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. 2018 Jan 25;18(1):5.
doi: 10.1186/s12893-018-0336-0.

Oncological and functional results after surgical treatment of bone metastases at the proximal femur

Grzegorz Guzik  1   2
Affiliations

Oncological and functional results after surgical treatment of bone metastases at the proximal femur

Grzegorz Guzik. BMC Surg. .

Abstract

Background: Metastatic lesions to the proximal femur occur frequently (about 10% of patients with cancer) and require surgical treatment. There are many surgical methods of treatment, however, use of the tumor modular endoprostheses seems to be particularly promising. The aim of study was to evaluate oncological and functional results of treatment in patients with proximal femur metastases. Oncological results were evaluated considering the survival of patients and the number of local recurrences. Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score.

Methods: Between 2010 and 2016, 122 patients with metastatic tumour to the proximal femur were treated in our hospital. Majority of the patients were women - 77 patients. The mean age was 67 years for women and 72 years for men. Pathological fracture was diagnosed in 98 cases. Metastatic bone tumors commonly develop from breast cancer - 48 and myeloma - 24. One hundred one patients underwent tumor resection and in 21 cases metastatic tumors was not resected. In 75 patients wide tumour resection and modular endoprosthetic replacement were prefomed. Twenty-one patients underwent standard or long stem hip endoprosthetic replacement. Intramedullary gamma nails were implanted in 20 cases and DHS plate in 6 cases. In 92 cases 3-4 weeks after surgery patients undergo external beam radiotherapy (8Gy). Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score. Oncological results were evaluated considering the survival of patients and the number of local recurrences.

Results: The mean follow-up of patients was 27 months (min 4, max 51). Forty-five patients died before last visit in hospital. The mean survival after modular endoprosthetic replacement was 860 days and after bone fixations 360 days. We noticed 9 cases of local recurrences or progressions, 6 in patients who had no radiotherapy. Three patients after modular endoprosthesis replacement and 6 after bone fixations. After surgery, all patients experienced improvement in the comfort of life resulting from reduction in pain. Mean VAS score before modular endoprosthetic replacement was 6.8 and after 3.4; before standard prothesoplasty 4.9 and after 2.8; and before and after bone fixation 6.9 -5.1. Mean MSTS score was respectively 6.4-19.8; 8.8-22.4 and 10.8-18.2. In 6 patients after modular endoprosthesis replacement, delayed wound healing were observed. Infectious complications were not observed after fixation with nails and plates. In 3 cases, the fixation was failed. The systemic complications affected 12 patients.

Conclusions: Results of surgical treatment for metastases to the proximal femur are particularly good in patients after standard or modular endoprostheses replacement. The author considers this treatment method to be optimal in patients with good prognosis.

Keywords: Bone metastasis; Modular endoprostheses; Proximal femur; Tumors resections.

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Conflict of interest statement

Ethics approval and consent to participate

The research has been performed in accordance with the declaration of Helsinki. As this retrospective analysis consists of anonymised clinical routine data, the Research Ethics Committee deems the application for and issue of an Ethics approval not necessary.

All the data were anonymised before the author started research (had access to the data).

All the patients gave a written consent to the use of data for research.

Name of Ethics committee: Ethics Committee in Cracov, ul Krupnicza 11a 31-123 Cracov, tel. + 48126191712, fax + 48124225755.

Consent for publication

Manuscript does not contains any individual person’s data.

Competing interests

The author declares that he has no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Survival In patients after different methods of surgery
Fig. 2
Fig. 2
Preoperative and postoperative radiograms series. a Proximal femur breast cancer metastasis, b radiogram after tumour resection and modular prosthesis implantation. c Proximal femur prostate cancer metastasis and fracture after stabilisation with use of gamma nail. Fail of fixation - gamma nail was broken, d after proximal femur resection and modular prosthesis implantation. e Proximal femur renal cancer metastasis, f local recurrence after tumor resection and endoprosthesis implantation, g radiogram after prosthesis removal
See this image and copyright information in PMC

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