The treatment of localized metastases in the proximal humerus from renal cell carcinoma.

Four cases of a localized metastatic renal cell carcinoma within the proximal humerus are reviewed. In three of these cases radiation therapy resulted in relief of bone pain but did not control progression of the secondary tumor. In one case palliative radiation treatment combined with intramedullary nailing resulted in the total destruction of the whole humerus by secondary tumor during the 10-month period before the patient died. In the other three cases aggressive surgical treatment was performed. This treatment consisted of an en bloc resection of the proximal humerus, with reconstruction of the proximal humerus with a long-stem Neer humeral head replacement prosthesis. To obtain a good functional result, the soft tissues were reconstructed onto on intercalary allograft in one case; artificial rotator cuffs were used in two cases. After a mean follow-up period of 20 months, all three patients who underwent aggressive treatment hod painless shoulders, with fair function and no recurrence of carcinoma. En bloc resection with reconstruction of the proximal humerus is on effective method of avoiding limb oblation and contrailing painful solitary lesions from metastatic renal cell carcinoma.