Bone metastases

Background

Bone metastases arise in 50% of all patients dying from carcinoma, increasing up to 70% in patients with breast and prostate cancer. The lesions can cause pain and fractures, leading to diminished quality of life and poorer survival. Current knowledge concerning adequate, personalized treatment of metastatic lesions of the long bones in patients with disseminated cancer is insufficient and inconclusive due to lack of large, prospective series with patient reported outcome measures. 

Aim

The OPTIMAL Study comprises two parts: a retrospective and a prospective part. For the retrospective part a large multicenter database was constructed and a survival estimation model (OPTIModel) was developed. Currently, tumor-specific prognostic factors are being investigated in order to improve the OPTIModel. 

The prospective OPTIMAL cohort, according to the ‘cohort multiple randomized controlled trial design’, aims to describe the quality of life and pain perception of patients after local treatment (radiotherapy and/or surgery) of metastases of the long bones, for both the entire cohort as well as for specific treatments separately. 

Relevance for cancer research

With this study a more personalized treatment for metastases in the long bones based on expected survival and impending fracture risk can be provided in order to improve functioning and the quality of life for the remaining lifetime in patients with disseminated cancer.

Project Outcomes

• Willeumier JJ, van der Linden YM, van der Wal CWPG, Jutte PC, van der Velden JM, Smolle MA, van der Zwaal P, Koper P, Bakri L, de Pree I, Leithner A, Fiocco M, Dijkstra PDS (2018). An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases. J Bone Joint Surg. Am., 100(3):196-204. doi: 10.2106/JBJS.16.01514 

• Willeumier JJ, Kaynak M, van der Zwaal P, Meylaerts SAG, Mathijssen NMC, Jutte PC, Tsagozis P, Wedin R, van de Sande MAJ, Fiocco M, Dijkstra PDS (2018). What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases? Clin Orthop Relat Res, 476(9):1823-1833. doi: 10.1007/s11999.0000000000000201

• Willeumier JJ, van der Hoeven NM, Bollen L, Willems LN, Fiocco M, van der Linden YM, Dijkstra PD (2017). Epidermal growth factor receptor mutations should be considered as a prognostic factor for survival of patients with pathological fractures or painful bone metastases from non-small cell lung cancer. Bone Joint J. 99-B(4):516-521. doi: 10.1302/0301-620X.99B4.BJJ-2016-0872.R1

• OPTIModel survival estimation tool for predicting remaining survival for patients with long bone metastases (available on www.optimal-study.nl and mobile version iOs and Android)

Team

• Prof. dr. P.D.S. Dijkstra (PI), MD, Orthopaedic Surgeon at the Leiden University Medical Center

• Dr. M. Fiocco, Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology 

• W.A. Goudriaan, MD, Leiden University Medical Centre, Department of Orthopaedics

• Dr. Y.M. Van der Linden (PI), Radiation Oncologist at the Leiden University Medical Center

• C.W.P.G. van der Wal, MD, Leiden University Medical Centre, Department of Orthopaedics

• J.J. Willeumier, MD, Leiden University Medical Centre, Department of Orthopaedics