Surgical treatment for pelvic bone metastases

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Abstract

Bone metastases are one of the important problems of modern orthopedic oncology. Because of the improvement of the methods of systemic drug treatment of malignant tumors, the overall duration of life expectancy of patients with generalized cancer, including bone metastases, can be up to 12–18 months and more. Metastases, including pelvic bone metastases, reduce the quality of life of patients, not only causing pain syndrome (PS), but also significantly placing restrictions on patients’ movement, often leading to disability. The possibilities of surgical correction of modern oncoortopedia can prevent pathological fractures, reduce PS and, as a result, stabilize or improve the functional status of patients.

The aim is to evaluate the results of treatment of patients with metastases of various solid tumors in pelvic bone.

Materials and methods. The analysis of the treatment of 67 patients who underwent various types of surgery for pelvic ring metastases. The average age of patients was 55.5 years (from 23 to 75 years). 51 (76.12%) patients with multiple metastases underwent minimally invasive palliative surgery. Radical surgery was performed in16 (23.88%) patients with solitary mass.

Results. The average blood loss during radical surgery was 1969 ml (from 150 to 4000 ml). The edges of resection during all surgeries are negative (R0). Six patients showed progression after the treatment of the disease. It was noted that 46 (90%) patients had a significant reduction in PS, up to complete disappearance, that allowed 42 (82%) patients to reduce the intake of analgesic drugs or completely abandon them, after minimally invasive palliative surgery.

Conclusion. In case of solitary pelvic bone metastases is necessary to perform radical surgery to achieve maximum oncological and functional results. In patients with multiple metastases in order to reduce PS and improve the quality of life rationally should be performed minimally invasive surgery, this will allow to start systemic drug treatment as soon as possible.

About the authors

Artem V. Buharov

Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre

Author for correspondence.
Email: ErinDmAl@yandex.ru
ORCID iD: 0000-0002-2976-8895

Cand. Sci. (Med.)

Russian Federation, Moscow

Vitali A. Derzhavin

Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre

Email: ErinDmAl@yandex.ru
ORCID iD: 0000-0002-4385-9048

Cand. Sci. (Med.)

Russian Federation, Moscow

Dmitrii A. Erin

Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre

Email: ErinDmAl@yandex.ru
ORCID iD: 0000-0002-3501-036X

Clinical Resident

Russian Federation, Moscow

Anna V. Yadrina

Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre

Email: ErinDmAl@yandex.ru
ORCID iD: 0000-0002-7944-3108

oncologist

Russian Federation, Moscow

Mamed D. Aliev

National Medical Research Radiological Centre

Email: ErinDmAl@yandex.ru
ORCID iD: 0000-0003-2706-4138

D. Sci. (Med.), Prof., Acad. RAS

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. CT of pelvic bones and a pelvis magnetic resonance imaging scan of the patient with para-acetabular part metastases before the surgical treatment.

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3. Fig. 2. X-ray of pelvic bones in direct projection after para-acetabular resection with endoprosthesis replacement using modular endoprosthesis based on conical leg.

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4. Fig. 3. CT of pelvic bones before the treatment, during RFA and after the osteoplasty. The litic component of the metastatic tumor is almost completely filled with bone cement.

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