Orthopedics

Feature Articles 

Metastases of the Pelvis: Does Resection Improve Survival?

Pietro Ruggieri, MD, PhD; Andreas F. Mavrogenis, MD; Andrea Angelini, MD; Mario Mercuri, MD

Abstract

Limited data are available to compare the outcome of wide en bloc resection and curettage for pelvic metastases. Previous studies have reported that curettage is associated with high mortality and decreased survival compared to wide resection and have justified consideration of a radical surgical approach to achieve pain palliation and tumor control. In this study, we aimed to evaluate the role of curettage/marginal resection compared to wide en bloc resection for patients with pelvic metastases. The hypothesis was that wide resection does not improve survival even in patients with solitary pelvic metastases.

Between 1985 and 2009, twenty-one patients with pelvic metastases were treated with wide resection (12 patients) and curettage/marginal resection (9 patients) and adjuvants. Sixteen patients had solitary pelvic metastases. At a mean of 28 months (range, 2–152 months), we found no difference in survival to death or local recurrence with wide en bloc resection compared to curettage or marginal resection, even in patients with solitary pelvic metastases. The overall survival to death and local recurrence was 30% and 47% at 60 months, respectively. Survival to death of patients treated with wide resection was 18% at 60 months compared to 62% at 60 months of patients treated with curettage/marginal resection; no difference in survival to death between wide resection and curettage/marginal resection was observed even in patients with solitary pelvic metastases. Survival to local recurrence of patients treated with wide en bloc resection was 67% at 36 months compared to 26% at 36 months of patients treated with curettage/marginal resection; this was also not statistically significant. One patient treated with wide resection for a solitary pelvic metastasis had a postoperative complication.

Drs Ruggieri, Mavrogenis, Angelini, and Mercuri are from the Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy.

Drs Ruggieri, Mavrogenis, Angelini, and Mercuri have no relevant financial relationships to disclose.

References 4, 6–10, 12, 15, 25, 26, 30–32, 37, 38 .

References 4, 6–9, 12, 15, 25, 26, 30–32, 37, 38 .

References 4 6–9 12 15 25 30–32 38 .

References 4, 7, 8, 12–15, 24, 26, 29, 43, 44 .

Metastatic disease is the most common malignancy of bone; prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. 1,2 The pelvis is the second most common site of bone metastases after the spine. Pain, bone destruction causing mechanical instability, and pathological fractures are the most common manifestations. 3–10 Treatment is mostly aimed at palliation. 7,8,11–15 Traditional treatments for pelvic metastases include surgery and external beam radiation therapy. If bone destruction is limited, analgesics, radiation therapy, hormonal therapy, chemotherapy, embolization, bisphosphonates, and minimally invasive techniques such as radiofrequency ablation, osteoplasty, and cryosurgery can be considered. 11,16–23

Lesions of the hemipelvis not directly involving the hip joint, pathological fractures sustained through an area of the pelvis other than the acetabulum, and avulsion fractures of the anterior superior/inferior iliac spines, iliac crest, and pubic rami seldom require surgical stabilization and reconstruction because pelvic stability is maintained. 24 In contrast, diffuse involvement of the pelvis, impending or existing pelvic discontinuity, and bony destruction of the periacetabular area warrant surgical treatment. 7,8,12–15,25–27 Moreover, all metastatic lesions are progressive and cause bone failure; tumor cell adhesive molecules bind the tumor cells to marrow stromal cells and bone matrix, allowing them to grow and produce angiogenic and bone-resorbing factors. 2,28 This may cause early implant failure if periacetabular reconstruction has been used after curettage or resection of pelvic metastases. 4,29 The use of polymethylmethacrylate (PMMA) to bridge large defects and suspend an acetabular component, conventional total hip replacement, massive allograft, or saddle megaprosthetic reconstruction are likely…

Abstract

Limited data are available to compare the outcome of wide en bloc resection and curettage for pelvic metastases. Previous studies have reported that curettage is associated with high mortality and decreased survival compared to wide resection and have justified consideration of a radical surgical approach to achieve pain palliation and tumor control. In this study, we aimed to evaluate the role of curettage/marginal resection compared to wide en bloc resection for patients with pelvic metastases. The hypothesis was that wide resection does not improve survival even in patients with solitary pelvic metastases.

