Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Bone metastases are difficult to treat surgically, necessitating a multidisciplinary approach that must be applied to each patient depending on the specifics of their case.
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The main indications for surgical treatment are a lack of response to chemotherapy, radiation therapy, hormone therapy, immunotherapy, and bisphosphonates which is defined by persistent pain or tumor progression; the risk of imminent pathological bone fracture; and surgical treatment for single bone metastases.
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An important aspect of choosing the right treatment for these patients is accurately estimating life expectancy. Improved chemotherapy, postoperative radiation therapy, and sustainable reconstructive modalities will increase the patient’s life expectancy.
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The surgeon should select the best surgical strategy based on the primary tumor and its characteristics, the presence of single or multiple metastases, age, anatomical location, and the functional resources of the patient.
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Preventive osteosynthesis, osteosynthesis to stabilize a fracture, resections, and reconstructions are the main surgical options for bone metastases.
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Resection and reconstruction with a modular prosthesis remain the generally approved surgical option to restore functionality, increase the quality of life, and increase life expectancy.
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Preoperative embolization is necessary, especially in the case of metastases of renal or thyroid origin. This procedure is extremely important to avoid complications, with a major impact on survival rates.
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extensive soft tissue involvement and fungation) Yu et al 20 Curettage plus PMMA plus internal fixation and oral bisphosphonates 0.0% 0% ∅ Saibaba et al 28 Curettage plus phenol plus subchondral bone graft plus gel foam layer
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with or without local adjuvant therapy or resection in healthy tissue. Bisphosphonate, effectively used in osteoporosis and metastatic bone diseases, was the first systematic drug studied regarding treatment of GCTB. The most commonly used zoledronic
Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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with the administration of bisphosphonates and denosumab, highlighting the significance of reducing skeletal-related events ( 5 , 7 ). Recent research emphasizes the significance of vascular endothelial growth factor (VEGF) inhibitors in extending
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-steroidal anti-inflammatory drugs, opioids and bisphosphonates have been used to treat patients reporting bone pain, with the most favourable outcomes detected in individuals treated with bisphosphonates, mainly pamidronate. 69 , 70 Although most lesions
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improved chemotherapy and radiotherapy, new targeted therapy such as bisphosphonates and denosumab (antigen against RANKL) reduce skeletal-related events (SREs). A broad spectrum of surgical options is available for reconstruction of defects. Many of the