Surgical Treatment of the Metastatic Tumors of the Femur / 대한정형외과학회잡지

ABSTRACT

Metastasis to bone with destruction of the skeletal system is a common problem in old patients with malignancy. Destruction of the musculoskeletal system poses major problems for the patients, including uncontrollable pain, forced immmobilization, pathologic fracture and hypercalcemia. The purpose of this study is to evaluate the effectiveness of surgical treatment and to suggest treatment guidelines for impending or established pathologic fractures due to metastasis of the femur. Between 1985 and 1995, thirty six patients who had pathologic or impending fractures in the femur underwent surgical treatment. The indications of surgery for pathologic fractures are 1) the possibility of survival time more than three months, 2) more benefits of sungical treatment than those of conservative treatment, 3) the possibility of rigid internal fixation, 4) patient s general condition allowing surgery, and those in impending fractures are 1) cortical destruction more than 50% or lytic lesion more than 2.5cm. The method of surgery was excision of the tumor and rigid internal fixation to allow early ambulation with or without bone cement augmentation. The results were analyzed by three criteria, the performance status, pain relief and survival time. Pain relief more than Lots was achieved in 80.6% of patients according to the Kaiko's criteria. The performance status improved more than one grade in all patients except one who died of acute respiratory failure and the mean improvement was 1.8 grade by the Functional Classification of the New York Heart Association. Postoperatively, most of the patients had only slight to moderate limitation of physical activities and felt comfortable at rest and ordinary activities. The survival time was 20.9 months in patients with single metastasis and 10.2 months in patients with multiple metastases. But there was no statistical significance due to large deviation of survival time in each case. In summary, surgical stabilization of the pathologic lesion involving the femur provided definite improvement of quality of life including pain relief and early ambulation. In selected patients with single metastasis, low grade malignancy, or good performance status, postoperative survival time may be expected to be prolonged. More aggressive treatment for the metastatic lesion of the femur is suggested.