Between 1985 and 2009, twenty-one patients with pelvic metastases were treated with wide resection (12 patients) and curettage/marginal resection (9 patients) and adjuvants. Sixteen patients had solitary pelvic metastases. At a mean of 28 months (range, 2–152 months), we found no difference in survival to death or local recurrence with wide en bloc resection compared to curettage or marginal resection, even in patients with solitary pelvic metastases. The overall survival to death and local recurrence was 30% and 47% at 60 months, respectively. Survival to death of patients treated with wide resection was 18% at 60 months compared to 62% at 60 months of patients treated with curettage/marginal resection; no difference in survival to death between wide resection and curettage/marginal resection was observed even in patients with solitary pelvic metastases. Survival to local recurrence of patients treated with wide en bloc resection was 67% at 36 months compared to 26% at 36 months of patients treated with curettage/marginal resection; this was also not statistically significant. One patient treated with wide resection for a solitary pelvic metastasis had a postoperative complication.

Drs Ruggieri, Mavrogenis, Angelini, and Mercuri are from the Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy.

Drs Ruggieri, Mavrogenis, Angelini, and Mercuri have no relevant financial relationships to disclose.

Correspondence should be addressed to: Pietro Ruggieri, MD, PhD, Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy (pietro.ruggieri@ior.it).*.

References 4, 6–10, 12, 15, 25, 26, 30–32, 37, 38 .

†.

References 4, 6–9, 12, 15, 25, 26, 30–32, 37, 38 .

*.

References 4 6–9 12 15 25 30–32 38 .

*.

References 4, 7, 8, 12–15, 24, 26, 29, 43, 44 .

Posted Online: July 07, 2011

Metastatic disease is the most common malignancy of bone; prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. 1,2 The pelvis is the second most common site of bone metastases after the spine. Pain, bone destruction causing mechanical instability, and pathological fractures are the most common manifestations. 3–10 Treatment is mostly aimed at palliation. 7,8,11–15 Traditional treatments for pelvic metastases include surgery and external beam radiation therapy. If bone destruction is limited, analgesics, radiation therapy, hormonal therapy, chemotherapy, embolization, bisphosphonates, and minimally invasive techniques such as radiofrequency ablation, osteoplasty, and cryosurgery can be considered. 11,16–23

Lesions of the hemipelvis not directly involving the hip joint, pathological fractures sustained through an area of the pelvis other than the acetabulum, and avulsion fractures of the anterior superior/inferior iliac spines, iliac crest, and pubic rami seldom require surgical stabilization and reconstruction because pelvic stability is maintained. 24 In contrast, diffuse involvement of the pelvis, impending or existing pelvic discontinuity, and bony destruction of the periacetabular area warrant surgical treatment. 7,8,12–15,25–27 Moreover, all metastatic lesions are progressive and cause bone failure; tumor cell adhesive molecules bind the tumor cells to marrow stromal cells and bone matrix, allowing them to grow and produce angiogenic and bone-resorbing factors. 2,28 This may cause early implant failure if periacetabular reconstruction has been used after curettage or resection of pelvic metastases. 4,29 The use of polymethylmethacrylate (PMMA) to bridge large defects and suspend an acetabular component, conventional total hip replacement, massive allograft, or saddle megaprosthetic reconstruction are likely to fail because of the deficient bone and the progressive osteolytic disease. 4,29

Doubt exists regarding resection compared to curettage for pelvic bone metastases, and limited data are available to compare the outcome of wide en bloc pelvic resection and curettage for metastases. Previous studies have reported that curettage is associated with high mortality and decreased survival compared with wide resection and have justified consideration of a radical surgical approach to achieve pain palliation and tumor control. 4,6–10,12,15,25,30–32 In this study, we aimed to evaluate the role of curettage/marginal resection compared to wide en bloc resection for patients with pelvic metastases. The hypothesis was that wide resection does not improve survival even in patients with solitary pelvic metastases. To our knowledge, this is the largest series to compare wide en bloc resection to curettage or marginal resection for pelvic bone metastases.

