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 Ohno; Hidetatsu Outani; Koichiro Yokoyama; Shoji Shimose; Haruhiko Fukuda; Yukihide Iwamoto

doi:10.1016/j.jos.2017.05.012

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

J Orthop Sci. 2017 Sep;22(5):938-945. doi: 10.1016/j.jos.2017.05.012. Epub 2017 Jun 17.

Authors

Nobuhito Araki¹, Hirokazu Chuman², Tomoya Matsunobu³, Kazuhiro Tanaka⁴, Hirohisa Katagiri⁵, Toshiyuki Kunisada⁶, Toru Hiruma⁷, Hiroaki Hiraga⁸, Hideo Morioka⁹, Hiroshi Hatano¹⁰, Kunihiro Asanuma¹¹, Yoshihiro Nishida¹², Koji Hiraoka¹³, Takeshi Okamoto¹⁴, Satoshi Abe¹⁵, Munenori Watanuki¹⁶, Takeshi Morii¹⁷, Hideshi Sugiura¹⁸, Yukihiro Yoshida¹⁹, Takatoshi Ohno²⁰, Hidetatsu Outani²¹, Koichiro Yokoyama²², Shoji Shimose²³, Haruhiko Fukuda²⁴, Yukihide Iwamoto²⁵

Affiliations

¹ Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and CVD, 3-3 Nakamichi 1-Chome, Higashinari-ku, Osaka 537-8511, Japan. Electronic address: nobaraki@nifty.com.
² Department of Orthopaedic Surgery, National Cancer Center, Tokyo, Japan.
³ Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan.
⁴ Department of Endoprosthetic Surgery, Oita University, Oita, Japan.
⁵ Department of Orthopaedic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
⁶ Department of Orthopaedic Surgery, Okayama University, Okayama, Japan.
⁷ Department of Orthopaedic Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁸ Department of Orthopaedic Surgery, Hokkaido Cancer Center, Sapporo, Japan.
⁹ Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
¹⁰ Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
¹¹ Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
¹² Department of Orthopaedic Surgery, Nagoya University, Nagoya, Japan.
¹³ Department of Orthopaedic Surgery, Kurume University, Kurume, Japan.
¹⁴ Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.
¹⁵ Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.
¹⁶ Department of Orthopaedic Surgery, Tohoku University, Sendai, Japan.
¹⁷ Department of Orthopaedic Surgery, Kyorin University, Mitaka, Japan.
¹⁸ Department of Orthopaedic Surgery, Aichi Cancer Center, Japan; Department of Physical Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹⁹ Department of Orthopaedic Surgery, Nihon University, Tokyo, Japan.
²⁰ Department of Orthopaedic Surgery, Gifu University, Gifu, Japan.
²¹ Department of Orthopaedic Surgery, Osaka University, Osaka, Japan.
²² Department of Orthopaedic Surgery, Kyushu Cancer Center, Fukuoka, Japan.
²³ Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan.
²⁴ JCOG Data Center, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan.
²⁵ Kyushu Rosai Hospital, Kitakyushu, Japan. Electronic address: yiwamoto@ortho.med.kyushu-u.ac.jp.

PMID: 28629828
DOI: 10.1016/j.jos.2017.05.012

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.

Publication types

Randomized Controlled Trial

MeSH terms

Clinical Decision-Making*
Femoral Neoplasms / complications
Femoral Neoplasms / secondary*
Femoral Neoplasms / surgery*
Fractures, Spontaneous / etiology
Fractures, Spontaneous / surgery*
Health Care Surveys
Humans
Orthopedic Procedures
Prospective Studies