The natural history and management of mammary cancer metastatic to the femur

In this study an attempt is made to evaluate the natural history of patients with mammary cancer metastatic to the femur and to identify those methods of management which are most effective. Forty‐six patients with 66 different femoral metastases were reviewed retrospectively from the Ellis Fischel State Cancer Hospital. The total incidence of long‐bone metastasis secondary to mammary cancer in 2,951 patients was 3.45% with 90% involving the femur, and 75% of all femoral lesions were associated with other bony metastasis. Fractures occurred, at some time, in 42.4% of all femoral metastasis. Fractures were not present initially in 51 lesions evaluated, but 38 of these were symptomatic and fractures subsequently occurred in 34.2% of the symptomatic lesions. Regardless of the mode of therapy, a statistically significant difference in survival was not found in patients who sustained pathologic fractures when compared to those who did not, nor did internal fixation of fractures alter survivals. A 50% improvement in the level of ability to ambulate was noted in the fracture group, due solely to internal fixation, whereas the non‐fracture and non‐surgically treated patients showed only a 2.6% improvement in ambulatory level. The authors conclude that prophylactic internal fixation merits more consideration in the management of patients with symptomatic femoral metastasis secondary to advanced mammary cancer.