Surgical treatment of bone metastases in patients with lung cancer

Abstract

Lung cancer is the leading cause of cancer mortality. Bone metastases are a common complication in lung cancer. The therapeutic approach and the type of surgical treatment of these lesions have not been clearly defined. Outcome and prognosis of patients with bony metastases and a variety of surgical interventions were analysed retrospectively. In 58 patients we performed 62 surgeries. The most common locations of metastases were the spine (32 patients), the proximal femur (10) and the pelvis (11). Twenty-one patients had a singular and 20 had multiple osseous lesions; 17 showed additional visceral involvement. Nine patients had a local progression of their disease and 49 a systemic progression. Patients with local progression (n = 9) had a better prognosis than the patients with systemic progression (p = 0.0083). Fracture (p = 0.0017) worsened prognosis, whereas the number of bone lesions or the presence of a visceral lesion did not. Patients with small lesions showed a better survival than patients with large lesions (p = 0.02). Ten percent of the patients died within 30 days and 78% within one year after surgery. Fracture of bone due to metastatic lung cancer worsens the prognosis whereas the number of bone lesions, the presence of a visceral lesion and the surgical approach do not.

Fig. 1

a A 58-year-old patient with a metastatic lesion of the thoracic spine (Th 10) with myelon compression in the CT scan as a first manifestation of an adenocarcinoma of the lung. b Radiograph of the thoracic spine of the same patient after tumour resection and instrumentation (Th8-Th12)

Fig. 2

a Radiograph of a 56-year-old patient showing a large osteolytic lesion in the right humerus with a pathologic fracture as first manifestation of metastatic lung cancer. b MRI of the same patient indicates the infiltration of the bone metastasis in the surrounding soft tissues. c Radiograph of the patient showing the tumour prosthesis after resection of the metastasis

Fig. 3

Survival probability after surgical therapy of 58 patients with bone metastases secondary to lung cancer

Fig. 4

Overall survival probability dependent on the type of histology