Diagnostiek en behandeling van botmetastasen

Michiel A.J. van de Sande, Jos A.M. Bramer, Paul C. Jutte, H.W.Bart Schreuder en P.D. Sander Dijkstra

Diagnosis and treatment of bone metastasis

  • The improved prognosis of cancer patients has led to an increased incidence of both bone metastases and (impending) pathological fractures.

  • A solitary bone lesion seen on radiography should never be assumed to be a metastasis.

  • Preoperative biopsy is necessary in patients with a known malignancy and a solitary lytic bone lesion as well as in patients in whom the primary tumor is unknown, in order to prevent an incorrect operation (also known as ‘whoops surgery’).

  • If the patient has an (impending) pathological fracture, normal bone healing is not to be expected, not even after stable fixation.

  • Surgical fixation of an impending pathologic fracture is recommended when radiography indicates that a length of more than 3 cm of the cortex of a long bone has been destroyed. If surgical treatment is necessary, it should support the whole long bone in order to enable full weight bearing.

  • When the diagnosis of a bone lesion is uncertain, referral to an experienced treatment centre is recommended.