[Retrospective analysis of surgical treatment for metastases in humerus of 59 cases].
OBJECTIVE
To evaluate different operative treatment options for patients with metastases of the humerus focusing on surgical procedures,  complications, function, and survival rate.


METHODS
From 2000 to 2009, 62 bone metastases of the humerus in 59 patients were surgically treated in our  institutions. Histological types were of lung (n=19), myeloma (n=10), breast (n=8), kidney (n=5), gastrointestinal tract (n=2), thyroid (n=2), prostate (n=1),  bile duct (n=1), larynx (n=1), ovarian (n=1), melanoma (n=1) and unknown tumors (n= 8). Severe osteolytic lesions close to the shoulder and elbow joint  were treated with resection and endoprosthetic replacement (n=32). Twenty-eight metasteses were stabilized by intramedullary locked nailing (17 cases)  or plate/screws (11 cases) with polymethylmethacrylate-assisted reconstruction. The remaining 2 lesions were treated with amputation because of wide  tumor contaminations after pathological fracture. Mirels' rating system was used to predict the risk of pathological fracture. The function of the upper limb  was assessed using the Musculoskeletal Tumor Society (MSTS) rating scale and survival rate was retrospectively analyzed.


RESULTS
The mean  survival time of patients after surgery was 9.6 months. The mean Mirels' score for impending pathologic fractures was 9.3. Complications of endoprosthetic  replacement recorded included disease relapse (n=2) and soft tissue infection (n=1), whereas, for intramedullary locked nailing and plate/screws  fixation, there were two cases of local recurrence, one case of plate/screw break and one case of radial nerve palsy. The mean MSTS score for the follow-up was 71% for endoprosthesis and 75.1% for locked intramedullary nailing or plate/screws fixation.


CONCLUSIONS
Immediate stability and pain relief  were the main purpose of surgical procedures to treat humerus metastases. Radiotherapy was only a local treatment; however systemic therapies, such  as chemotherapy, hormonotherapy and bisphophonate play a critical role in increasing survival rate of bone metastatic patients.
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing 100044, China.
Yi
Y
Yang
Rong-li
RL
Yang
Wei
W
Guo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D006811:Humerus; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult