Carcinoma of the breast metastatic to the skeleton.

A review of 319 patients with breast carcinoma metastatic to the skeleton revealed a large variation in age at diagnosis, interval between diagnosis of primary disease and metastasis, and survival time with metastasis. The presence of bony metastasis only is a good prognostic sign, and the presence of neurologic defects without successful correction is a poor prognostic sign. Bone lesions are radiosensitive, and fractures usually heal with radiation. It is difficult to define impending fractures, but large lytic lesions, increased body weight, increased activity, and areas of high stress are factors that can be used to determine the risk of fracture. Femoral neck fractures should be treated by endoprostheses or total hip arthroplasty and femoral shaft fractures by appropriate internal fixation. In the present series humeral fractures were successfully managed conservatively, but it is possible that with a wider data base the advantages of immediate rigid fixation by internal fixation with methylmethacrylate cement would be more obvious. Use of methylmethacrylate should be restricted to patients with short-term survival expectancies and large defects. Most spinal metastases can be treated by radiation and orthoses, but an aggressive approach is indicated for patients with neurologic deficits. Laminectomy is indicated for lesions that produce posterior compression, anterior decompression for lesions producing anterior compression, and stabilization for alignment deformities or instability.