Misc Clin Onc

Question 1

What is the definition of an uncomplicated bone met

Answer 1

Absence of impending or established pathological fracture (Mirel score)
Absence of neurological compromise
Association of soft tissue mass
Previous radiation

Question 2

What type of Mets are detected by a technicium 99m bone scan

Answer 2

Osteoblastic mets

Question 3

What is the key role of different imaging modalities for different types of bone Mets

Answer 3

X-ray: appendicular skeleton when there is significant cortical loss
CT: osteolytic Mets
FDG PET: metabolically active Mets
Tc99m bone scan: osteoblastic mets (good for prostate, breast, lung)
MRI: soft tissue components, assessing neurological compression, bone marrow assessment

Question 4

What factors should be considered when determining plan for spinal Mets

Answer 4

Patient:
-Age, ECOG, comorbidities, preference

Tumour:
-systemic control and options, prognosis, histology (radio sensitivity), SINS, bilsky, neurological symptoms + onset

Treatment:
- available options (surgical, interventional, radiation, systemic)

Question 5

What are the general management options for symptomatic bone Mets

Answer 5

Supportive care
Analgesia
Bone modifying agents eg bisphos or denosumab
Surgery
Radiation
Interventional
Systemic therapy