Malignant Bone Tumours

Thermal Ablation in Osteoid Osteomas Results of Thermal Ablation in Osteoid Osteomas 246 Thermal Ablation in Malignant Bone Tumours 246 Results of Thermal Ablation in Malignant Bone Tumours 247 Complications 248 Summary 249 References 250... 

The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1 2000. 

While primary malignant bone tumours are rare, bone metastases are a common finding among all malignancies. More than 50% of all patients with metastatic disease to the musculoskeletal system will present with symptoms - mainly pain - and will have severe constraints regarding quality of life for their remaining lifetime. 

Results of Thermal Ablation In Malignant Bone Tumours... 

Table 9.2. Primary and secondary success rate of different ablation therapies in malignant bone tumours in terms of pain relief. Cryo Cryopiasty, KP kyphoplasty, OP osteoplasty, R radiation therapy, RFA radiofrequency ablation)...

Furthermore, in malignant bone tumours, when surgery and/or radiotherapy are no longer appUca-ble, these methods offer a new, very effective therapeutic option for pain management. The exact role of minimally invasive ablative therapies among the huge armamentarium of different treatment options is not fully defined therefore, additional study evidence must be obtained to appreciate the high potential of these therapies. 

Another study examined the relationship between fluoride levels and osteosarcoma, a rare malignant bone tumour, commonly occiuring in the age group of 10-24 years. This study was planned in order to analyse serum levels of fluoride in patients of osteosarcoma and fluoride content of their drinking water by comparing 10 patients of osteosarcoma and 10 healthy volxmteers (who served as control) [31 ]. 

Bone. The value of MRS in the discrimination of benign and malignant bone tumours has been evaluated by Zhang et Cho and lipids were detected in malignant tumours, whereas no Cho was seen in normal bone marrow and most benign tumours. 

Bisphosphonates are widely used for the prevention and treatment of osteopenia and osteoporosis and for the reduction of skeletal complications in patients with malignant bone disease. Several oral bisphosphonates, including alendronate, risedronate, and ibandronate, are approved worldwide for the treatment of osteoporosis in postmenopausal women, as are intravenous (i.v.) formulations of ibandronate (3 mg quarterly) and zoledronic acid (5 mg annually). Several i.v. bisphosphonates are available for the treatment of the skeletal complications that frequently occur in malignant disease, such as hypercalcaemia of malignancy (HCM), multiple myeloma, and bone metastases associated with solid tumours. Pamidronate is approved worldwide for the treatment of HCM, multiple myeloma, and breast cancer bone metastases. Although not registered for oncology indications in the United States, i.v. ibandronate is widely available elsewhere for HCM and breast cancer bone metastases. 

In this setting, thermal ablation will be mainly a symptomatic, supportive (palliative) therapy, which can also be applied in conjunction with other therapies such as resection, radiotherapy or chemotherapy. In contrast to the treatment of malignant tumours, local thermal ablation is considered the method of choice in treatment of symptomatic benign bone tumours such as osteoid osteomas. 

Various malignancies can also induce an anaemic state. This is often associated with decreased serum EPO levels, although iron deficiency, blood loss or tumour infiltration of the bone marrow can be complicating factors. In addition, chemotherapeutic agents administered to this patient group often adversely affect stem cell populations, thus rendering the anaemia even more severe. 

Cancer is uncommon during the first two decades of life, but is nonetheless a substantial concern. In the United States, cancer is diagnosed in approximately 12 400 children and adolescents annually and is the most common cause of death from any kind of disease between 1 and 19 years of age. In the United States and other developed countries, lymphoid neoplasms (leukaemia, lymphoma) and cancers of the central nervous system are the most common paediatric malignancies. Other kinds of childhood tumours include embryonal tumours of the retina, sympathetic nervous system, kidney, and liver tumours of bone and soft connective tissues and certain gonadal neoplasms. Different kinds of cancer (e.g. carcinomas of liver or thyroid) may predominate in children in parts of the world where specific environmental risk factors are more prevalent. 

Q7 The total serum calcium concentration is normally about 9.5 mg dl 1. Approximately half of this is bound to plasma protein, mostly to albumin. Most of the remainder is unbound or ionized calcium, which is the physiologically and clinically important form. Hypercalcaemia, normally defined as a serum concentration of >12 mgdl-1, may sometimes be caused by excessive consumption of calcium in the diet. More important pathologically is malignant disease. Hypercalcaemia occurs when there are bone metastases associated with breast or prostate cancer. However, many tumours can produce a PTH-like protein causing elevated serum calcium levels. Furthermore, intoxication and immobilization of vitamin D or excess vitamin D may also cause hypercalcaemia. 

AE = Adverse event BC = Breast cancer CLOD = Clodronate EHDP = Etidronate HCM = Hypercalcaemia of malignancy IBN = Ibandronate i.v = Intravenous LC = Lung cancer MM = Multiple myeloma OST = Other solid tumours (renal, head and neck, thyroid, other) PDB = Paget s disease of bone PAM = Pamidronate PC = Prostatecancer PLA = Placebo PMO = Postmenopausal osteoporosis RIS = Risedronate ZOL = Zoledronicacid. 

Llombart-Bosch A, Lacombe MJ, Peydro-Olaya A, et al. Malignant peripheral neuroectodermal tumours of bone other than Askin s neoplasm chatacterization of 14 new cases with immunohistochemistry and electron microscopy. Virchows Arch A Pathol Anat Histopathol. 1988 412 421-430. 

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