Humeral metastasis of renal cancer: surgical options and a review of literature

Roberto Casadei, G Drago, F Di Pressa, Davide Maria Donati

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy.

HYPOTHESIS: Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis.

MATERIAL AND METHODS: 56 patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used.

RESULTS: The average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases.

DISCUSSION: Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life.

Original languageEnglish
Pages (from-to)533-538
Number of pages6
JournalOrthopaedics and Traumatology: Surgery and Research
Volume104
Issue number4
DOIs
Publication statusE-pub ahead of print - Jun 2018

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Kidney Neoplasms
Neoplasm Metastasis
Humerus
Prostheses and Implants
Intramedullary Fracture Fixation
Renal Cell Carcinoma
Bone and Bones
Elbow Prosthesis
Kidney
Recurrence
Spontaneous Fractures
Infection
Femur
Radiotherapy
Quality of Life
Drug Therapy
Survival
Therapeutics
Neoplasms

Keywords

  • Humerus
  • Metastasis
  • Pathological fracture
  • Renal Cancer
  • Tumor

Cite this

Humeral metastasis of renal cancer: surgical options and a review of literature. / Casadei, Roberto; Drago, G; Di Pressa, F; Donati, Davide Maria.

In: Orthopaedics and Traumatology: Surgery and Research, Vol. 104, No. 4, 06.2018, p. 533-538 .

Research output: Contribution to journalArticle

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abstract = "INTRODUCTION: The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy.HYPOTHESIS: Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis.MATERIAL AND METHODS: 56 patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used.RESULTS: The average age was 63 years. Metastasis was single in 55{\%} of cases, and in 45{\%} metachronous. A pathologic fracture (PF) occurred in 64{\%} of cases. Only 9{\%} of patients had a mechanical complication, 7{\%} an infection and 5{\%} neurological deficit. A local recurrence occurred in 14{\%} of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64{\%}, 63{\%} and 59{\%} respectively in patients with proximal, diaphyseal and distal humerus metastases.DISCUSSION: Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life.",
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T1 - Humeral metastasis of renal cancer: surgical options and a review of literature

AU - Casadei, Roberto

AU - Drago, G

AU - Di Pressa, F

AU - Donati, Davide Maria

N1 - Copyright © 2018. Published by Elsevier Masson SAS.

PY - 2018/6

Y1 - 2018/6

N2 - INTRODUCTION: The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy.HYPOTHESIS: Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis.MATERIAL AND METHODS: 56 patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used.RESULTS: The average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases.DISCUSSION: Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life.

AB - INTRODUCTION: The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy.HYPOTHESIS: Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis.MATERIAL AND METHODS: 56 patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used.RESULTS: The average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases.DISCUSSION: Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life.

KW - Humerus

KW - Metastasis

KW - Pathological fracture

KW - Renal Cancer

KW - Tumor

U2 - 10.1016/j.otsr.2018.03.009

DO - 10.1016/j.otsr.2018.03.009

M3 - Article

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SP - 533

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JF - Orthopaedics and Traumatology: Surgery and Research

SN - 1877-0568

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ER -