Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 1;7(1):121-4.
doi: 10.7150/jca.13377. eCollection 2016.

Radiotherapy, Bisphosphonates and Surgical Stabilization of Complete or Impending Pathologic Fractures in Patients with Metastatic Bone Disease

Michal J Wolanczyk  1 , Khashayar Fakhrian  2 , Irenäus A Adamietz  2
Affiliations

Radiotherapy, Bisphosphonates and Surgical Stabilization of Complete or Impending Pathologic Fractures in Patients with Metastatic Bone Disease

Michal J Wolanczyk et al. J Cancer. .

Abstract

Purpose: To report the treatment outcomes of patients with metastatic bone disease with complete or impending pathologic fractures, who were treated with postoperative radiotherapy (RT), bisphosphonates or both after orthopedic stabilization.

Material and methods: We retrospectively evaluated the results of RT, bisphosphonates or both after orthopedic stabilization for complete or impending pathologic fractures in 72 patients with skeletal metastases. After surgery, 32 patients (44%) were treated with RT alone (group 1), 31 patients (43%) were treated with RT and bisphosphonates (group 2) and 9 (13%) patients were treated with bisphosphonates (group 3), respectively. Patients were treated with a median dose of 30Gy (30-40 Gy/2-3Gy per fraction).The local tumor progression, pain progression and need for re-operation or re-radiotherapy were assessed from patients' medical records. Median follow-up time was 9 months.

Results: Median overall survival time was 14 months (95% CI: 12-17). Secondary surgical intervention at the same location was necessary in 1 patient of group 1 (2%), 2 patients of group 2(5%) and 2 patients of group 3 (15%), respectively (p=0.097). Local tumor progress was observed in 3 patients of group 1 (9%), 2 patients of group 2 (7%) and 4 patients in group 3 (44%), respectively (p=0.021). Local pain progress was observed in 19%, 16% and 67% of the same groups (p=0.011).

Conclusion: Our data confirm the efficacy and necessity of postoperative RT after orthopedic stabilization for metastatic bone disease to control the local disease. Bisphosphonates do not obviate the need for RT in the management of bone metastases after surgical stabilization. The combined treatment might lead to a better local tumor and pain control.

Keywords: Pathological fracture; bisphosphonates; bone metastasis; orthopedic stabilization; postoperative radiotherapy.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Overall survival of the whole cohort.
See this image and copyright information in PMC

References

    1. Damron TA, Sim FH. Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect. 2000;49:461. - PubMed
    1. Damron TA, Bogart JA, Bilsky M. Evaluation and management of complete and impending pathologic fractures in patients with metastatic bone disease, multiple myeloma, and lymphoma. UpToDate, Accessed on July 25; 2015.
    1. Ogilvie C.M, Fox E.J, Lackman R.D. Current surgical management of bone metastases in the extremities and pelvis. Semin Oncol. 2008;35:118–28. - PubMed
    1. Biermann J.S, Holt G.E, Lewis V.O, Schwartz H.S, Yaszemski M.J. Metastatic Bone Disease: Diagnosis, Evaluation, and Treatment. J Bone Joint Surg Am. 2009;91:1518–1530. - PubMed
    1. Townsend P.W, Smalley S.R, Cozad S.C, Rosenthal H.G, Hassanein R.E. Role of postoperative radiation therapy after stabilization of fractures caused by metastatic disease. Int J Radiat Oncol Biol Phys. 1995;31:43–9. - PubMed

LinkOut - more resources