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TREATMENTS FOR METASTATIC HUMERAL TUMORS

Dept. of Orthopaedics, Tokyo disaster medical center, 3256 Midori-cho, Tachikawa-shi, Tokyo, 190-0014, Japan

Purpose: To analyze the cases with metastatic humeral tumors and to discuss treatment methods for humeral metastasis.

Methods: Forty-two cases (46 bones) with metastatic humeral tumors were reviewed. There were 23 males and 19 females and the average age was 57.4 (range 37 to 88). The common origins were lung, liver, and kidney(25/42 cases) and the common metastatic site was proximal one third of the humerus (28/46 bones). Seventeen cases were solitary humeral metastasis at the first examination and 21 cases sufferred from pathological fractures. All cases were treated for humeral lesions. The cases were divided into two groups :surgical treatment group (SG, 24 cases) and conservative treatment group (CG, 18 cases). The two group were compared.

Results: Surgical treatments included tumor resection with replacement of the endoprosthesis, tumor resection and internal fixation, and palliative medullary nailing. The plates and screws or medullary nails were used for internal fixation and the bone cement was also used. Conservative treatments included chemotherapy, radio-therapy, and brace or splint. One year survival rate of SG was 36.4% and CG was 6%. All cases of SG and 6/18 cases showed pain relief or decrease, and 22/24 cases of SG showed improvement of ADL, although only three cases of CG obtained improvement of ADL.

Discussion: The results showed surgical treatments for humeral metastasis obtained improvement of QOL. The survival rate of SG higher than CG, but the reason seemed that the surgeryies were performed for the cases with reratively good general conditions. Internal fixation with the bone cement seemed to be effective for rigid fixation.

Conclusion: Surgical treatment should be performed as possible for metastatic humeral tumors, and rigid fixation with or without tumor resection seemed important.

The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.