النقائل العظمية: ماذا تفعل عندما يفشل العلاج الإشعاعي أحادي الجرعة في تخفيف الألم

References

DOI: 10.1016/j.annonc.2020.07.019

• In patients with good PS, pathological or impending pathological fractures of the extremities are preferentially treated with orthopaedic surgery to fix or prevent fracture.
• Prophylactic stabilisation of impending fractures is generally preferred to fixation after fracture as functional recovery is better, inpatient stays are shorter and surgical complications fewer.
• In the proximal femur and humerus, a long-stem cemented or modular tumour endoprosthesis is preferred to facilitate rapid mobilisation.
• In the diaphysis of a long bone, a plate, an intramedullary nail or a prosthesis may be implanted.
• Postoperative fractionated RT is usually recommended to prevent prosthesis failure and reduce the need for subsequent surgery.
• Prophylactic surgery is generally recommended for lesions 30 mm in greatest dimension, lytic destruction of 50% of the cortex of a long bone and continued pain with weight-bearing after RT.
• The predominant goals of surgical treatment are to maintain patient functionality and mobility by relieving pain preventing impending fractures and/or neural compression or stabilising a pathological fracture.