Management of bone metastases in breast cancer

Managing patients with bone metastases requires a multidisciplinary approach applying the expertise of orthopedic surgeons, radiation oncologists, medical oncologists, and radiologists. Small lesions can usually be successfully treated with radiation therapy alone, with subsequent surgical stabilization only for continued symptoms or fracture. Bones with diffuse, permeative destruction should be internally stabilized prophylactically if possible, followed by postoperative radiation therapy. Unless contraindicated, all patients with metastatic carcinoma of the breast with involvement of the bone should receive systemic osteoclast inhibitor therapy for the prevention of skeletal related events, irrespective of pain symptoms or extent of disease. Future treatment modalities will further decrease the substantial morbidity associated with the development and progression of bone metastases.