Bonetto Rémi, Tallet Agnès, Mélot Anthony, Calderon Benoît, Barlesi Fabrice
Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, service d'oncologie multidisciplinaire et innovations thérapeutiques, 13920 Marseille cedex 15, France.
Institut Paoli-Calmettes, département d'oncologie-radiothérapie, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France.
Bull Cancer. 2017 Jun;104(6):585-592. doi: 10.1016/j.bulcan.2017.02.004. Epub 2017 Apr 6.
Bone metastasis are the most common cause of pain related to cancer, reducing patients' quality of life, and sometimes threatening their life-expectancy. Their management has to be pluridisciplinary, because of all the therapeutic options and the diversity of bone metastasis locations. The aim of this work is to propose a rational decisional algorithm for the treatment strategy of these secondary locations. Anti-resorbtive drugs with systemic action, surgery, conventional or stereotactic radiation therapy, and new techniques of interventional radiology are options that could be used separately or combined. They have shown benefits on symptomatic treatment, improving quality of life. Their indications vary according to the tumor site (short vs. long bones, carrier vs. non-carrier bones), the symptomatology (pain, neurologic symptoms), and the presence of complications (most of all fractures). The diverse presentations lead us to define this decisional algorithm, to guide the practice, while giving the maximal benefit to each patient according to each metastasis.
骨转移是癌症相关疼痛的最常见原因，会降低患者的生活质量，有时还会威胁其预期寿命。由于所有的治疗选择以及骨转移部位的多样性，其管理必须是多学科的。这项工作的目的是为这些继发性部位的治疗策略提出一种合理的决策算法。具有全身作用的抗吸收药物、手术、传统或立体定向放射治疗以及介入放射学的新技术都是可以单独使用或联合使用的选择。它们已显示出对症状治疗有益，可改善生活质量。它们的适应症根据肿瘤部位（短骨与长骨、承重骨与非承重骨）、症状（疼痛、神经症状）以及并发症的存在情况（最主要的是骨折）而有所不同。这些不同的表现促使我们定义这种决策算法，以指导实践，同时根据每个转移灶为每位患者提供最大益处。
