Documente Academic
Documente Profesional
Documente Cultură
Hanif Andhika W
METASTATIC BONE DISEASE
Stimulation of osteoclast
Formation and Activation of
Osteoclasts Molecular insights
RANK/RANKL/Osteoprotegerin (members of TNF family)
Most of osteolytic
factors act via
Bone-derived
osteoblast
growth factors Osteolytic factors
production
IGF, TGFof PTHrP, IL-11
RANKL
Osteoblasts
Osteoclasts Mineralised bone matrix
RANKL
The Soil and Seed Theory
Tumour cell Bone microenvironment Interactions:
the Vicious Circle in Prostate Cancer
Cancer cells
Osteoblastic
factors
Adrenomedullin
Bone-derived
ET-1,
growth factors Osteolytic factors
IGF, TGF PTHrP,RANKL, IL-11
New bone
Osteoblasts
Osteoclasts Mineralised
RANKL bone matrix
Osteoblasts
Bone matrix
RANKL
Adapted by Hamdy Azim from Armstrong AP, et al. Prostate 2008; 68:92-104.
METASTATIC BONE DISEASE
- Metastatic
- Myeloma
- Lymphoma
- Chondro Sa / Fibro Sa /
Malignant Fibrous
Histiocytoma
(MFH)
METASTATIC BONE DISEASE
- Structural support
- Hematopoeitic system
- Mineral metabolism
METASTATIC BONE DISEASE
Structural Support :
Causes Impending Fx : Fx likely to occur
with physiologic loading / ADL
Risk of pathologic fx in Weight Bearing
Bone 50% cortical destruction
Diaphysis Femur : Long permeative lytic
METASTATIC BONE DISEASE
Hematopoiesis :
Suppresion due marrow replacement
with tumor cell (Ca Breast, Prostate,
Lung, Thyroid) anemia normo
chronic / cytic
METASTATIC BONE DISEASE
Medical :
- Once meta (+) prognosis poor
- Prognosis : Median survival : 6 48 mos
(Lung < 6, thyroid 48)
Medical th/ :
Surgical :
Indications for operative treatment
- Established pathologic fracture
- Lesions 2,5 cm in the femur Impending fx
Prophylactic int.
- Lytic lesions 50% cortical
fixation
involvement/(cross section)
- Risk of Fx determined by CT-Scan
- After fixation Radio th/
METASTATIC BONE DISEASE