanın (55 erkek, 15 bayan) kemik metastazlarının yeri ve sayısı, klinik ve histopatolojik özellikleri, ilk ve ardışık metastazlarının zamanı, metastaz sonrası yaşam süreleri, metastaz natürü (blastik, miks, litik), cerrahi rekonstrüksiyon tipi, sistemik etkileri ve iç organ metastaz durumu istatistiksel olarak analiz edildi.Bulgular: Primer tanılar 43 hastada (%61.42) böbrek hücreli karsinom, 15 hastada (%21.43) prostat karsinom, 12 hastada (17.15) mesane karsinomu idi. Osteolitik lezyonlar daha sık saptandı (n=61 %87). En yaygın uygulanan cerrahi tedavi sırasıyla ekstremitelerde geniş rezeksiyon ile prostetik replasman; geniş rezeksiyon ile ve/veya kemik çimento uygulamaları ile internal fiksasyondu (n=21). 65 hastaya ekstremite koruyucu prosedürler uygulanırken 2 hasta ampute edildi. Ortalama yaşam beklentisi böbrek hücreli karsinom hastalarında 13 ay, prostat karsinomlu hastalarda 16 ay, mesane karsinomlu hastada 11 ay olarak saptandı.Çıkarımlar: Ürolojik maligniteli hastalarda kemik metastazlarının varlığı, primer malignitenin tedavi planını değiştirmektedir. Ürolojik maligniteli hastalarda kemik metastazları geç tanı alabilmektedir. Bu hastaların metastaz açısından uzun yıllar takibi gerekmektedir
Anahtar Kelimeler
Mesane karsinomu; kemik metastazı; prostat karsinomu; böbrek hücreli karsinomu; cerrahi tedavi
Kaynakça
- Roodman GD. Mechanisms of bone metastasis. N Engl J Med 2004;350:1655–64.
- Motzer RJ, Bander NH, Nanus DM. Renal-cell carcino- ma. N Engl J Med 1996;335:865–75.
- Russo P. Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol 2000;27:160–76.
- Athar U, Gentile TC. Treatment options for metastatic re- nal cell carcinoma: a review. Can J Urol 2008;15:3954–66.
- Hadzi-Djokić J, Pejcić T, Aćimović M, Andrejević V, Radosavljević R. Penile metastasis from invasive bladder cancer. Acta Chir Iugosl 2009;56:101–3.
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225–49.
- Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prog-nostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17:2530–40.
- Capanna R, Campanacci DA. The treatment of metas- tases in the appendicular skeleton. J Bone Joint Surg Br 2001;83:471–81.
- Fidler M. Incidence of fracture through metastases in long bones. Acta Orthop Scand 1981;52:623–7.
- Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic frac- tures. Clin Orthop Relat Res 1989;249:256–64.
- Teunis T, Nota SP, Hornicek FJ, Schwab JH, Lozano- Calderón SA. Outcome after recon-struction of the proxi- mal humerus for tumor resection: a systematic review. Clin Orthop Relat Res 2014;472:2245–53.
- Tillman RM. The role of the orthopaedic surgeon in meta- static disease of the appendicular skeleton. Working Party on Metastatic Bone Disease in Breast Cancer in the UK. J Bone Joint Surg Br 1999;81:1–2.
- Schaiff RA, Hall TG, Bar RS. Medical treatment of hyper- calcemia. Clin Pharm 1989;8:108–21.
- Harrington KD. Orthopaedic management of metastatic bone disease. St. Louis: Mosby; 1988.
- Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol 2004;22:2942–53.
- Brown ML. Bone scintigraphy in benign and malignant tumors. Radiol Clin North Am 1993;31:731–8.
- Thomson V, Pialat JB, Gay F, Coulon A, Voloch A, Granier A, et al. Whole-body MRI for metastases screening: a pre- liminary study using 3D VIBE sequences with automatic sub-traction between noncontrast and contrast enhanced images. Am J Clin Oncol 2008;31:285–92.
- Cheville JC, Tindall D, Boelter C, Jenkins R, Lohse CM, Pankratz VS, et al. Metastatic prostate carcinoma to bone: clinical and pathologic features associated with cancer-spe- cific survival. Cancer 2002;95:1028–36.
- Mani S, Todd MB, Katz K, Poo WJ. Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers. J Urol 1995;154:35– 40.
- Kessler O, Mukamel E, Hadar H, Gillon G, Koneche- zky M, Servadio C. Effect of im-proved diagnosis of renal cell carcinoma on the course of the disease. J Surg Oncol 1994;57:201–4.
- Kollender Y, Bickels J, Price WM, Kellar KL, Chen J, Mer- imsky O, et al. Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention. J Urol 2000;164:1505–8.
- Santini D, Procopio G, Porta C, Ibrahim T, Barni S, Maz- zara C, et al. Natural history of malignant bone disease in renal cancer: final results of an Italian bone metastasis sur- vey. PLoS One 2013;8:e83026.
- Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol 2011;196:117– 22.
- Rades D, Schild SE, Abrahm JL. Treatment of painful bone metastases. Nat Rev Clin On-col 2010;7:220–9.
- Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabrò T, et al. Protocol of surgical treatment of long bone pathological fractures. Injury 2010;41:1161–7.
- Eralp L, L, ical Karaoğlu A, Bozan E. Results of surgical management in patients with metastasis to the hip. Acta Orthop Traumatol Turc 2001;35:41–7.
- Scholl BM, Jaffe KA. Oncologic uses of the retrograde femoral nail. Clin Orthop Relat Res 2002;394:219–26.
- Ashford RU, Benjamin L, Pendlebury S, Stalley PD. The modern surgical and non-surgical management of appen- dicular skeletal metastases. Orthopaedics and Trauma 2012;26:184–99.
