[Treatment of pathological fractures caused by metastatic bone cancer]

The diagnosis of metastatic bone cancer is usually easy but in some cases the metastatic lesion is found before primary lesion is diagnosed. In such cases, the diagnosis is essential before treatment is begun. For these cases, bone scintigraphy and MRI are useful. Since curative treatment for metastatic bone cancer is impossible in most cases, it is important to decide the purpose of the treatment before starting. The aims are elongation of the life, decrease of pain, recovery from paralysis, attainment of stability, treatment and prophylaxis of the pathological fracture, and improvement of QOL. As for treatment of the pathological compression fracture of the spine combined with paralysis, the decompression operation should be done as early as possible, because at 48 hours after the paralysis is completed, recovery can not be expected even if complete decompression is performed. The decompression operation is performed with complete resection of the affected vertebrae anteriorly and then by rigid fixation with instrumentation posteriorly. As for the treatment of the pathological fracture of the extremities, in most cases operative treatments are indicated. Most pathological fractures of the extremities occur in the femur and humerus. In case of a proximal femur and humerus, wide excision of the tumor combined with the affected bone is performed, and the defect is then replaced with the prosthesis. When the shaft of the bone is affected, segmental resection of the bone is done in most cases and the defect is then replaced with ceramics and bone cement and fixed with intramedullary nails.