Treatment of cancer metastatic to the diaphysis of long bones

Cancer metastatic to bone is an important issue for both the general orthopaedist as well as orthopaedic oncologists. The number of cases of metastatic carcinoma to the skeleton is far higher than the number of primary sarcomas of bone. Appropriate treatment can be given by general orthopaedists if a systematic and organized approach is taken to diagnosis and operative intervention. The first and most important step in treatment is proving the diagnosis. Once the diagnosis of metastatic carcinoma is made then definitive treatment can proceed. The most appropriate treatment is not always surgical intervention. However, if surgical intervention is chosen, intramedullary nails are a good choice of fixation. Lesions should be debulked to decrease the tumor burden. Bony defects should be filled with polymethylmethacrylate. Intramedullary nails are usually chosen for fixation, and are placed from one end of the bone to the other to protect from further spread of disease. Most patients should be considered for palliative external beam radiation therapy postoperatively. The goals of treatment are pain relief and preservation or return of function.