Management of Metastatic Bone Disease Algorithms for Diagnostics and Treatment

Abstract

Background: Bone is a frequent site of metastases in advanced cancer and is associated with significant skeletal morbidity. Current treatment options are aimed at preserving and improving functional independence and quality of life.

Materials and methods: A review of current literature focusing on diagnostic tools and treatment approaches of bone metastasis in advanced cancer was performed and conclusions were incorporated into diagnostic and treatment algorithms.

Results: Radiologic imaging has added valuable tools for screening and diagnostics of bone metastasis. Clinical management of skeletal metastasis includes improved pain management, introduction of bone modifying agents and advancements in surgical and radiation therapy. We propose three algorithms enhancing the sensitivity of diagnostics and improving multidisciplinary management of vertebral and non-vertebral bone metastasis.

Conclusion: Bone metastases are an expression of a systemic disease. Treatment options include highly specialized modalities yet need to be tailored to individual needs. Algorithms help standardize treatment procedures and can improve treatment outcome in a multidisciplinary setting.

Keywords: Metastatic bone disease; algorithm for diagnostic and treatment; bone-targeted agents; multidisciplinary management; non-vertebral bone metastasis; review; skeletal morbidity; vertebral bone metastasis.