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Skelettmetastaser

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Sakkunnig:

  • Skelettmetastaser är en allvarlig komplikation vid cancer. I detta skede har sjukdomen spridits och är i de flesta fall obotlig. 1-3
  • Metastaserna kan uppstå till följd av direkt inväxt, retrograd venöst blodflöde eller hematologisk spridning av tumöremboli.
  • Vid fraktur eller hotande fraktur kan det finnas indikation för operativ stabilisering eller rekonstruktion i palliativt syfte.
  • Operativ behandling tycks inte öka överlevnaden.
  1. Hansen BH, Keller JØ. Operativ behandling af knoglemetastaser i bækken og ekstremiteter. Ugeskrift for Læger 2005; 167: 4559-62. PubMed  
  2. Jensen AB, Kamby C, Hansen B, Keller J. Knoglemetastaser. Ugeskr Læger 2007; 169: 3753-5. PubMed  
  3. Riccio AI, Wodajo FM, Malawer M. Metastatic carcinoma of the long bones. Am Fam Physician 2007; 76: 1489-94. PubMed  
  4. Manabe J. Treatment modalities for metastatic bone tumors and associated issues: focusing on surgical indications and techniques for metastatic lesions in limb bones. J Orthop Sci 2000; 5: 524-31. PubMed  
  5. Aaron AD. Treatment of metastatic adenocarcinoma of the pelvis and the extremities. J Bone Joint Surg Am 1998; 80: 763-4. PubMed  
  6. Peh WC. Screening for bone metastases. Am J Orthop 2000; 29: 405. PubMed  
  7. Kagan AR, Bassett LW, Steckel RJ, Gold RH. Radiologic contributions to cancer management. Bone metastases. AJR Am J Roentgenol 1986; 147: 305-12. PubMed  
  8. Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol 2001; 177: 229-36. PubMed  
  9. Dickinson F, Liddicoat A, Dhingsa R, Finlay D. Magnetic resonance imaging versus radionuclide scintigraphy for screening in bone metastases. Clin Radiol 2000; 55: 653. PubMed  
  10. Cook GJ, Fogelman I. Detection of bone metastases in cancer patients by 18F-fluoride and 18F- fluorodeoxyglucose positron emission tomography. Q J Nucl Med 2001; 45: 47-52. PubMed  
  11. Qaseem A, Snow V, Shekelle P, et al. Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice from the American College of Physicians. Ann Intern Med 2008; 148: 141–6.
  12. British Association of Surgical Oncology Guidelines: The management of metastatic bone disease in the United Kingdom. The Breast Specialty Group of the British Association of Surgical Oncology. Eur J Surg Oncol 1999; 25: 3-23. PubMed  
  13. Durr HR, Refior HJ. Prognosis of skeletal metastases. Orthopade 1998; 27: 294-300. PubMed  
  14. Durr HR, Muller PE, Lenz T et al. Surgical treatment of bone metastases in patients with breast cancer. Clin Orthop 2002; 396: 191-6. PubMed  
  15. Wedin R, Bauer HC, Wersäll P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop 1999; 358: 128-39. PubMed  
  16. Nielsen OS, Bentzen SM, Sandberg E et al. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metasatses. Radiother Oncol 1998; 47: 233-40. PubMed  
  17. Pavlakis N, Schmidt RL, Stockler M. Bisphosphonates for breast cancer (Review) Cochrane Database of Systematic Reviews, issue 3, 2005. The Cochrane Library  
  18. Bauer HC. Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br 2005; 87: 608-17. PubMed  
  19. Hansen BH, Keller J, Laitinen M et al. The Scandinavian Sarcoma Group Skeletal Metastases Register. Survival after surgery for bone metastases in the pelvis and extremities. Acta Orthop Scand Suppl 2004; 75: 11-5. PubMed  
  20. Andersen Schmidt L, Pfeiffer P. Metastatisk medullært tværsnitssyndrom. Ugeskr Læger 2006; 168: 2810-3. PubMed  
  21. Bauer HFC, Wedin R. Survival after surgery for spinal and extremity metastases. Acta Orthop Scand 1995; 66: 143-6. PubMed  
  22. Durr HR, Huhne JH, Hagena FW et al. Surgical treatment for myeloma of the bone. Arch Orthop Trauma Surg 1997; 116: 463-9. PubMed  
  23. Durr HR, Maier M, Pfaler M et al. Surgical treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop 1999; 367: 283-90. PubMed  
  • Andris Kreicbergs, professor emeritus i ortopedi, Karolinska institutet

Tidigare sakkunniga

  • Bjørnar Grenne, ST-läkare och PhD, Sørlandet Sykehus Arendal