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)
- Many descriptors used
- Pain
- 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
- Pain