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Role of Surgery in Oligometastatic Disease

  • Chapter
Metastatic Bone Disease

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Abstract

Solitary and oligometastatic lesions occur in a subset of patients afflicted by bone metastases. Oligometastases may represent a distinct spectrum of disease for which aggressive surgical management may prolong survival or even potentiate cure. Basic research and empiric clinical evidence suggest that some cancers are biologically restricted in the capacity for distant spread. Renal cell carcinoma and thyroid cancer have been most frequently reported to benefit from aggressive treatment of bone oligometastases. Complete surgical resection of solitary and oligometastases has been associated with improved survival in numerous retrospective studies. Although rare compared with widespread bone metastases, the incidence of resectable oligometastatic cases likely outnumbers that of primary bone sarcomas.

Advances in cancer screening, diagnostics, and medical treatment will likely render more patients amenable to curative intent resection surgery. Minimally invasive ablation techniques including cryoablation, radiofrequency ablation, irreversible electroporation, and microwave ablation have been utilized for the definitive local control of bone metastases with promising early results. Smaller lesions distant from neurovascular structures are optimal for ablative techniques. Surgeons should consider whether metastatic bone disease patients may be treated with curative or at least life-prolonging intent before proceeding to purely palliative strategies.

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  1. Division of Orthopaedic Oncology, City of Hope, 1500 East Duarte Road, Duarte, CA, USA

    George T. Calvert MD, MBA

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  1. Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah, USA

    R. Lor Randall

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Calvert, G.T. (2016). Role of Surgery in Oligometastatic Disease. In: Randall, R. (eds) Metastatic Bone Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5662-9_22

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