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artículos originales0 la alergología en el sistema sanitario público de la comunidad de Madrid: situación actual y oportunidades en el sistema sanitario público del siglo XXi Allergology in the public health service of the Community of Madrid: current situation and opportunities in the XXI century public health system

Results: We analyzed 114 patients, 50% female and male, median age 67 years (55-79), 43% greater than 70. Primary tumor site was lung (34.2%), breast (22.8%), hematological cancers (9.6%), prostate (7.9%) and thyroid (2.6%). Metastasis locations were 62.3% in femur and 33.3% in humerus. 71% had PS 0-1, 20.2% were oligometastatic and 56% had visceral metastasis. 31.6% were prophylactic surgery, 69.4% due to fracture (83.3% pathological, 9% traumatic, 7.7% mix component). 36% received perioperative radiotherapy and 34.2% bone-targeted agents. Intervention was mainly endomedullary nailing (69.3%) and oncological surgery (26.3%), with 20% of early complications and 7.8% of late ones. 47 patients (41.2%) had a skeletal-related event: pain (38.3%), fractures (34%), hypercalcemia (17%), and spinal compression (10.7%). Median overall survival (OS) and progression free survival (PFS) according to type of tumor is: Lung 9.3 and 8.2 months, respectively. Prostate 28 and 26.3 months. Hematological cancers 22.3 and 17.9 months. Breast 50.8 and 27.4 months. Thyroid 98.3 and 71.2 months. Comparing prophylactic vs emergency surgery, median OS is 25.6 vs 18.5 months (p-value 0.166), and median PFS 21.8 vs 19.5 months (p-value 0.677). Complication were lower in the first group (13.9% early and 5.6% late complications). The subanalysis by type of tumor shows a significant difference in OS in lung cancer (17.7 vs 4.7, p-value 0.002).Conclusions: Surgical treatment of bone metastases is an emerging treatment modality, being an effective and safe alternative. Prophylactic surgery, if possible, should be performed since it is related to lower complication rates, more radical attitude and better prognosis.Legal entity responsible for the study: The authors.