This study was based on 192 patients treated surgically for 228 metastatic
lesions of the long bones from 1986 through 1995, The survival rate was 0.3
at 1 year after surgery. The surgical treatment consisted of resection and
reconstruction of the involved bone (18), intralesional curettage (133), o
r stabilization only (77), Reconstruction was achieved by an endoprosthesis
in 54 cases, by an osteosynthetic device in 162, by cement only in 10, In
two cases no reconstruction was performed. The local failure rate was 11% a
nd the median time to failure was 8 months. Local failure was most frequent
in patients with kidney cancer (24%) and in diaphyseal and distal femoral
lesions (20%). Among 162 operations involving osteosynthetic devices, 22 (1
4%) were failures as compared with one of 54 (2%) endoprostheses. Sixty per
cent of the patients received preoperative or postoperative radiotherapy. F
ive of the six patients who had surgery for local tumor progression had not
received radiotherapy, Eight of 10 nonunions and all five patients who dev
eloped a stress fracture had been treated with radiotherapy. It is conclude
d that endoprosthetic reconstructions are preferable to osteosynthetic devi
ces, The skeletal complications associated with radiotherapy may be circumv
ented by the use of endoprostheses.