[Surgical treatment of osseous metastases of the pelvis].
Metastases are the most frequent malignant tumors of the skeleton. Breast cancer is the most frequent primary tumor with osseous metastases followed by renal cell carcinomas, bronchial carcinomas, and thyroid tumors. The predominant localization of bone metastases is the spine, followed by the pelvis, femur, ribs, skull, sternum, and humerus. The overall incidence of bone metastases has increased due to improved diagnosis, prolonged survival by adjuvant therapy, and improved follow-up. Osseous metastases of the pelvis are usually diagnosed only late in the course of the disease because of their considerable delayed onset of clinical symptoms. Therefore, treatment is usually focused on a palliative approach to reduce pain and to improve the quality of life. We introduce three patients with bronchial, renal cell, and cholangiocellular carcinoma in an incurable tumor stage with osseous metastases in the pelvis. The metastatic osteolyses caused pain and symptoms of instability. Despite high doses of opiate analgesics, the patients were neither free of pain nor could they be mobilized. The palliative treatment included preoperative tumor embolization followed by tumor resection and implantation of a hip prosthesis. The preoperative embolization reduced intraoperative bleeding and made tumor resection, osteosynthesis, and implantation of the hip prosthesis possible. Mobilization with moderate pain could be achieved in these three patients for the rest of their lives.
Bading
S
S
Unfallchirurgische Klinik, Medizinische Hochschule, Hannover. susanne.bading@gmx.de
Mössinger
E
E
Baus
S
S
Bastian
L
L
D000328:Adult; D001859:Bone Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010346:Patient Care Management / Q000379:methods; D010386:Pelvic Neoplasms / Q000556:secondary* / Q000601:surgery*; D010388:Pelvis / Q000601:surgery*; D016896:Treatment Outcome