Materials and Methods

The medical files of 21 patients with pelvic bone metastases from variable primary tumors treated with surgery and adjuvants at our institution between 1985 and 2009 were retrospectively analyzed. Fifteen men and 6 women had a mean age of 56 years (range, 34–76 years). All patients had preoperative biopsy of the pelvic lesion. Adjuvants were administered according to the primary tumor’s histology. Mean follow-up was 28 months (range, 2–152 months). No patient was lost to postoperative follow-up evaluation (Table ). All patients or their relatives gave written informed consent to be included in this study. This study was approved by the Institutional Review Board/Ethics Committee of our institution.

Patient Details

Table 1. Patient Details

Pelvic location of metastases was classified according to Enneking and Dunham (Figure ). 33 Surgical indications included acute symptoms that did not decrease after a combination of protected weight bearing and medical treatment, and restoration of satisfactory function and control of pain if not achieved within 1 to 3 months following radiation therapy. 4 The indications for en bloc resection included extensive bone loss and destruction that precluded standard internal fixation or joint arthroplasty, and a solitary bone metastasis, especially purely lytic lesion (Figure ). Occasionally, wide resection was indicated in patients with prolonged disease-free survival and isolated metastases of breast, renal cell, or thyroid carcinoma. Most patients with solitary pelvic locations were treated with wide en bloc resection (Figures ,); 2 patients with multiple metastases were also treated with en bloc resection because of “favorable” pelvic location in the iliac wing or ischiopubic rami. Three patients with multiple metastases (Figure ) and 6 patients with solitary pelvic metastases were treated with curettage or marginal resection because of diffuse pelvic bone involvement that precluded wide resection. Hip reconstruction was performed in 3 patients with extensive acetabulum destruction and protrusion of the femoral head (Table ).

Number of patients and pelvic location of metastases.

Figure 1:. Number of patients and pelvic location of metastases.

Preoperative radiograph (A) and coronal MRI of the pelvis (B) of a 76-year-old man with metastatic colon cancer. Postoperative radiograph after type II and III pelvic resection and hip reconstruction (C).

Figure 2:. Preoperative radiograph (A) and coronal MRI of the pelvis (B) of a 76-year-old man with metastatic colon cancer. Postoperative radiograph after type II and III pelvic resection and hip reconstruction (C).

Preoperative coronal MRI of the pelvis of a 64-year-old woman with metastatic endometrial cancer (A). Postoperative radiograph after type II and III pelvic resection and iliofemoral pseudarthrosis (B).

Figure 3:. Preoperative coronal MRI of the pelvis of a 64-year-old woman with metastatic endometrial cancer (A). Postoperative radiograph after type II and III pelvic resection and iliofemoral pseudarthrosis (B).

Preoperative radiograph (A) and axial CT scan (B) of the pelvis of a 62-year-old woman with metastatic ovarian cancer. Postoperative radiograph after type II and III pelvic resection and hip reconstruction (C).

Figure 4:. Preoperative radiograph (A) and axial CT scan (B) of the pelvis of a 62-year-old woman with metastatic ovarian cancer. Postoperative radiograph after type II and III pelvic resection and hip reconstruction (C).

Preoperative axial CT scan of the pelvis of a 59-year-old man with metastatic thyroid cancer (A). Axial CT scan after curettage of the sacroiliac lesion (B).

Figure 5:. Preoperative axial CT scan of the pelvis of a 59-year-old man with metastatic thyroid cancer (A). Axial CT scan after curettage of the sacroiliac lesion (B).

