1. 2014;17;227-234Clinical Benefits of Femoroplasty: A Nonsurgical Alternative for the Management of Femoral Metastases
   Retrospective Review
   Faride Chejne-Gomez, MD, Roberto Medina-Santillan, MD, Carolina Hernandez-Porras, MD, Abelardo Meneses-Garcia, MD, Jorge Guajardo, MD, Ricardo Plancarte, MD, Georgina Galindo-Hueso, MD, Ulises Nieves, MD, and Oscar Cerezo, MSc.

BACKGROUND: Bone metastases occur frequently in advanced cancer. The spine, pelvis, ribs, skull and femur are the most affected sites. It is reported that up to 83% of the patients develop pain at some point of the disease. The patient can also develop fractures and disability, particularly in the femur..

OBJECTIVES: To evaluate the effectiveness of percutaneous femoroplasty in patients with metastatic osseous disease located in the proximal femur (trochanter, neck, and femoral head).

STUDY DESIGN: A retrospective clinical review, comparing pain status “before vs after” intervention.

SETTING:  National Cancer Institute in Mexico.

METHODS: We included patients over 18 years old, with mild to severe pain due to metastasis in the proximal femur (trochanter, neck, or head), or with a high risk of fracture according to Mirels scale (> 8 points) or severe osteoporosis according to the World Health Organization (a Karnofsky score more than 50%). Exclusion criteria were femoral fracture. We recorded the following variables age, sex, type of neoplasm, concomitant therapy,

We used the Karnofsky functionality scale, the VAS pain intensity assessment, the “Mayo Clinic” scale to measure improved functionality, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTC QLQ-C15-PAL) (Spanish version) questionnaires. Follow-up was performed at 7 days, one month after femoroplasty, and during the individual outpatient that lasted one year on average.

RESULTS: Eighty subjects were enrolled. Seventy-three percent were women. The most frequent tumors were breast (46.3%), followed by multiple myeloma (18.7%). All patients had a decrease in the intensity of pain, analgesic consumption, and improved quality of life, at 7 and 30 days after the intervention. There were no complications with serious consequences. Two participants experienced  polymethylmetacrylate  (PMMA) leakage, without clinical or functional impact. In 4 patients, the needle was occluded during the filling process and we had to place another biopsy needle through the same entry site to finish the injection process.

LIMITATIONS: The sample was a single group of patients evaluated before and after the femoroplasty. We did not include a control group.

CONCLUSION: The results of the current report suggest that femoroplasty, a percutaneous cement placement analogous to a vertebroplasty, might be a therapeutic option for patients with metastatic bone disease of the proximal femur, providing the patient an analgesic reduction and a better quality of life.