title: Clinical presentations of below knee bone metastases: a case series.
abstract: Bone metastases are a common complication of advanced malignancy; however, presentation of below-the-knee metastases, particularly affecting the fibula and tibia, are infrequently observed in both the clinical setting and the literature, and present a therapeutic challenge to patients and physicians alike. Due to the weight-bearing capacity of bones below-the-knee, the disruption of the structural and functional integrity of these bones can reduce mobility and thus quality of life. Treatment options for these patients include surgery, radiotherapy, and/or chemotherapy. Candidates for surgery typically have affected weightbearing bones. For patients not suitable for surgery, radiotherapy is prescribed for pain relief and bone remineralization. Herein, we report four cases in which two female and two male patients developed painful below knee metastases. Orthopedic surgery was consulted for all cases. Two patients underwent surgical fixation followed by radiotherapy, while the other two received palliative radiotherapy alone.
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Choi
authors.affiliation: Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Probyn
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Leigha
authors.initials: L
authors.lastname: Rowbottom
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: McDonald
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Bobrowski
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chan
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Pearl
authors.initials: P
authors.lastname: Zaki
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Turner
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Edward.Chow@sunnybrook.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary; D003937:Diagnosis, Differential; D005260:Female; D005360:Fibula; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D010166:Palliative Care; D013977:Tibia; D014057:Tomography, X-Ray Computed
keywords: Bone metastases; fibula; pathological fracture; tibia