➢ The differential diagnosis of an aggressive bone lesion includes metastatic disease, multiple myeloma, lymphoma, and primary sarcoma of bone. Evaluation includes radiographs of the entire bone; laboratory tests; computed tomography (CT) scanning of the chest, abdomen, and pelvis; bone scintigraphy; and biopsy.
➢ Except in rare circumstances, the treatment of skeletal metastasis is palliative and the goals of care center around pain relief and the maintenance of function.
➢ Nonoperative interventions include chemotherapy, bone-modulating agents such as bisphosphonates and denosumab, radiation therapy, and ablation with cementoplasty.
➢ When prophylactic operative stabilization is indicated to prevent pathological fracture, a cephalomedullary nail is preferred for femoral diaphyseal lesions. Postoperative external-beam radiation is indicated for local disease control.
➢ High-quality treatment of these patients relies on the close coordination of multiple different specialists.
Investigation performed at University of Connecticut Health, Farmington, Connecticut
Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article.
- Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated