Evaluation and management of carcinoma metastatic to bone

A large proportion of people in whom carcinoma is diagnosed develop bone metastases. The goal of treatment is to relieve pain, prevent fracture, and maintain function. Traditional treatment has emphasized external beam radiation therapy and surgery. Recent literature, however, reports the results of investigations into the cellular mechanisms responsible for bone resorption. The results of treatment regimens targeting these mechanisms utilizing biphosphonates and various radiopharmaceuticals are encouraging. Surgical indications should be individualized and are site specific, and new techniques have been described. A recent review of the results of treatment indicates that poor prognostic factors for survival include pathologic fracture, a primary tumor in the lung, and visceral or brain metastases. Favorable prognostic factors are solitary skeletal metastases and breast or kidney primary tumors. Continued research into the incidence and biology of these tumors and on the results of innovative treatments is essential in the effort to enhance the quality of life for these patients.