Öz
Objective: The purpose of this study was to evaluate symptomatic bone metastases from urological malignancies and the efficacy of surgical treatment of bone metastases in achieving local tumor control.
Methods: This was a retrospective observational study of patients diagnosed with bone metastases from urological malignancies who died from their diseases between 2002 and 2013. Data on clinicopathology, number and sites of bone metastasis, time to first and subsequent metastasis, survival after metastasis, nature of metastasis (blastic, mixed, lytic), type of surgical reconstruction, systemic affections, and visceral organ metastasis for 70 bone metastases from deceased urological malignancies patients (55 male, 15 female) with evidence of bone metastasis were statistically analyzed.
Results: Forty-three patients (61.42%) had renal cell carcinoma (RCC), 15 patients (21.43%) had prostate cancer, and 12 patients (17.15%) had bladder carcinoma as primary diagnosis. Osteolytic lesions were most prevalent (n=61; 87%). The most common surgical modality for extremities was wide resection with prosthetic replacement (42 patients), followed by wide resection or wide resection with bone cement application with internal fixation (21 patients); 65 patients were treated with limb salvage procedures, and 2 patients were treated with amputation. Overall median survival was 13 months for RCC, 16 months for prostate carcinoma, and 11 months for bladder carcinoma patients.
Conclusion: Detection of bone metastases in patients with urological malignancies influences the treatment strategy. Diagnosis of bone metastases may be delayed in urologic malignities; thus, these patients receive long-term clinical follow-up.
Anahtar Kelimeler
Bladder carcinoma bone metastasis prostate carcinoma renal cell carcinoma surgical treatment
Kaynakça
- Roodman GD. Mechanisms of bone metastasis. N Engl J Med 2004;350:1655–64.
- Motzer RJ, Bander NH, Nanus DM. Renal-cell carcino- ma. N Engl J Med 1996;335:865–75.
- Russo P. Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol 2000;27:160–76.
- Athar U, Gentile TC. Treatment options for metastatic re- nal cell carcinoma: a review. Can J Urol 2008;15:3954–66.
- Hadzi-Djokić J, Pejcić T, Aćimović M, Andrejević V, Radosavljević R. Penile metastasis from invasive bladder cancer. Acta Chir Iugosl 2009;56:101–3.
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225–49.
- Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prog-nostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17:2530–40.
- Capanna R, Campanacci DA. The treatment of metas- tases in the appendicular skeleton. J Bone Joint Surg Br 2001;83:471–81.
- Fidler M. Incidence of fracture through metastases in long bones. Acta Orthop Scand 1981;52:623–7.
- Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic frac- tures. Clin Orthop Relat Res 1989;249:256–64.
- Teunis T, Nota SP, Hornicek FJ, Schwab JH, Lozano- Calderón SA. Outcome after recon-struction of the proxi- mal humerus for tumor resection: a systematic review. Clin Orthop Relat Res 2014;472:2245–53.
- Tillman RM. The role of the orthopaedic surgeon in meta- static disease of the appendicular skeleton. Working Party on Metastatic Bone Disease in Breast Cancer in the UK. J Bone Joint Surg Br 1999;81:1–2.
- Schaiff RA, Hall TG, Bar RS. Medical treatment of hyper- calcemia. Clin Pharm 1989;8:108–21.
- Harrington KD. Orthopaedic management of metastatic bone disease. St. Louis: Mosby; 1988.
- Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol 2004;22:2942–53.
- Brown ML. Bone scintigraphy in benign and malignant tumors. Radiol Clin North Am 1993;31:731–8.
- Thomson V, Pialat JB, Gay F, Coulon A, Voloch A, Granier A, et al. Whole-body MRI for metastases screening: a pre- liminary study using 3D VIBE sequences with automatic sub-traction between noncontrast and contrast enhanced images. Am J Clin Oncol 2008;31:285–92.
- Cheville JC, Tindall D, Boelter C, Jenkins R, Lohse CM, Pankratz VS, et al. Metastatic prostate carcinoma to bone: clinical and pathologic features associated with cancer-spe- cific survival. Cancer 2002;95:1028–36.
- Mani S, Todd MB, Katz K, Poo WJ. Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers. J Urol 1995;154:35– 40.
- Kessler O, Mukamel E, Hadar H, Gillon G, Koneche- zky M, Servadio C. Effect of im-proved diagnosis of renal cell carcinoma on the course of the disease. J Surg Oncol 1994;57:201–4.
- Kollender Y, Bickels J, Price WM, Kellar KL, Chen J, Mer- imsky O, et al. Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention. J Urol 2000;164:1505–8.
- Santini D, Procopio G, Porta C, Ibrahim T, Barni S, Maz- zara C, et al. Natural history of malignant bone disease in renal cancer: final results of an Italian bone metastasis sur- vey. PLoS One 2013;8:e83026.
- Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol 2011;196:117– 22.
- Rades D, Schild SE, Abrahm JL. Treatment of painful bone metastases. Nat Rev Clin On-col 2010;7:220–9.
- Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabrò T, et al. Protocol of surgical treatment of long bone pathological fractures. Injury 2010;41:1161–7.
- Eralp L, L, ical Karaoğlu A, Bozan E. Results of surgical management in patients with metastasis to the hip. Acta Orthop Traumatol Turc 2001;35:41–7.
- Scholl BM, Jaffe KA. Oncologic uses of the retrograde femoral nail. Clin Orthop Relat Res 2002;394:219–26.
- Ashford RU, Benjamin L, Pendlebury S, Stalley PD. The modern surgical and non-surgical management of appen- dicular skeletal metastases. Orthopaedics and Trauma 2012;26:184–99.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Ekim 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 49 Sayı: 6 |