Curettage and resection were performed according to surgeon preference. Curettage was extensive in all cases to avoid gross remaining tumor. When a sharp sclerotic tumor margin was apparent on plain radiographs, the metastatic lesion was likely to be slowly progressive and therefore not highly vascular. When extensive reticulated osteolysis was apparent without a clearly defined margin, or there was evidence of an extracortical soft tissue mass, preoperative arteriography and embolization was performed. Intraoperative blood loss from tumor vessels within bone was controlled by bone wax, electrocoagulation, phenol application, and packing the tumor cavity with PMMA.

Postoperative management included bed rest and analgesics, and progressive mobilization as tolerated. The purpose was to mobilize the patients as soon as possible to prevent immobilization-related complications such as deep venous thrombosis and urinary infections. Routine follow-up evaluation was performed every 3 months for the first 2 years, every 6 months for the following 3 years, and then annually. Each follow-up evaluation included clinical and imaging studies. The presence of local recurrence, metastasis, or death was assessed and the patients subdivided as follows: (1) no evidence of disease: patients with no evidence of local recurrence or metastasis; (2) died with disease: patients who died from the tumor; and (3) alive with disease: patients with local recurrence or metastasis.

Actuarial overall survival and survival to death were analyzed using the Kaplan-Meier survival analysis. 34 Comparison of the curves was done with the log-rank test. The differences in survival to death and local recurrence were evaluated using the chi-square test. The data were recorded in a Microsoft Excel 2003 spreadsheet (Redmond, Washington) and analyzed using MedCalc Software Version 11.1 (MedCalc, Mariakerke, Belgium).

Results

Overall survival to death of patients with pelvic bone metastases was 56% at 36 months (Figure ). Overall survival to local recurrence was 47% at 36 months (Figure ). Survival to death of patients with pelvic bone metastases treated with wide en bloc resection was 50% at 36 months. Survival to death of patients with pelvic bone metastases treated with curettage and marginal resection was 62% at 36 months (Figure ). No difference was found ( P=.570) in survival to death between wide en bloc resection and curettage/marginal resection.

Graphs showing the overall survival to death (A) and the overall survival to local recurrence (B) of patients with pelvic bone metastases.

Figure 6:. Graphs showing the overall survival to death (A) and the overall survival to local recurrence (B) of patients with pelvic bone metastases.

Graphs showing the survival to death (A) and local recurrence (B) of patients with pelvic bone metastases treated with wide en bloc resection and curettage/marginal resection (95% confidence interval: 0.1860–2.5261). No statistical difference in survival to death (chi-square test, P=.570) or local recurrence (chi-square test, P=.0683) between wide en bloc resection and curettage/marginal resection was found.

Figure 7:. Graphs showing the survival to death (A) and local recurrence (B) of patients with pelvic bone metastases treated with wide en bloc resection and curettage/marginal resection (95% confidence interval: 0.1860–2.5261). No statistical difference in survival to death (chi-square test, P=.570) or local recurrence (chi-square test, P=.0683) between wide en bloc resection and curettage/marginal resection was found.

Survival to local recurrence of patients with pelvic bone metastases treated with wide en bloc resection was 67% at 36 months. Survival to local recurrence of patients with pelvic bone metastases treated with curettage and marginal resection was 26% at 36 months (Figure ). No difference was found ( P=.0683) in survival to local recurrence between wide en bloc resection and curettage/marginal resection.

Postoperative complications were encountered only in 1 patient in this series. This patient had wide en bloc resection for a solitary pelvic bone metastasis and developed a urinary fistula that complicated his postoperative recovery.

