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Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

  • Authors:
    • Kazuhiko Hashimoto
    • Shunji Nishimura
    • Tomohiko Ito
    • Ryosuke Kakinoki
    • Koji Goto
  • View Affiliations / Copyright

    Affiliations: Department of Orthopedic Surgery, Kindai University Hospital, Osakasayama, Osaka 589‑8511, Japan
    Copyright: © Hashimoto et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 65
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    Published online on: July 16, 2024
       https://doi.org/10.3892/mco.2024.2763
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Abstract

As managing pathological fractures of the extremities can be difficult, the present study aimed to present a treatment algorithm for lower extremity bone malignancies. A total of 38 patients with impending and pathological fractures were treated at the Department of Orthopedic Surgery in Kindai University Hospital. 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, outcomes, follow‑up period and the MSTS scores and ECOG‑PS were compared in cases of primary malignant tumors and those cases of metastatic malignant tumors were retrospectively surveyed. Post‑treatment MSTS scores in cases of impending and pathological fractures were compared between intramedullary nail fixation and non‑intramedullary nail fixation procedures. Disease sites included the sub‑trochanteric femur in 10 patients, trochanteric femur in 8, femoral diaphysis in 7, femoral neck in 5, bilateral trochanteric femur in 3, proximal tibia in 3 and distal femur in 2 patients. A total of 10 patients had metastases between 3‑20 sites. The median pre‑fracture ECOG‑PS score was 1. Adjuvant radiotherapy was administered to 5, chemotherapy to 8 and radiotherapy with chemotherapy to 10 patients. Surgical procedures included intramedullary nails in 18 patients, tumor arthroplasty in 4, plate fixation in 3, artificial head replacement in three, compression hip screw (CHS) in 3, conservative treatment in 2, bilateral intramedullary nail fixation in 2 and artificial bone stem with combined intramedullary nail and plate fixation, right‑sided artificial head replacement and left‑sided CHS in 1 patient each. The MSTS score was 19.9±8.95 for intramedullary nail fixation and 24.3±7.45 for other procedures, with a negative association between the MSTS score and pre‑fracture ECOG‑PS. The median follow‑up period was 8 months. The outcomes were as follows: Alive with disease, 23 patients; continued disease‑free, 1 patient; and dead due to disease, 14 patients. The 1‑year postoperative overall survival rate was 60.5%. Moreover, the group with metastatic malignant tumors, which had significantly worse ECOG‑PS, had significantly lower MSTS scores than the group with primary malignant tumors. The authors' treatment algorithm for malignant bone tumors of the lower extremity was shown to be useful.
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1 

Hoshi M, Iwai T, Oebisu N, Shimatani A, Takada N and Nakamura H: Pathological fracture of a solitary bone cyst in the calcaneus: A case series and literature review. Arch Orthop Trauma Surg. 143:1155–1162. 2023.PubMed/NCBI View Article : Google Scholar

2 

Salunke AA, Chen Y, Tan JH, Chen X, Khin LW and Puhaindran ME: Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?: A systematic review and meta-analysis. Bone Joint J. 96 B:1396–1403. 2014.PubMed/NCBI View Article : Google Scholar

3 

Urakawa H, Tsukushi S, Hosono K, Sugiura H, Yamada K, Yamada Y, Kozawa E, Arai E, Futamura N, Ishiguro N and Nishida Y: Clinical factors affecting pathological fracture and healing of unicameral bone cysts. BMC Musculoskelet Disord. 15(159)2014.PubMed/NCBI View Article : Google Scholar

4 

Fontanella C, Fanotto V, Rihawi K, Aprile G and Puglisi F: Skeletal metastases from breast cancer: Pathogenesis of bone tropism and treatment strategy. Clin Exp Metastasis. 32:819–833. 2015.PubMed/NCBI View Article : Google Scholar

5 

Scorianz M, Gherlinzoni F and Campanacci DA: Metastases to the long bones: Algorithm of treatment. In: Management of bone metastases. Denaro V, Di Martino A and Piccioli A (eds). Springer, Berlin, pp93-102, 2019.

