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Team Approach: The Treatment of Metastatic Tumors of the Femoral Diaphysis

O’Sullivan, Michael B., MD1; Saha, Debasmita, MD1; Clement, Jessica M., MD1; Dowsett, Robert J., MD1; Pacheco, Rafael A., MD1; Balach, Tessa, MD2,a

doi: 10.2106/JBJS.RVW.16.00012
Team Approach Review Article
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Disclosures

  • ➢ The differential diagnosis of an aggressive bone lesion includes metastatic disease, multiple myeloma, lymphoma, and primary sarcoma of bone. Evaluation includes radiographs of the entire bone; laboratory tests; computed tomography (CT) scanning of the chest, abdomen, and pelvis; bone scintigraphy; and biopsy.
  • ➢ Except in rare circumstances, the treatment of skeletal metastasis is palliative and the goals of care center around pain relief and the maintenance of function.
  • ➢ Nonoperative interventions include chemotherapy, bone-modulating agents such as bisphosphonates and denosumab, radiation therapy, and ablation with cementoplasty.
  • ➢ When prophylactic operative stabilization is indicated to prevent pathological fracture, a cephalomedullary nail is preferred for femoral diaphyseal lesions. Postoperative external-beam radiation is indicated for local disease control.
  • ➢ High-quality treatment of these patients relies on the close coordination of multiple different specialists.

1Department of Orthopaedic Surgery (M.B.O.), Division of Hematology–Oncology (D.S. and J.M.C.), Division of Radiation Oncology (R.J.D.), and Department of Diagnostic Imaging and Therapeutics (R.A.P.), University of Connecticut Health, Farmington, Connecticut

2Department of Orthopaedic Surgery, The University of Chicago, Chicago, Illinois

aE-mail address for T. Balach: tbalach@uchicago.edu

Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated
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