Discussion

The treatment of pelvic bone metastases depends largely on the location of the lesion and the extent of bone involvement. 35 Surgical options include curettage and resection with or without reconstruction using bone cement, internal fixation, arthroplasty, massive allografts, or tumor megaprostheses. 4,30,31,35–37 Results of these treatments were variable; the perioperative morbidity for curettage was high. However, curettage was not compared to wide en bloc resection, and most series were reporting on pelvic surgery focusing on periacetabular reconstruction for combined groups of patients with sarcomas and metastatic lesions. Relatively few series described the survival and outcome of patients with metastatic disease of the pelvis other than acetabular reconstruction (Table ). 4,10,12,14,39,40 The rationale of this study was to compare wide en bloc resection to curettage/marginal resection for pelvic bone metastases; our results showed no difference in survival to death or local recurrence even in patients with solitary pelvic metastases. Possibly the differences would have reached statistical significance with larger groups.

Summary of Reported Cases on Surgical Treatment of Pelvic Metastases

Table 2. Summary of Reported Cases on Surgical Treatment of Pelvic Metastases

Our study has several limitations. First, the limited numbers of patients, the different primary tumors, and the retrospective design may be considered important limitations. However, although small, to the best of our knowledge this is the largest series to compare wide en bloc resection to curettage or marginal resection for pelvic bone metastases. Moreover, the variability of primary metastatic tumors treated suggests that this approach may well have a similar outcome for a larger cohort. Second, we did not control for other factors that affect survival in late-stage cancer patients, such as overall tumor burden, functional status, tumor response to therapy, and types of therapy. Third, we did not analyze the effect of adjuvants on survival between the 2 study groups, because the patients who had either adjuvant treatment were too few; a statistical analysis would have led to a statistical type II error. We believe that survival studies are difficult in cancer patients with bone metastases, and well-controlled institutional series are useful for decision making.

Treatment options in patients with bone metastases are mostly aimed at palliation. Novel palliative adjunctive treatments for metastatic bone disease include selective embolization, percutaneous cementoplasty, and radiofrequency ablation. 10,11,16,18–23,41 Serial embolization provides for devascularization, size reduction, calcification of margins, and pain relief. It is typically performed in 4- to 6-week intervals until symptomatic improvement occurs or the tumor’s vascularity disappears as judged by angiography, magnetic resonance imaging, or computed tomography. Preoperative embolization provides for tumor devascularization; typically, surgery should be performed within 24 to 48 hours after embolization to prevent recanalization. 11,16,19,41 Since all metastatic bone lesions are hypervascular, all patients may be indicated for embolization. By hyperselective catheterization and embolization of the pathological feeding arteries to the lesion with the most appropriate embolic agent, embolization can be expected to be successful in up to 90% of cases. 41 Percutaneous injection of PMMA, calcium sulphate copolymers, or terpolymer resins with combeite glass-ceramic reinforcing particles may provide pain relief, defect filling, and intraosseous stabilization in patients with bone metastases. 20,23

The main indications for acetabuloplasty include pain, impending fractures, and bone reinforcement. 10,20,23 Contraindications for percutaneous acetabuloplasty include articular cortical destruction of the acetabular roof >5 mm in diameter and soft tissue involvement >3 times the area of bone destruction. 10 Radiofrequency thermal ablation is a form of electrosurgery in which an alternating current of high-frequency radio waves (>10 kHz) passes from an electrode tip in human tissue and dissipates its energy as heat. The main goals of percutaneous radiofrequency ablation for bone metastases are pain relief and local control of tumor growth. Satisfactory results have been reported without major complications. 21 Radiofrequency ablation can be combined with percutaneous cementoplasty to stabilize impending fractures resulting from metastatic disease. 20,23

The objective of surgery for pelvic metastases is directed at preserving hip function and palliation by curettage or resection and total joint reconstruction when the acetabulum is involved. There is little doubt that the treatment of patients with metastatic carcinoma of the pelvis is considerably more difficult than for other sites. 6,37,42 The size of the tumors often is greater, surgical resection is more complex, failure rate is higher, disability levels are greater, and patient survival is considerably poorer. 7,8,12,26 However, doubt exists that patients who had curettage for pelvic tumors have higher mortality compared with patients who had wide resections. This may be challenged on the basis that most patients with pelvic metastases have curettage as palliative treatment. However, in contrast to the literature, in this series, the type of surgical treatment resulted in no significant difference in patient outcome; survival to death and local recurrence was not improved with wide en bloc resection of pelvic metastases. Although not significant, 1 complication occurred in a patient with bladder cancer after wide resection for a solitary metastasis.

