Factors associated with the decision of operative procedure for proximal femoral bone metastasis: Questionnaire survey to institutions participating the Bone and Soft Tissue Tumor Study Group of the Japan Clinical Oncology Group

Nobuhito Araki, Hirokazu Chuman, Tomoya Matsunobu, Kazuhiro Tanaka, Hirohisa Katagiri, Toshiyuki Kunisada, Toru Hiruma, Hiroaki Hiraga, Hideo Morioka, Hiroshi Hatano, Kunihiro Asanuma, Yoshihiro Nishida, Koji Hiraoka, Takeshi Okamoto, Satoshi Abe, Munenori Watanuki, Takeshi Morii, Hideshi Sugiura, Yukihiro Yoshida, Takatoshi OhnoHidetatsu Outani, Koichiro Yokoyama, Shoji Shimose, Haruhiko Fukuda, Yukihide Iwamoto

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Pathological fracture of the proximal femur is a main cause of cancer patients losing their ability to walk. Although both osteosynthetic devices (predominantly intramedullary nails) and prosthetic replacement have been widely performed for treatment, controversies exist regarding which procedure should be used for the various conditions. In order to decide the eligibility criteria of a planned randomized prospective study about the treatment of pathological fractures of the proximal femur, we assessed the factors affecting the selection of operative procedures using questionnaires sent to the members of the Bone and Soft Tissue Tumor Study Group (BSTTSG) of the Japan Clinical Oncology Group (JCOG). Methods Questionnaire surveys to evaluate (1) the priority levels of the factors, (2) the equipoise range of each factor in situations where either procedure could be applied, (3) risk and benefit of each procedure, and (4) the degree of bone destruction affecting the selection of operative procedures, were sent to 26 institutions. Results Over 80% of the institutions answered. Orthopaedic surgeons of BSTTSG decided on the procedure according to the following factors in descending order: life expectancy, performance status before fracture, the degree of bone destruction, walking ability before fracture, general complications, the number of bone metastases in other sites, and the visceral metastasis status. With regard to bone destruction, (1) the involvement of the head, neck, calcar, and intertrochanteric region, (2) transverse destruction >1/2, and (3) soft-tissue tumor extension, were the factors that led to the choice of prosthesis treatment. Conclusions Using these identified factors, the inclusion criteria for the prospective randomized study of the surgical treatment of metastatic bone tumors of the proximal femur were optimized. The evaluation system about the bone destruction of metastases needs to be refined through the following prospective randomized study.

Original languageEnglish
Pages (from-to)938-945
Number of pages8
JournalJournal of Orthopaedic Science
Volume22
Issue number5
DOIs
Publication statusPublished - Sep 2017

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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