Oncological and functional results after surgical treatment of bone metastases at the proximal femur

BACKGROUND Metastatic lesions to the proximal femur occur frequently (about 10% of patients with cancer) and require surgical treatment. There are many surgical methods of treatment, however, use of the tumor modular endoprostheses seems to be particularly promising. The aim of study was to evaluate oncological and functional results of treatment in patients with proximal femur metastases. Oncological results were evaluated considering the survival of patients and the number of local recurrences. Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score. METHODS Between 2010 and 2016, 122 patients with metastatic tumour to the proximal femur were treated in our hospital. Majority of the patients were women - 77 patients. The mean age was 67 years for women and 72 years for men. Pathological fracture was diagnosed in 98 cases. Metastatic bone tumors commonly develop from breast cancer - 48 and myeloma - 24. One hundred one patients underwent tumor resection and in 21 cases metastatic tumors was not resected. In 75 patients wide tumour resection and modular endoprosthetic replacement were prefomed. Twenty-one patients underwent standard or long stem hip endoprosthetic replacement. Intramedullary gamma nails were implanted in 20 cases and DHS plate in 6 cases. In 92 cases 3-4 weeks after surgery patients undergo external beam radiotherapy (8Gy). Functional results were assessed as pain intensity in VAS score and performance in Karnofsky and MSTS score. Oncological results were evaluated considering the survival of patients and the number of local recurrences. RESULTS The mean follow-up of patients was 27 months (min 4, max 51). Forty-five patients died before last visit in hospital. The mean survival after modular endoprosthetic replacement was 860 days and after bone fixations 360 days. We noticed 9 cases of local recurrences or progressions, 6 in patients who had no radiotherapy. Three patients after modular endoprosthesis replacement and 6 after bone fixations. After surgery, all patients experienced improvement in the comfort of life resulting from reduction in pain. Mean VAS score before modular endoprosthetic replacement was 6.8 and after 3.4; before standard prothesoplasty 4.9 and after 2.8; and before and after bone fixation 6.9 -5.1. Mean MSTS score was respectively 6.4-19.8; 8.8-22.4 and 10.8-18.2. In 6 patients after modular endoprosthesis replacement, delayed wound healing were observed. Infectious complications were not observed after fixation with nails and plates. In 3 cases, the fixation was failed. The systemic complications affected 12 patients. CONCLUSIONS Results of surgical treatment for metastases to the proximal femur are particularly good in patients after standard or modular endoprostheses replacement. The author considers this treatment method to be optimal in patients with good prognosis.