Bone Metastasis and Treatment in Esophageal Cancer

The 5-year survival rate of esophageal cancers is 15–25%. It is the sixth most common type of cancer that causes death. Primary tumor cells metastasize in three ways, via neighborhood, lymphatic, and hematogenous routes. Bones are anatomical structures to which malignancies frequently metastasize due to their dense vascular structure. After the lung and liver, bones are the third most common anatomical structure to be metastasized. Bone metastases are most frequently observed in the vertebrae, in the pelvic bones, and in the extremities. Following metastasis to the bone, osteolytic lesions develop if bone destruction occurs, but osteoblastic lesions develop if the new bone is regenerated. Both osteoblastic and osteolytic lesions may occur together and are called mixed types. Fewer surgical options are available for patients with bone metastases whose life expectancy is less than 12 months. In pathologic fractures secondary to metastatic bone lesions, osteosynthesis is performed with intramedullary nails and plates. These methods provide additional support for osteosynthesis with bone cementum during surgical fixation. If extensive bone resections are performed during surgeries, intercalary prostheses can be used. Due to the rarity and low life expectancy of esophageal cancers, there are no large series of studies on the treatment of bone metastases of esophageal cancers. Approximately half of the patients diagnosed with esophageal cancer have distant metastases at the time of diagnosis. Patients with bone metastases have a poor prognosis, but patients who received chemotherapy have better survival. The rarity and short survival of esophageal cancers are the main reason for the scarcity of literature on the detection and treatment of bone metastases. In the diagnosis, follow-up, and treatment of bone metastases in esophageal cancers, it is recommended to apply the diagnosis and treatment protocols of bone metastases of other cancers.