Modular tumor endoprostheses in surgical palliation of long-bone metastases: a reduction in tumor burden and a durable r
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Modular tumor endoprostheses in surgical palliation of long-bone metastases: a reduction in tumor burden and a durable reconstruction Marcel-Philipp Henrichs1, Juliane Krebs1, Georg Gosheger1, Arne Streitbuerger1, Markus Nottrott1, Tim Sauer3, Steffen Hoell4, Gurpal Singh1,2 and Jendrik Hardes1*
Abstract Background: Surgical treatment of bone metastases has become increasingly important as patients live longer with metastatic cancer and one of the main aims is a long-lasting reconstruction which survives the patient. Conventional osteosynthesis may not be able to achieve this objective in the context of modern day cancer care. Methods: This study evaluates the oncological outcomes, treatment-related complications, and function after resection of metastases and reconstruction with modular tumor endoprostheses in 80 patients. All patients who underwent surgical treatment with modular tumor prostheses for bone metastases from 1993 to 2008 were traced by our tumor database and clinical information was recorded from patient case. Results: Mean age was 63 years. The most common primary tumors were renal cell (47%), breast (21%), and lung (8%). The proximal femur was affected in 45%, proximal humerus in 26%, and the distal femur in 17% of cases. In 22 cases, the tumor prosthesis was implanted during a revision operation. Mean overall survival after surgery was 2.9 years. Overall survival rate was 70% at one year and 20% at five years. Implant survival was 83% after one year and 74% at five years. Overall rate of operative revision was 18%. Conclusions: Our data collectively suggest that despite higher costs, implantation of modular tumor endoprostheses may be a suitable treatment for bone metastases with a low complication rate and rapid improvement in function in appropriately selected patients. Keywords: Bone metastasis, Modular, Surgical reconstruction, Survival, Tumor burden, Tumor endoprostheses
Background Surgical treatment of bone metastases has become increasingly important in view of the longer life expectancy of patients with metastatic cancer, coupled with advances in musculoskeletal oncology [1,2]. Estimation of prognosis and survival is subjective. It has been shown that estimation of survival in cancer patients may be correct only in 18% and underestimated in 43% of patients [3]. In addition, current decision-making in metastatic cancer patients needs to consider not only prognosis and survivorship, but also quality of life and function [1,4]. The skeleton is the third most common site of metastases, * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany Full list of author information is available at the end of the article
and metastases are the most common tumors of bone. At least every third to fifth patient with cancer develops bone metastases [1]. One of the most common complications of long bone skeletal metastases is a
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