Areas remote from the hip joint can be removed with no formal reconstruction and no effective change in activity levels. 4,24,29,43 However, reconstructive surgery about the acetabulum to restore the hip joint, maintain the length of the limb, and retain muscle function is complex and difficult. 7,8,12,26 Depending on the anatomical area of the hemipelvis that is primarily involved, several reconstructive procedures have been reported including pelvic prostheses, massive allografts (with or without a total hip prosthesis), arthrodesis, and pseudarthrosis. In our practice, we acknowledge that complications may exceed the potential value of the procedure for the patient and do not routinely perform a complex reconstruction procedure in our cancer patients with pelvic metastases treated by resection. We believe that reconstruction of the pelvis adds complexity to surgery that inherently has a high associated complication rate, and usually should be reserved for patients with a primary bone sarcoma. 45 We perform preoperative embolization in all patients with hypervascular tumors to reduce intraoperative blood loss. 11,19,46 If uncontrolled bleeding occurs despite previous embolization, it may be controlled by rapid curettage of the soft tissue mass and packing of the defect with PMMA. 8,21,23,29

When periacetabular bone loss is minimal, curettage and cementation may be all that is required to control local disease, relieve pain, and restore function. When the lesion is small but causes destruction of the hip joint, a hip replacement is performed. However, implant stability may be impaired by the cancer and/or any postoperative chemotherapy or radiation therapy. As such, only 3 of our patients had reconstruction of the pelvic defect. These patients had type II and III pelvic involvement and were selected by surgeon discretion, not by protocol; all maintained a stable construct during the follow-up evaluation. When cancer has destroyed the acetabulum to the extent that it is no longer a contained defect, more extensive surgical procedures are necessary. In these cases, en bloc resection of the diseased bone is performed, using the same surgical principles to achieve tumor-free margins of resection as for primary bone tumors, and perform hemipelvectomy. Although these procedures are associated with increased morbidity and mortality rates, require longer hospitalization and rehabilitation, 35 and do not add to patient survival according to the results of the present series, we consider this approach more appropriate when locally advanced disease precludes internal stabilization. Although a bone tissue bank is available in our hospital, we do not advocate the use of allograft reconstruction in patients with pelvic metastases.

Limited data are available regarding the survival of patients with solitary pelvic metastases. 4,10,30,31,36,40 There is rarely an indication for wide en bloc resection for solitary bone metastases such as from renal or thyroid cancer without extraskeletal metastases. 29,43 Surprisingly, thyroid cancer was the most common primary tumor with pelvic metastases observed in this cohort. Although it has been reported that for patients with solitary pelvic metastases the favorable median survival may justify consideration of a radical surgical approach to achieve pain palliation and tumor control, 10,24,39,47 our study showed that major surgeries are not related with improved survival compared to curettage in these patients.

