Artificial intelligence in personalized selection of surgical treatment tactics for bone metastases

Introduction. Selection of surgical treatment tactics for patients with bone metastases is one of the important problems of modern oncology. In the majority of patients with metastatic bone lesions, surgical interventions are aimed at palliative treatment; however, in some cases of solitary metastases, radical resections with a reconstructive component can be performed. Lifespan prognosis associated with histological structure of malignant tumor is the main and crucial factor in determination of suitable type of surgical treatment.

Aim. To create software for selection of surgical tactics treatment in patients with bone metastases.

Materials and methods. Treatments of 715 patients who underwent surgical interventions for bone metastases of various locations were analyzed. In total, 780 surgeries were performed. Surgical interventions due to complex progression of bone metastases in the vertebral bones were performed in 48.5 % of cases, long bones in 247 (35 %) cases, pelvic bones in 81 (11 %) cases, thoracic bones in 40 (5.5 %) cases.

Results. Complete elimination or significant reduction of pain syndrome after surgical treatment of bone metastases were observed in 629 (88 %) patients. Improved quality of life per the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales after surgery was observed in 633 (88.5 %) patients. Postoperative complications developed in 49 (7 %) patients, mostly of infectious type (21 (3 %) cases). Errors in selection of surgical treatment tactics were identified in 49 (7 %) cases. Overall 1-year survival was 52 %. Based on the results of analysis of international literature data and our own experience, treatment algorithm for this patient category was modernized, and 14-point lifespan prognosis scale was developed. Their use allowed to develop the BoneMetaLife software for determination of surgical treatment tactics for bone metastases.

Conclusion. Adequate surgical tactics for treatment of bone metastases of various parts of the skeleton and favorable oncological prognosis improves patients’ quality of life and increases survival in patients with solitary metastases. Development of new treatment tactics based on patient lifespan prognosis and algorithms of surgical treatment will allow to decrease the probability of errors in selection of onco-orthopedic help and increase treatment effectiveness.

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