Treatment of patients with metastatic lesions of the long bones

Bukharov A.V.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-2976-8895

Derzhavin V.A.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-4385-9048

Golubev P.V.

Herzen Moscow Research Cancer Institute

Yadrina A.V.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-7944-3108

Treatment of patients with metastatic lesions of the long bones

Authors:

Bukharov A.V., Derzhavin V.A., Golubev P.V., Yadrina A.V.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2021;(5): 89‑94

DOI: 10.17116/hirurgia202105189

Downloaded: 26

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Bukharov AV, Derzhavin VA, Golubev PV, Yadrina AV. Treatment of patients with metastatic lesions of the long bones. Pirogov Russian Journal of Surgery. 2021;(5):89‑94. (In Russ.)
https://doi.org/10.17116/hirurgia202105189

Подписка 2025 (Pirogov Russian Journal of Surgery)

Close metadata

OBJECTIVE

To optimize orthopedic care in patients with complicated course of metastatic lesions of the long bones.

MATERIAL AND METHODS

There were 201 patients (72 men and 129 women) who underwent orthopedic care for metastatic lesions of the long bones for the period from 2006 to 2019. Breast cancer metastases were diagnosed in 71 (35%) cases, kidney cancer — 56 (28%) patients, prostate cancer — 19 (9%) cases, metastases without a primary identified focus — 15 (8%) patients. Other forms were observed in 40 (20%) patients. All patients were divided into two groups. The first group included 136 patients (68%) who underwent segmental resections with bone replacement. Of these, 100 (73%) patients had secondary lesions of the lower limb bones and 36 (27%) patients with metastatic lesions of the upper limb bones. A threat of pathologic fracture was in 63 (46%) cases, fracture — in 73 (54%) patients. The second group consisted of 65 (32%) patients who underwent immersion osteosynthesis. Of these, 47 (72%) patients had metastatic lesions of the lower limb bones and 18 (28%) patients had secondary lesions of the upper limb bones. A threat of pathologic fracture was in 24 (37%) patients, fracture — in 41 (63%) patients.

RESULTS

In the first group, mean surgery time was 140 min, in the second group — 120 min. Mean blood loss in the first group was 600 ml, in the second group — 300 ml. Patients were activated on the 3^rd postoperative day in both groups. We analyzed surgical, anatomical and functional results in both groups using MSTS, Watkins and Karnofsky’s scales.

CONCLUSION

Oncological replacement and osteosynthesis are the main methods of surgical treatment of secondary lesions of the long bones. However, our data emphasize advisability of bone replacement, since this method ensures the most adequate stabilization, pain syndrome relief and long-term improvement of the quality of life.

Keywords:

bone metastases

pathologic fracture

immersion osteosynthesis

replacement

Authors:

Bukharov A.V.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-2976-8895

Derzhavin V.A.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-4385-9048

Golubev P.V.

Herzen Moscow Research Cancer Institute

Yadrina A.V.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center

ORCID: 0000-0002-7944-3108

Received:

16.06.2020

Accepted:

17.07.2020

List of references:

Sze WM, Shelley M, Held I, Wilt T, Mason M. Palliation of metastatic bone pain: single fraction versus multiplefraction radiotherapy — a systematic review of randomized trials. Clin Oncol. 2003;15(6):345-352.
Takahashi T, Nishimura K, Yamano T and Gika M. Role of Palliative Radiotherapy for Bone Metastasis. J Palliat Care Med. 2014;4(171).
Wu J, Wong R, Johnston M, et al. Meta-analisis of dose — fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003;55(3):594-605.
Gatenby RA, Gawlinski ET, Gmitro AF, et al. Acidmediated tumor invasion: a multidisciplinary study. Cancer Res. 2006;66:5216-5223.
Coleman RE. Adjuvant bisphosphonates in breast cancer: are we witnessing the emergence of a new therapeutic strategy. Eur J Cancer. 2009;45:1909-1915.
Coleman R. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20)Pt.2:6243-6249.
Schulman K, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer. 2007;109(11):2334-2342.
Bukharov AV, Derzhavin VA, Yadrina AV, Golubev PV. Orthopedic manual for metastatic lesion of long bones. Research and practice in medicine. 2019. (In Russ.).
Bychkova NM, Khmelevsky EV. Features of metastatic bone involvement in different primary tumors and their implications for external beam radiotherapy. Onkologiya. Zhurnal im. P.A. Herzen, 6, 2016. (In Russ.). https://doi.org/10.17116/onkolog20165612-20
Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra. Treatment of pathological fractures of the long bones. PDS EFORT Open Rev. 2016;1(5):136-145. https://doi.org/10.1302/2058-5241.1.000008
Ratasvuori M, Wedin R, Hansen BH, Keller J, Trovik C, Zaikova O, Laitinen M. Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases. Journal of Surgical Oncology. 2011;10(4):360-365. https://doi.org/10.1002/jso.23654
Rath B, Tingart M, Migliorini F, Eschweiler J, Zureik R, Hardes J. Differentiated treatment strategies for bone metastases of the extremities. Orthopade. 2019;48(9):752-759. Review. German. https://doi.org/10.1007/s00132-019-03791
Karpenko VYu, Derzhavin VA, Bukharov AV, Danilova TV, Andreev MS. Early outcomes of reverse shoulder arthroplasty for tumors of the humerus. Vestnik travmatologii i ortopedii im N.N. Priorova. 2015;2:25-30. (In Russ.). https://doi.org/10.32414/0869-8678-2015-2-25-30
Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev. 2017;1:136-145. https://doi.org/10.22141/1608-1706.2.17.2016.74654
Szendrői M, Antal I, Szendrői A, Lazáry Á, Varga. Diagnostic algorithm, prognostic factors and surgical treatment of metastatic cancer diseases of the long bones and spine. PP.EFORT Open Rev. 2017;2(9):372-381. Epub 2017 Sep 1. https://doi.org/10.1302/2058-5241.2.170006
Guzik G. Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg. 2018;18(5). https://doi.org/10.1186/s12893-018-0336-0

Close metadata