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Surgery and Soft-Tissue Tumours

Hindawi Publishing Corporation
Publication Date
DOI: 10.1080/135771402753667664
  • Research Article
  • Biology
  • Medicine


Surgery and Soft-Tissue Tumours EMSOS abstracts S19 SURGERY AND SOFT-TISSUE TUMOURS ORAL PRESENTATIONS C79 Reliability of Risk Factors and Scoring Systems in Predicting Fracturing in Metastatic Femoral Bone Lesions Y.M. van der Linden, H.M. Kroon, P.D.S. Dijkstra, E.M. Noordijk Leiden University Medical Center, Leiden, The Netherlands Objective: In randomised Dutch Bone Metastasis Study on the palliative effect of single versus multiple fraction irradiation on painful bone metastases all impending fractures were excluded from participation. During intensive follow-up 35 fractures occurred in 1157 patients. A subset of 102 patients with a femoral lesion, in which 8 fractures occurred within 12 weeks after irradia- tion (8%), was used to assess the pre-treatment fracture risk. Methods: Pre-treatment radiographs were collected. A radiologist, orthopaedic surgeon and radiation oncologist independently and without knowledge of the outcome after treatment (fracture yes/ no) scored size and extent in mm, radiographic appearance/struc- ture/aspect, localisation, percentage of cortical involvement and estimated risk of fracturing. Known risk factors (size >2.5 cm, cortical involvement >50% or continuing pain after irradiation) and an adjusted Mirels’ scoring system* were applied to evaluate effectiveness (table1). Results: If a score of 9 points as Mirels suggested was applied sensi- tivity for predicting a fracture was high but specificity very low (table2). The positive predictive value of Mirels was low (<10%). Size >2.5 cm, cortical involvement >50% or continuing pain were not predictive of fracturing. Conclusion: In this study reliability of accepted risk factors and scoring systems in predicting fracturing in patients with a femoral bone metastasis is low. The use of Mirels’ scoring system will lead to excessive surgical overtreatment (positive predictive value <10%). Also size >2.5 cm, cortical involvement >50% or contin- uing pain after irradiation are not specific enough. Deve

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