6 

Scully SP, Ghert MA, Zurakowski D, Thompson RC and Gebhardt MC: Pathologic fracture in osteosarcoma: Prognostic importance and treatment implications. J Bone Joint Surg Am. 84:49–57. 2002.PubMed/NCBI

7 

Chung LH, Wu PK, Chen CF, Weng HK, Chen TH and Chen WM: Pathological fractures in predicting clinical outcomes for patients with osteosarcoma. BMC Musculoskelet Disord. 17(503)2016.PubMed/NCBI View Article : Google Scholar

8 

Hage WD, Aboulafia AJ and Aboulafia DM: Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 31:515–528. 2000.PubMed/NCBI View Article : Google Scholar

9 

Piccioli A, Spinelli MS and Maccauro G: Impending fracture: A difficult diagnosis. Injury. 45 (Suppl 6):S138–S141. 2014.PubMed/NCBI View Article : Google Scholar

10 

Blagden SP, Charman SC, Sharples LD, Magee LR and Gilligan D: Performance status score: Do patients and their oncologists agree? Br J Cancer. 89:1022–1027. 2003.PubMed/NCBI View Article : Google Scholar

11 

Enneking WF, Dunham W, Gebhardt MC, Malawar M and Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 286:241–246. 1993.PubMed/NCBI

12 

Hu YC, Lun DX and Wang H: Clinical features of neoplastic pathological fracture in long bones. Chin Med J (Engl). 125:3127–3132. 2012.PubMed/NCBI

13 

Angelini A, Trovarelli G, Berizzi A, Pala E, Breda A, Maraldi M and Ruggieri P: Treatment of pathologic fractures of the proximal femur. Injury. 49 (Suppl 3):S77–S83. 2018.PubMed/NCBI View Article : Google Scholar

14 

Guzik G: Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg. 18(5)2018.PubMed/NCBI View Article : Google Scholar

15 

Ji Y, Wu Y and Li J: Use of three-dimensional-printed custom-made prosthesis to treat unicondylar femoral defect secondary to pathological fracture caused by giant cell tumor. J Int Med Res. 49(3000605211025347)2021.PubMed/NCBI View Article : Google Scholar

16 

Johnson NA, Uzoigwe C, Venkatesan M, Burgula V, Kulkarni A, Davison JN and Ashford RU: Risk factors for intramedullary nail breakage in proximal femoral fractures: A 10-year retrospective review. Ann R Coll Surg Engl. 99:145–150. 2017.PubMed/NCBI View Article : Google Scholar

17 

Kosygan KP, Mohan R and Newman RJ: The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 84:19–22. 2002.PubMed/NCBI View Article : Google Scholar

18 

Willeumier JJ, van der Linden YM, van de Sande MAJ and Dijkstra PDS: Treatment of pathological fractures of the long bones. EFORT Open Rev. 1:136–145. 2017.PubMed/NCBI View Article : Google Scholar

19 

Swanson KC, Pritchard DJ and Sim FH: Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg. 20:56–65. 2000.PubMed/NCBI View Article : Google Scholar

20 

Dijstra S, Wiggers T, van Geel BN and Boxma H: Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg. 160:535–542. 1994.PubMed/NCBI

21 

Wedin R and Bauer HC: Surgical treatment of skeletal metastatic lesions of the proximal femur: Endoprosthesis or reconstruction nail? J Bone Joint Surg Br. 87:1653–1657. 2005.PubMed/NCBI View Article : Google Scholar

22 

Harvey N, Ahlmann ER, Allison DC, Wang L and Menendez LR: Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res. 470:684–691. 2012.PubMed/NCBI View Article : Google Scholar

23 

Moore J, Isler M, Barry J and Mottard S: Major wound complication risk factors following soft tissue sarcoma resection. Eur J Surg Oncol. 40:1671–1676. 2014.PubMed/NCBI View Article : Google Scholar

