Innovative treatment for bone metastases

Vânia Oliveira

Vânia Oliveira is Specialist of Orthopedics and integrates the CHUPorto Musculoskeletal Tumor Treatment Unit.She obtained the PhD in Medical Sciences at ICBAS –UP in april of 2021, under the supervision of Prof. António Araújo and co-advising of Prof. Sander Dijkstra.

Cancer patients live progressively longer. Bone metastases have a clinical and socioeconomic impact and are associated with pain, fracture, and functional impairment. Patients benefit early local control in association with systemic treatments.

The present thesis comprised three studies and aimed to contribute to increasing the quality of life of patients with multiple bone metastases.

Retrospectively, it identified over and undertreatment due to the difficulty in estimating survival and the lack of defined prognostic criteria for patient ion.

Numerically, the thermal necrosis effect of cement polymerization at the cement-tumor-bone interface was investigated. Significant necrosis was observed with low- or high-viscosity cement and a titanium or CF-PEEK intramedullary nail. Low viscosity cement with titanium nail displayed the largest necrotic area.

Prospectively, a minimally invasive, low-cost combined treatment including radiofrequency ablation and double-balloon kyphoplasty for spinal lesions, or curettage, radiofrequency ablation, cementing, and internal fixation in the long bone lesions was also studied. It showed a rapid and significant pain relief and functional improvement, with an impact on patients’ quality of life. In addition, local control with tumor suppression was observed in the treated location. The combined procedures showed an effective synergistic and complementary effect, with patients with short and medium survival significantly benefitting this treatment.

This thesis innovates in the combined treatment for long bone lesions and biomechanical study, showing impactful results that contribute to advances in the treatment of bone metastases. In the future, nanotechnology should be used for systemic treatments.

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