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Patient Details

Patient No./Sex/Age, y Histology Pelvic Location a Other Location Preop Treatment Surgery/Margins Postop Treatment Complication Local Recurrence/Treatment Oncologic Outcome Follow-up, mo
1/M/65 Bladder III - CHT EBR/wide No - No DWD 6
2/M/76 Colon II–III Lung CHT, SE EBR, THA/wide No - No DWD 29
3/M/49 Cerebrum Sacrum - RT EBR/wide No - 24 mo/RFA, SE DWD 46
4/M/50 Bladder III - RT, CHT External hemipelvectomy/wide No Urinary fistula No DWD 2
5/F/44 Endometrial III - No EBR/wide Brachytherapy, RT - No NED 35
6/M/62 Kidney I - SE EBR/wide RT - 24 mo/RT DWD 41
7/M/57 Thyroid I Stomach RT EBR/wide IORT - No NED 43
8/M/44 Unknown Sacrum - No EBR/wide RT - No DWD 22
9/M/75 Unknown I - No EBR/wide RT - No DWD 6
10/F/48 Thyroid III - No EBR/wide RT - No NED 6
11/M/59 Lung Sacrum - No EBR/wide RT - No DWD 152
12/F/64 Endometrial II–III - RT, SE EBR, iliofemoral pseudarthrosis/wide No - No NED 4
13/F/62 Ovarian II–III - No Resection, THA/marginal RT - No NED 13
14/F/34 Unknown II–III - RT, CHT Resection/marginal No - 9 mo/iliofemoral pseudarthrosis DWD 13
15/F/43 Thyroid III - No Curettage, phenol, PMMA No - No NED 37
16/M/59 Thyroid Sacrum & ilium Lung IORT, SE Curettage, phenol CHT - 2 mo/CHT AWD 28
17/M/52 Thyroid I–II Lung IORT, SE Curettage, phenol, PMMA No - 26 mo/RT DWD 66
18/M/67 Bladder II–III - RT, CHT, SE Curettage, phenol, PMMA No - No AWD 12
19/M/49 Kidney II - SE Curettage, THA RT, CHT - No DWD 15
20/M/64 Unknown I Femur No Curettage, phenol, PMMA RT - 9 mo/RT AWD 10
21/M/57 Bladder I - CHT, SE Curettage, phenol RT - 2 mo/RT AWD 6

Summary of Reported Cases on Surgical Treatment of Pelvic Metastases

Author No. Patients No. Solitary/Synchronous Metastases Surgery/Reconstruction (No. Patients) Complications (No. Patients) Follow-up, mo Local Recurrence Survival
Boyle et al 40 3 3/0 Internal hemipelvectomy/massive allograft (2) Wound infection (3), DVT, and acetabular cup loosening (2 with reconstruction) Range, 5–32 1 patient 1 patient alive at 32 mo
Kunisada & Choong 12 4 Intralesional/saddle prosthesis Wound infection and dislocation Range, 2–21 2 patients alive at 12 and 21 mo
Marco et al 4 55 40 multiple skeletal metastases/18 visceral metastases Protrusio acetabular cup, THA, and modified Harrington reconstruction with pins, screws, and bone cement (54); hemipelvis endoprosthesis (1) Early: death from hyponatremia, DVT, wound infection, disseminated intravascular coagulopathy, sacral decubitus ulcer, hematoma, Ogilvie syndrome, hip subluxation (14); late: fixation failure (5) Mean, 16±2.8; median, 16 25% 20% at median 9 mo (mean, 18 mo; range, 5.9–12 mo)
Nilsson et al 32 32 4/28 Intralesional/Harrington reconstruction Excessive perioperative bleeding (2), dislocation (2), wound infection (1), DVT (2) Range, 0.5–106 40% at median 11 mo (range, 0–106 mo)
Renard et al 14 5 1/4 Curettage (4), wide resection (1)/saddle prosthesis Renal failure (1), wound infection migration, prosthesis revision (1) Range, 0–36 1 patient 1 patient alive at 36 mo
Yasko et al 10 14 8/6 En bloc resection/segmental allograft pelvisprosthesis composite and saddle prosthesis (4) Dislocation of hip prosthesis, revision with a constrained cup liner (1 with reconstruction); wound necrosis, flap coverage (1 without reconstruction) Median, 53–74.5 (range, 12–129) 0% 93%±7% at 24 mo and 56%±15% at 60 mo (disease free)
Ruggieri et al a 21 16/5 Curettage/marginal resection (9), wide en bloc resection (12)/THA (3) Wide en bloc resection, urinary fistula (1) Mean, 28 (range, 2–152) 30% (7 patients) 15% at 66 mo (death) and 47% at 26 mo (local recurrence)

10.3928/01477447-20110526-07

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