Orthopedic surgery relieves breast cancer metastases

By Lynda Williams, Senior medwireNews Reporter

Results of a review demonstrate the key role orthopedic surgery can play in the care of breast cancer patients with bone metastases.

The study reports the outcome of 115 patients, aged an average of 57.3 years, who underwent 132 orthopedic operations between 1980 and 2005 to treat pain, instability, fracture or impending fracture of the long bones, and spinal compression.

Median overall survival in the patients was 17 months after bone metastases diagnosis, with significant differences according to site and extent of disease.

For example, the patients with a single bone lesion survived for a medium of 65 months versus 13 months in patients with visceral metastases. Patients who sustained an extremity fracture had significantly poorer survival than those without such injury (10 vs 25 months).

In addition, patients who underwent wide resection had significantly better survival than those with marginal or intralesional resections (median survival not reached versus 19 and 12 months, respectively).

In multivariate analysis, however, overall survival was significantly predicted by extent of tumor spread, with a small but significant decrease in survival with age over 55 years.

The patients underwent surgery alongside hormone therapy (16%), chemotherapy (36%), and/or radiotherapy (53%).

Highlighting the need for a multidisciplinary approach to metastatic disease, Bernd Wegener (Ludwig-Maximilians-University Munich, Germany) and co-authors say: "Orthopedic surgeons should be active members in this multidisciplinary team with oncologists, radiologists and radiation-oncologists.

"Their part will become more important in the future as new operative techniques and materials will enable patients with metastatic breast cancer, who live longer because of better systemic approaches, to live with a better quality of life."

As described in BMC Musculoskeletal Disorders, the patients had bone metastases in the spine (n=65), proximal femur (n=46), humerus (n=8), pelvis (n=5), ribs (n=5), and other sites (n=3).

Fourteen patients underwent incisional biopsy, one patient underwent proximal humerus resection without reconstruction. Spine metastases were treated with vertebroplasty, dorsal decompression alone, or with dorsal instrumentation, or by partial or complete vertebral resection with ventral stabilization.

In addition, 15 patients underwent tumor resection and received a tumor-endoprosthesis, 19 patients underwent hip arthroplasty, and one patient received a semiconstrained knee endoprosthesis.

Wide resection was performed in nine patients without visceral tumor spread, while 60 patients underwent palliative intralesional or marginal surgery.

Complications were reported for 15 patients including three cases each of deep vein thrombosis, postoperative hematoma, and osteosynthesis failure.

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