**6.6 Surgery**

Surgical management of bone metastases is typically reserved for lesions with a complete or impending pathologic fracture or spine metastases that cause mechanical instability or spinal cord compression [5, 44]. Nonetheless, for highly selected patients with advanced cancer who present with or develop a bone lesion as the only focus of cancer beyond the primary site, resection of the bone metastasis may optimize local tumor control, provide durable pain relief, and possibly prolong survival.
