Orthopaedic Jobs

Metastastic Renal Cell Carcinoma


- See Metastatic Carcinoma:

- Discussion:
    - will destroy the cortex and will have a soft tissue component;
    - diagnosis is confirmed either w/ a bone scan which shows a renal mass (inaddition to the metastatic bone lesions) or
            an abdominal CT scan;
    - note that this type of carcinoma can often be succesfully treated even with skeletal metastatsis;
    - renal cell carcinoma is the only common carcinoma that is not radiosensitive (as compared to breast, thryroid, prostate);
    - ref: Images in Clinical Medicine. Metastasis of Renal-Cell Carcinoma

- Work Up:

    - CT scan of chest and kidneys:
           - allows detailed assesment for metastatic disease as well as assement of unilateral vs bilateral renal disease;
    - labs: urinanalysis
    - angiogram of metastatic lesions will show arteriovenous shunting;

- Treatment:
    - surgery may cause a life threating hemorrhage, hence a preoperative  embolization is recommended;
            - most orthopaedists need to see this only once before they will insist on a preoperative arteriogram and embolization;
    - whereas intramedullary nails can be inserted across most carcinomas without the occurance of carcinoma seeding, there is some
            evidence that seeding can occur with renal cell carcinoma;
            - therefore great consideration should be taken with an isolated metatstatic lesion which requires prophylactic fixation;
            - in these cases consideration is given to resection of the mass (with associated bone) inaddition to nephrectomy;
    - w/ pathologic frx or pending frx, hardware failure/loss of fixation is more common w/ renal cell carcinoma because patients
            tend to have long term survival and persistent local tumor osteolysis is common;
            - as noted by Wedin R, et al (1999), endoprosthetic reconstruction has a lower failure rate than osteosynthetic devices;
            - ref: Failures after operation for skeletal metastatic lesions of long bones.  
    - need for resection of the isolated metastasis:
            - in the report by Baloch et al (2000), the authors followed patients with solitary bony metatasis;
                    - they emphasized the need for radical excision of the metatasis inorder to achieve local control of the tumor;
            - in the report by Les KA, et al, the cases of 78 patients with osseous metastases from kidney cancer were reviewed to determine
                    rate of local progression after operative resection as compared with more traditional intralesional procedures;
                    - group I consisted of 41 (53%) patients who were treated with intralesional procedures involving internal fixation with
                               or without curettage or polymethylmethacrylate;
                              - of the 41 patients, additional operations were recommended for 17 (41%) of the patients who had local
                                        osseous progression;
                           - 14 additional procedures including 9 wide resections with reconstruction, 3 amputations, and two mass excisions
                                        were done;
                   - group II consisted of 37 (47%) patients who were treated with marginal or wide resection with or without reconstruction;
                           - in this group, only one patient required additional operative intervention for local osseous progression;
                   - median survival of patients in Group I was 20 months compared with 35 months for patients in Group II;
                   - this study shows that despite shorter average survival, patients who undergo intralesional surgery are at
                           high risk of reoperation for local progression;
                   - resectional surgery should be considered in patients with skeletal metastases from kidney cancer to
                           lessen the risk of reoperation for local progression;
                   - references
                           Radical surgery for the solitary bony metastasis from renal-cell carcinoma
                           Local Progression After Operative Treatment of Metastatic Kidney Cancer 

             



- references:

Preoperative embolization in the treatment of osseous metastases from renal cell carcinoma.

Bone metastases from renal carcinoma. The preoperative use of transcatheter arterial occlusion.

Radical surgery for the solitary bony metastasis from renal-cell carcinoma

Treatment of osseous metastases in patients with renal cell carcinoma.

Renal cell carcinoma bone metastasis: epidermal growth factor receptor targeting.

Proximal femoral replacement for metastatic bone disease.

Solitary bony metastasis from renal cell carcinoma: Significance of surgical treatment.

Treatment of osseous metastases in patients with renal cell carcinoma.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 1, 2016 10:20 am