24 

Goryń T, Pieńkowski A, Szostakowski B, Zdzienicki M, Ługowska I and Rutkowski P: Functional outcome of surgical treatment of adults with extremity osteosarcoma after megaprosthetic reconstruction-single-center experience. J Orthop Surg Res. 14(346)2019.PubMed/NCBI View Article : Google Scholar

25 

Roudier MP, True LD, Higano CS, Vesselle H, Ellis W, Lange P and Vessella RL: Phenotypic heterogeneity of end-stage prostate carcinoma metastatic to bone. Hum Pathol. 34:646–653. 2003.PubMed/NCBI View Article : Google Scholar

26 

Ganesh K and Massagué J: Targeting metastatic cancer. Nat Med. 27:34–44. 2021.PubMed/NCBI View Article : Google Scholar

27 

Mavrogenis AF, Pala E, Romagnoli C, Romantini M, Calabro T and Ruggieri P: Survival analysis of patients with femoral metastases. J Surg Oncol. 105:135–141. 2012.PubMed/NCBI View Article : Google Scholar

28 

Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A and Buckley L: Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br. 20:108–112. 2009.PubMed/NCBI View Article : Google Scholar

29 

Saad F, Lipton A, Cook R, Chen YM, Smith M and Coleman R: Pathologic fractures correlate with reduced survival in patients with malignant bone disease. Cancer. 110:1860–1867. 2007.PubMed/NCBI View Article : Google Scholar

30 

Mirels H: Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 249:256–264. 1989.PubMed/NCBI

31 

Hashimoto K, Nishimura S, Ito T, Kakinoki R and Goto K: Treatment algorithm for metastatic malignancies in the lower extremities. Mol Clin Oncol. 21(51)2024.PubMed/NCBI View Article : Google Scholar

32 

Gharibi A, La Kim S, Molnar J, Brambilla D, Adamian Y, Hoover M, Hong J, Lin J, Wolfenden L and Kelber JA: ITGA1 is a pre-malignant biomarker that promotes therapy resistance and metastatic potential in pancreatic cancer. Sci Rep. 7(10060)2017.PubMed/NCBI View Article : Google Scholar

33 

Mariean CR, Tiucă OM, Mariean A and Cotoi OS: Cancer Cachexia: New insights and future directions. Cancers (Basel). 15(5590)2023.PubMed/NCBI View Article : Google Scholar

34 

Law ML: Cancer cachexia: Pathophysiology and association with cancer-related pain. Front Pain Res (Lausanne). 3(971295)2022.PubMed/NCBI View Article : Google Scholar

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Copy and paste a formatted citation
Spandidos Publications style
Hashimoto K, Nishimura S, Ito T, Kakinoki R and Goto K: Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors. Mol Clin Oncol 21: 65, 2024.
APA
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., & Goto, K. (2024). Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors. Molecular and Clinical Oncology, 21, 65. https://doi.org/10.3892/mco.2024.2763
MLA
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., Goto, K."Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors". Molecular and Clinical Oncology 21.3 (2024): 65.
Chicago
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., Goto, K."Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors". Molecular and Clinical Oncology 21, no. 3 (2024): 65. https://doi.org/10.3892/mco.2024.2763
Copy and paste a formatted citation
x
Spandidos Publications style
Hashimoto K, Nishimura S, Ito T, Kakinoki R and Goto K: Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors. Mol Clin Oncol 21: 65, 2024.
APA
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., & Goto, K. (2024). Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors. Molecular and Clinical Oncology, 21, 65. https://doi.org/10.3892/mco.2024.2763
MLA
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., Goto, K."Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors". Molecular and Clinical Oncology 21.3 (2024): 65.
Chicago
Hashimoto, K., Nishimura, S., Ito, T., Kakinoki, R., Goto, K."Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors". Molecular and Clinical Oncology 21, no. 3 (2024): 65. https://doi.org/10.3892/mco.2024.2763
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