Palliative care of proximal femur metastatic disease and osteolytic lesions: results following surgical and radiation treatment

• Published in: BMC cancer Vol. 24; no. 1; pp. 1431 - 16
• Main Authors: Mehnert, Elisabeth, Möller, Fränze Sophie, Hofbauer, Christine, Weidlich, Anne, Winkler, Doreen, Troost, Esther G C, Jentsch, Christina, Kamin, Konrad, Mäder, Marcel, Schaser, Klaus-Dieter, Fritzsche, Hagen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.11.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Bone Neoplasms - mortality; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Bone Neoplasms - surgery; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Care and treatment; Comparative analysis; Development and progression; Diagnosis; Diseases; Female; Femoral Neoplasms - mortality; Femoral Neoplasms - radiotherapy; Femoral Neoplasms - secondary; Femoral Neoplasms - surgery; Femur - pathology; Femur - radiation effects; Femur - surgery; Fractures, Spontaneous - etiology; Fractures, Spontaneous - surgery; Germany; Health aspects; Humans; Impending fracture; Intramedullary nailing; Kaplan-Meier Estimate; Lung cancer, Non-small cell; Male; Metastasis; Middle Aged; Multimodal cancer therapies; Osteolysis; Osteolysis - etiology; Osteolytic bone lesions; Palliative Care - methods; Palliative treatment; Pathological fracture; Patient outcomes; Prevention; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Proximal femoral metastasis; Radiation; Radiotherapy; Radiotherapy, Adjuvant - adverse effects; Radiotherapy, Adjuvant - methods; Retrospective Studies; Risk factors; Germany; Pathological fracture; Intramedullary nailing; Proximal femoral metastasis; Osteolytic bone lesions; Impending fracture; Multimodal cancer therapies; Skeletal-related events
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-13170-0

Femoral bone metastases (FBM) or lesions (FBL) can lead to loss of mobility and independence due to skeletal-related events (SRE), e.g. pain, deformity and pathological fractures. Aim of this study was to analyze effects of radiotherapy and surgery, different surgical techniques and complications on disease-specific survival (DSS). Patients who underwent palliative therapy for FBM or FBL between 2014 and 2020 were retrospectively analyzed. Chi-square test was used to detect intergroup differences. Survival was calculated using Kaplan-Meier method, Cox regression and compared using log-rank test. Complications were evaluated using Chi-Square test. 145 patients were treated for proximal femoral BM/BL or pathologic fractures (10 bilaterally). Three groups were classified: surgery only (S, n = 53), surgery with adjuvant radiation (S + RT, n = 58), and primary radiation only (RT, n = 44). Most common primary tumors were breast (n = 31), prostate (n = 27), and non-small cell lung cancer (n = 27). 47 patients underwent surgery for an impending, 61 for a manifest pathological fracture. There were no significant differences in DSS between the 3 groups (S = 29.8, S + RT = 32.2, RT = 27.1 months), with the S + RT group having the longest one-year survival. Local complications occurred in 25 of 145 patients after a mean interval of 9.9 months. Due to the steadily increasing incidence and survival of patients with FBM/FBL, indication for prevention and treatment of painful and immobilizing SREs should be critically assessed. Surgical treatment should always be performed with maximum stability and, whenever possible, adjuvant RT.