Bone Metastases, Softcover reprint of the original 1st ed. 1991
Diagnosis and Treatment

Bone Metastases brings together the many recent developments that are gradually improving the prospects for patients with secondary involvement of the skeleton in a primary cancer elsewhere. The morbidity from bone metastases is extensive, and the palliative and supportive treatment that sufferers require for many months or even years constitutes a major health problem. A multidisciplinary approach is essential since a variety of specialists are involved: radiation and medical oncologists, general and orthopaedic surgeons, general physicians, radiologists and nuclear medicine physicians, symptom control and terminal care specialists. The book's editors, themselves authorities in the fields of oncology and bone disease respectively, have brought together experts from all these disciplines to provide comprehensive coverage of metastatic bone disease. They cover the biology and pathophysiology, hypercalcaemia, imaging, assessment of response to treatment, types of treatment (systemic, radiotherapy, surgery), and symptomatic and supportive care. Particularly new approaches included are magnetic resonance imaging, the assessment of skeletal response and isotope therapy.

1 The Nature of Metastatic Bone Disease.- Biology of Bone Metastases.- Patterns of Bone Metastases.- Morbidity from Bone Metastases.- Assessment of Skeletal Disease.- 2 Normal Bone Remodelling and Its Disruption in Metastatic Bone Disease.- Normal Bone Structure.- Normal Bone Modelling.- Normal Bone Remodelling.- Regulation of Bone Remodelling.- Effects of Tumours on Bone.- Osteosclerosis.- Effects of Some Specific Tumour Cell Types in Bone.- Summary.- 3 The Bone Scan in Metastatic Disease.- Pathophysiology of Skeletal Uptake of Diphosphonate.- Bone Scan Imaging.- Breast Cancer.- Prostatic Cancer.- Other Genito-urinary Tract Tumours.- Lung Cancer.- Neuroblastoma.- Other Tumours.- 4 Radiology.- Skeletal Survey.- Distribution and Routes of Spread.- Radiographic Appearances.- Computed Tomography.- Radiological Appearances at Specific Sites.- Radiological Appearance of Specific Metastases.- Comparison of Skeletal Survey and Isotope BoneScans.- Response to Treatment.- Summary.- 5 Magnetic Resonance Imaging.- Principles of Magnetic Resonance Imaging.- Technical Considerations.- MRI of Normal Bone Marrow.- MRI of Pathological Bone Marrow.- Comparison of Malignant and Osteoporotic Vertebral Collapse.- Patterns of Vertebral Metastases.- Sensitivity of MRI.- Spinal Cord Compression.- Monitoring Response to Treatment.- Conclusions.- 6 Assessment of Response to Treatment.- Imaging of Bone Metastases.- Biochemical Monitoring.- Subjective Assessment.- Tumour Markers.- Suggestions for Future Study.- 7 The Systemic Treatment of Bone Metastases.- Systemic Therapy.- Direct Anti-tumour Therapy.- Inhibitors of Tumour Effects on Host Cells.- Conclusions and Prospects.- 8 Pathogenesis and Management of Cancer-Associated Hypercalcaemia.- Pathogenesis of Cancer-Associated Hypercalcaemia.- Classification.- Mediators of Hypercalcaemia.- Mechanisms of Hypercalcaemia: Summary.- Management of Cancer-Associated Hypercalcaemia.- Clinical Assessment.- Indications for Treatment.- Principles of Medical Management.- Specific Management Problems.- 9 Radiotherapy in the Management of Bone Metastases.- Principles of External Beam Irradiation.- Radiotherapy Treatment Techniques for Bone Metastases.- Biological Effects of Ionising Radiation.- Pathological Changes after Bone Irradiation.- Clinical Use of Radiotherapy for Bone Metastases.- Conclusion.- 10 Isotope Therapy for Bone Metastases.- Characteristics of Radionuclides Used for Therapy.- The Criteria for Selection.- Mechanisms for Localisation.- The Use of Radionuclides for Therapy.- Radiopharmaceuticals for Therapy.- Monoclonal Antibodies.- Radionuclide Therapy for Bone Metastases: Current Status.- The Future.- 11 The Role of the Orthopaedic Surgeon in the Treatment of Skeletal Metastases.- Impending Fractures.- Pathological Fractures.- Non-pathological Fracture in a Patient with Malignant Disease.- Spinal Instability.- Compression of the Spinal Cord or Cauda Equina.- Non-metastatic Orthopaedic Conditions in Patients with Malignant Disease.- 12 Symptomatic and Supportive Care.- The Use of Drugs to Control Pain from Bone Metastases.- Orthopaedic Surgical Treatment.- Radiotherapy.- Transcutaneous Nerve Stimulation.- Acupuncture.- Intercostal Nerve Block.- Paravertebral Block.- Dorsal Root Ganglion Rhizolysis.- Percutaneous Cervical Cordotomy.- Pituitary Alcohol Injection.- The Place of the Support Team.- Conclusion.