Endoprosthetic treatment of metastatic pathological fractures.

Due to a prolonged time of survival patients with lowrisk skeletal dissemination may develop a local relapse after surgical treatment of a pathological fracture. In a series of 180 patients with bone metastases of breast cancer, a local metastatic recurrency was observed 8-36 months after operative treatment in 12 patients. All of them had a receptor-positive primary and were free from visceral metastases; only one had received radiotherapy postoperatively. Patients with low-risk disease therefore should undergo more radial surgical procedures than patients with poor prognosis, in whom reconstitution of stability represents the most important therapeutic goal. In cases with low-risk disease and histologically proven residual tumour a postoperative irradiation should be administered as a rule.