title: Radiotherapy, Bisphosphonates and Surgical Stabilization of Complete or Impending Pathologic Fractures in Patients with Metastatic Bone Disease.
abstract: OBJECTIVE
  To report the treatment outcomes of patients with metastatic bone disease with complete or impending pathologic fractures, who were treated with postoperative radiotherapy (RT), bisphosphonates or both after orthopedic stabilization.
  
  
  METHODS
  We retrospectively evaluated the results of RT, bisphosphonates or both after orthopedic stabilization for complete or impending pathologic fractures in 72 patients with skeletal metastases. After surgery, 32 patients (44%) were treated with RT alone (group 1), 31 patients (43%) were treated with RT and bisphosphonates (group 2) and 9 (13%) patients were treated with bisphosphonates (group 3), respectively. Patients were treated with a median dose of 30Gy (30-40 Gy/2-3Gy per fraction).The local tumor progression, pain progression and need for re-operation or re-radiotherapy were assessed from patients' medical records. Median follow-up time was 9 months.
  
  
  RESULTS
  Median overall survival time was 14 months (95% CI: 12-17). Secondary surgical intervention at the same location was necessary in 1 patient of group 1 (2%), 2 patients of group 2(5%) and 2 patients of group 3 (15%), respectively (p=0.097). Local tumor progress was observed in 3 patients of group 1 (9%), 2 patients of group 2 (7%) and 4 patients in group 3 (44%), respectively (p=0.021). Local pain progress was observed in 19%, 16% and 67% of the same groups (p=0.011).
  
  
  CONCLUSIONS
  Our data confirm the efficacy and necessity of postoperative RT after orthopedic stabilization for metastatic bone disease to control the local disease. Bisphosphonates do not obviate the need for RT in the management of bone metastases after surgical stabilization. The combined treatment might lead to a better local tumor and pain control.
authors.affiliation: 1. Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Wolanczyk
authors.affiliation: 2. Department of Radiation Oncology, Ruhr-University of Bochum, Germany.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Fakhrian
authors.affiliation: 2. Department of Radiation Oncology, Ruhr-University of Bochum, Germany.
authors.forename: Irenäus A
authors.initials: IA
authors.lastname: Adamietz
keywords: Pathological fracture; bisphosphonates; bone metastasis; orthopedic stabilization; postoperative radiotherapy