Treatment algorithm for metastatic malignancies in the lower extremities

Abstract

Abstract Background A high prevalence of proximal femoral metastases persists in cancer patients, especially regarding lower extremity fractures. This study offers a detailed analysis of the clinical characteristics in patients undergoing surgical treatment for pathological or impending fractures, enhancing treatment strategies in metastatic malignancies. Methods Thirty patients who underwent treatment for impending and pathological fractures at our hospital were included. The retrospective study covered parameters such as age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcome, and follow-up period. We compared post-treatment MSTS scores in cases of impending and pathological fractures, and between intramedullary nailing and other surgical procedures. The one-year postoperative survival rate was also calculated. Furthermore, we compared the operative time, blood loss, and survival rates of impending and pathological fractures. Results Participants had a median age of 70.5 years, with disease sites primarily in the subtrochanteric femur, trochanteric femur, femoral diaphysis, femoral neck, and other locations. Pathologies included multiple myeloma, unknown primary, lung, breast, kidney, liver, gastric, esophageal, and uterine cancers. The median ECOG-PS score pre-fracture was 2. Treatment approaches involved radiotherapy, chemotherapy, and a combination of both. Surgical interventions included intramedullary nailing (16 cases), endoprosthesis (1 case), bipolar head replacement (3 cases), and compression hip screw (3 cases), among others. A negative correlation (r = -0.63) existed between MSTS and pre-fracture ECOG-PS scores. Operative time was significantly shorter in impending than pathological fractures, with impending fractures also showing significantly lower blood loss. Conclusion Our treatment algorithm for malignant bone tumors of the lower extremity was efficient, potentially optimizing treatment strategies for such cases, and contributing to improved patient care and outcomes in oncology and orthopedic surgery.