Radical surgery for the solitary bony metastasis from renal-cell carcinoma

Baloch, Khalid; Grimer, R. J.; Carter, S. R.; Tillman, R. M.

doi:10.1302/0301-620x.82b1.0820062

Cited by 60 publications

(33 citation statements)

References 20 publications

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“…Some authors argue that, for patients with a long projected survival, an endoprosthesis is the more durable surgical option [5,21]. Some have even suggested that EPR should be the treatment of choice in isolated lesions from renal cell metastasis because these patients may have prolonged survival [1,15]. In our series, 51% of patients survived 1 year, 29% survived 2 years, and 11% survived 5 years.…”

Section: Discussionmentioning

confidence: 56%

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Harvey

Ahlmann

Allison

et al. 2012

Clinical Orthopaedics &Amp; Related Research

151

161

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Background The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages. Questions/purposes We determined whether function, complications, and survivorship differed between the two approaches. Methods We retrospectively reviewed 158 patients with 159 proximal femur metastatic lesions treated with surgical stabilization. Forty-six were stabilized with IMN and 113 were treated with EPR. The minimum followup was 0.25 months (mean, 16 months; median, 17 months; range, 0.25-86 months). Results The mean Musculoskeletal Tumor Society score was 24 of 30 (80%) after IMN and 21 of 30 (70%) after EPR. There were 12 complications (26%) in the IMN group, including 10 nonunions, six of which went on to mechanical failure. There were complications in 20 of 113 (18%) of the EPR group, which consisted of 10 dislocations (9%) and 10 infections (9%). There were no mechanical failures with EPR. Both implants remained functional for the limited lifespan of these patients in each group at all time intervals. EPRs were associated with increased implant longevity compared with IMNs (100% versus 85% 5-year survival, respectively) and a decreased rate of mechanical failure (0% versus 11%, respectively) when compared with the intramedullary devices. Conclusions Patients with metastatic disease to the proximal femur may live for long periods of time, and these patients may undergo stabilization with either IMN or EPR with comparable functional scores and the implant survivorship exceeding patient survivorship at all time intervals. Endoprostheses demonstrate a lower mechanical failure rate and a higher rate of implant survivorship without mechanical failure than IMN devices.

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Section: Discussionmentioning

confidence: 56%

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Harvey

Ahlmann

Allison

et al. 2012

Clinical Orthopaedics &Amp; Related Research

151

161

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“…58 In addition to general prognostic factors, peripheral location of bone metastases is a favourable factor. 12,[59][60][61][62] Only two studies were identifi ed that compared diff erent radiotherapy modalities, including in combination with surgery, for brain metastases from renal cell carcinoma. Thus, recommendation of a specifi c treatment modality is not possible.…”

Section: Discussionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

283

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Section: Discussionmentioning

confidence: 99%

“…Adequate resection margins are the surgically independent risk factor for local recurrence and patient survival [17,18]. Excision of solitary metastases with adequate margins (and adjuvant therapy) may provide prolonged survival [17]. Excision of metastatic tumours in the presence of multiple metastases may be performed for intractable pain, and for impending or pathological fractures [19].…”

Section: Discussionmentioning

confidence: 99%