GeneralG16PathologicFxsJTG幻灯片.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * Based on a retrospective study of 78 pts with metastatic disease to long bones. 27 patients fractured within 6 months. Their mean Mirels score was 10 while those without fracture had a score of 7. * * * * * * * * * * * * * * * * * * * Renal Cell Wedin, et al., CORR 1999 228 metastatic lesions treated with endoprosthetic or osteosynthesis 24% failure rate in renal cell lesions 20% failure rate in diaphyseal and distal femur lesions 14% failure rate for osteosynthesis, 2% for endoprosthesis Complications Infection malnutrition hematomyelopoetic suppression Hemorrhage vascular tumors ( renal and thyroid) Tumor recurrence Failure of fixation Thromboembolic disease Embolization Hypervascular tumors Renal cell carcinoma Thyroid carcinoma Pheochomocytoma Post embolization Pre embolization Pre-operative embolization can preventhemorrhage with intra-lesional surgery Summary Diagnosis and treatment requires a multidisciplinary approach Aggressive surgical treatment relieves pain, restores function, and facilitates nursing care Biopsy all solitary lesions or refer appropriately Understand tumor biology and tailor treatment References Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 1989; 249:256 Gainor BJ, Buchert P. Fracture healing in metastatic bone disease Clin Orthop 1983; 176:297-302. Eckardt JJ, et.al. Endoprosthetic reconstructions for bone metastases. Clin Orthop 2003; 415:S254-262. References Ward WG, et.al. Metastatic disease of the femur: surgical treatment. Clin Orthop 2003; 415:S230-244 Kelly CM, et.al. Treatment of metastatic disease of the tibia. Clin Orthop 2003; S219-219 van der Linden YM, et.al. Simple radiographic parameter predicts fracturing in metastatic femoral bone lesions:results from a randomized trial. Radiotherapy and Oncology 2003; 69: 21-31 References Singletary SE, et.al. A role for curative surge