Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France.
Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Service de radiologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France.
Joint Bone Spine. 2019 Mar;86(2):185-194. doi: 10.1016/j.jbspin.2018.03.005. Epub 2018 Apr 6.
Bone is the third metastatic site after liver and lungs. Bone metastases occur in one out of three lung cancers and are usually of osteolytic aspect. Osteolytic bone metastases are responsible of long bone and vertebral fractures leading to restricted mobility, surgery and medullar compression that severely alter quality of life and that have a huge medico-economic impact. In the recent years, Bone Metastatic Multidisciplinary Tumour Board (BMTB) have been developed to optimize bone metastases management for each patient in harmony with oncology program. In this review, we will go through all the different aspects of bone metastases management including diagnosis and evaluation (CT scan, Tc 99m-MDP bone scan, FDG-PET scan and biopsy for molecular diagnosis), systemic bone treatments (zoledronic acid and denosumab) and local treatments (interventional radiology and radiotherapy). Surgical strategies will be discussed elsewhere. Based on the last 2017-Lung Cancer South East French Guidelines, we present a practical decision tree to help the physicians for decision making in order to reach a personalized locomotor strategy for every patient.
骨骼是继肝脏和肺部之后的第三大转移部位。三分之一的肺癌患者会发生骨骼转移，且通常为溶骨性。溶骨性骨转移会导致长骨和脊柱骨折，从而导致活动受限、需要手术以及骨髓压迫，严重影响生活质量，并对医疗经济产生巨大影响。近年来，已经开发出骨转移多学科肿瘤委员会（BMTB），以与肿瘤学计划协调一致，优化每位患者的骨转移管理。在这篇综述中，我们将全面探讨骨转移管理的各个方面，包括诊断和评估（CT 扫描、Tc 99m-MDP 骨扫描、FDG-PET 扫描和分子诊断活检）、全身骨骼治疗（唑来膦酸和地舒单抗）和局部治疗（介入放射学和放射治疗）。手术策略将在其他地方讨论。基于 2017 年法国东南部肺癌指南，我们提出了一个实用的决策树，以帮助医生做出决策，从而为每位患者制定个性化的运动策略。
