Treatment algorithm for metastatic malignancies in the lower extremities

Area of Science:

• Orthopedic Surgery
• Oncology
• Pathology

Background:

• Proximal femoral metastases are common in cancer patients, often leading to lower extremity fractures.
• Effective surgical treatment strategies are crucial for managing metastatic malignancies and improving patient outcomes.

Purpose of the Study:

• To analyze the clinical characteristics of patients undergoing surgical treatment for pathological or impending proximal femoral fractures.
• To enhance treatment strategies for metastatic malignancies affecting the femur.
• To compare outcomes between impending and pathological fractures, and different surgical modalities.

Main Methods:

• Retrospective analysis of 30 patients treated for impending or pathological femur fractures at Kindai University Hospital.
• Data collected included patient demographics, fracture site, primary malignancy, Eastern Cooperative Oncology Group performance status (ECOG-PS), treatment modalities, operative details (time, blood loss), postoperative complications, Musculoskeletal Tumor Society (MSTS) scores, and survival rates.
• Statistical comparisons were made between fracture types and surgical procedures.

Main Results:

• The median age of patients was 70.5 years, with common primary sites including lung, breast, and multiple myeloma.
• A significant negative correlation (R=-0.63) was observed between MSTS scores and pre-fracture ECOG-PS.
• Impending fractures demonstrated significantly shorter operative times and lower blood loss compared to pathological fractures.

Conclusions:

• The study's findings suggest an efficient treatment algorithm for malignant bone tumors of the lower extremity.
• Optimizing treatment strategies can improve patient care and outcomes in orthopedic oncology.
• Understanding the differences between impending and pathological fractures aids in surgical planning and resource allocation.