Metastatic Tumours

Metastatic Tumours, pelvic radiograph showing bone metastases
Pelvic radiograph showing bone metastases. Image by Chih-Yu Chen, Yong-Te Hsueh, Tsung-Yu Lan, Wei-Hsin Lin, Karl Wu and Rong-Sen Yang, Wikimedia Commons, CC BY-SA 2.0.
Metastatic Tumours, femoral head with bone metastasis
Femoral head with bone metastasis. Image by Ma Jesus Fernández-Aceñero und Teresa Aramendi Sánchez, Wikimedia Commons, CC BY-SA 2.0.

Bony Metastases

Survival

Median survival after diagnosis of bony mets:

  • Thyroid:  48 mth
  • Prostate:  40 mth
  • Breast:  24 mth
  • Myeloma:  20 mth
  • Renal:  < 6 mth.  If solitary met, there is a chance of long term survival
  • Lung:  < 6 mth

Radiotherapy

  • Breast & prostate more responsive than lung

Indications for Prophylactic Fixation

  • Considerations:
    • Pain
      • Persistent pain despite radiation
    • Location of lesion
      • Involvement of subtrochanteric region ↑ risk
      • Any lesion between lesser trochanter & femoral head causing functional pain or > 2.5 cm should be fixed
      • Avulsion of lesser trochanter
    • Lesion size
      • Many descriptors used
        • Lesion > 2.5 cm involving femoral cortex
        • > 50% femoral cortical involvement (100% incidence of pathologic fracture)
  • Mirels system
    • Pain
      • Mild (1)
      • Moderate (2)
      • Severe (3)
    • Location of lesion
      • Upper limb (1)
      • Lower limb (2)
      • Peritrochanter (3)
    • Size of lesion
      • < 1/3  (1)
      • 1/3-2/3  (2)
      • > 2/3  (3)
    • Type of lesion
      • Blastic  (1)
      • Mixed  (2)
      • Lytic  (3)
    • Assessment – score out of 12:
      • < 7, not at risk of fracture
      • 8,  15% risk of fracture
      • 9,  33% risk
      • >=9, should be used as an indication for fixation

Adjuvant Therapy for Metastatic Bone Disease by Dr Vikram David

Management of Metastatic Bone Disease

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.