Metastatic Bone Disease Treatments at MUSC Health

Patients are living longer with metastatic cancers. While that news is positive, metastatic cancer, particularly metastatic bone disease, can impact a patient’s quality of life.
Weakened bones, a heightened risk for fractures and severe pain at the metastasis site, all key symptoms of metastatic bone disease, can rob patients of their mobility and ability to function. 

“There is a correlation between pathologic fracture risk and how much bone has been lost from the cancer in the bone, so early treatment is essential,” says Dr. Lee Leddy. He and his partner, Dr. Zeke Walton, are MUSC Health orthopedic surgeons who specialize in benign and malignant bone and soft tissue tumors in children and adults and metastatic bone cancer. 

Cancers can spread to any bone, but some cancers tend to spread to certain regions.

“We see the majority of skeletal metastatic disease in the long bones, the pelvis and the spine,” says Leddy, who also holds the John A. Siegling Chair in MUSC’s Department of Orthopedics. “Cancer in the breast, lung, kidney, thyroid, prostate and multiple myeloma have the most affinity to spread to the bone.”

MUSC Health’s NCI-designated Hollings Cancer Center offers a variety of treatments that can make a positive difference in a patient’s quality of life by reducing pain and improving function. 

Drs. Leddy and Walton are part of a multidisciplinary team of orthopedic surgical oncologists, medical oncologists, radiation oncologists, and musculoskeletal radiologists who work together to make guideline-directive individualized care plans for each patient.

“The management of metastatic bone disease has changed significantly in the last decade, says Dr. Walton. “Genetic sequencing is much better than it was 10 years ago, and our ability to find actionable mutations and control them with immunotherapy is extending the lives of our patients.”

Drs. Leddy and Walton assess the patient’s condition and discuss with medical and radiation oncologists if there is a need for surgical intervention. “The situation is nuanced and depends on the anatomic location of the cancer, how much bone destruction has occurred, the type of cancer that the patient has, where they are in their cancer journey, and what other treatments they have failed.”

If surgery is deemed the best treatment for preventing a fracture, repairing a broken bone or strengthening a patient’s musculoskeletal system to allow for weight-bearing and daily living activities, Drs. Leddy and Walton offer 3 surgical options depending on the patient’s condition. They can stabilize the bone with metal implants and screws, fill the defects in the bone with bone cement or remove the tumor and/or the bone and reconstruct it with a metal endoprosthetic.

“We are tending to be more aggressive because our patients are more likely to live longer and need something more stable that will last longer,” Dr. Walton says. “If a patient has a metastatic lesion on the femur, instead of putting a nail in it, we will open the lesion and resect it or remove that entire piece of bone where the lesion is and reconstruct it with an endoprosthetic.”

Dr. Leddy says the goal of surgery is often palliative and, in most cases, not specific to improving overall survival. “Surgery can reduce patients’ pain and decrease the need for pain medications, as well as improve mobility and overall function,” he says. “Surgery for metastatic bone disease can prevent an impending fracture, decrease pain, and improve quality of life, but does not necessarily improve survival.”

He and Dr. Walton typically see two types of patients: Those who have been diagnosed with known metastatic disease and are seeking palliative treatment, and those who have no known diagnosis for the source of their pain.

“Our diagnosed patients have already started other treatments but have weak bones from cancerous lesions that may be about to break and are causing them immense pain,” he says. “Often, cancers in the organs such as lung and kidney don’t cause pain or other symptoms until the cancer spreads to the bone; that is often why patients come to the orthopedic clinic. Between 30 and 40 percent of patients have no known diagnosis when they first come to see me.”

For patients without a known diagnosis and who are experiencing pain in their bones, Drs. Leddy and Walton utilize a specific algorithm including scans and labs to identify a primary cancer and the source of the pain.

“Generally, with this investigative strategy, we can find about 90 percent of primary tumors without having to do a biopsy,” he says. “It’s Important to get an accurate diagnosis with a skeletal lesion that appears aggressive, and no known primary cause has been identified.”

For many patients, medical oncology will provide the best outcome, he says.

Advanced treatment options include immunotherapy, radiofrequency ablation, medications used to prevent fractures, and radiation therapy if the patient shows no risk of impending fracture and if the tumor is radiation sensitive.

Drs. Leddy and Walton are enthusiastic about the treatment and care that their patients receive at MUSC Health.

“Most of our patients come to us seeking pain relief, and we want to alleviate it and collaborate with our team of specialists and subspecialists to help them return to a pain-free life whenever possible,” says Dr. Leddy, who along with Dr. Walton, treats patients from the Carolinas and Georgia.

“The treatment paradigm for metastatic cancer has changed significantly in the past decade,” Dr. Walton says. “MUSC Health’s multidisciplinary team of specialists and subspecialists and cutting-edge treatment modalities have put us at the forefront of these changes. We can provide complex skeletal reconstruction to patients with metastatic bone disease and deliver advanced care that improves outcomes for our patient and extends their lives.