Metastatic Tumours

Bony Metastases

Survival

Median survival after diagnosis of bony mets:

  • Thyroid:  48 mth
  • Prostate:  40 mth
  • Breast:  24 mth
  • Myeloma:  20 mth
  • Renal:  < 6 mth.  If solitary met, there is a chance of long term survival
  • Lung:  < 6 mth

Radiotherapy

  • Breast & prostate more responsive than lung

Indications for Prophylactic Fixation

  • Considerations:
    • Pain
      • Persistent pain despite radiation
    • Location of lesion
      • Involvement of subtrochanteric region ↑ risk
      • Any lesion between lesser trochanter & femoral head causing functional pain or > 2.5 cm should be fixed
      • Avulsion of lesser trochanter
    • Lesion size
      • Many descriptors used
        • Lesion > 2.5 cm involving femoral cortex
        • > 50% femoral cortical involvement (100% incidence of pathologic fracture)
  • Mirels system
    • Pain
      • Mild (1)
      • Moderate (2)
      • Severe (3)
    • Location of lesion
      • Upper limb (1)
      • Lower limb (2)
      • Peritrochanter (3)
    • Size of lesion
      • < 1/3  (1)
      • 1/3-2/3  (2)
      • > 2/3  (3)
    • Type of lesion
      • Blastic  (1)
      • Mixed  (2)
      • Lytic  (3)
    • Assessment – score out of 12:
      • < 7, not at risk of fracture
      • 8,  15% risk of fracture
      • 9,  33% risk
      • >=9, should be used as an indication for fixation

Adjuvant Therapy for Metastatic Bone Disease by Dr Vikram David

Management of Metastatic Bone Disease