Nonoperative management of femoral, humeral, and acetabular metastases in patients with breast carcinoma.

A retrospective analysis of 59 cases of metastatic breast carcinoma involving the long bones and acetabula was done in an attempt to determine the role of radiation therapy in the management of bone metastases. A total of 97 bone lesions were treated with radiation as the initial therapeutic modality. Seven patients had pathologic fractures when first seen, and 2 had sustained fractures while receiving radiation therapy, and 2, following completion of radiation therapy. All patients had pain relief and improvement in their performance status. A third of patients had radiographic evidence of bone healing. None of the high-risk lesions that may ordinarily be subjected to prophylactic orthopedic stabilization in many medical centers sustained a pathologic fracture after the completion of radiation therapy. We conclude that the use of radiation therapy in initial management of bone metastases in patients with breast cancer is usually effective, and that prophylactic surgical intervention is not warranted in most cases.