Abstract
Multiple myeloma may be associated with extensive bone destruction, impending or present pathological fracture, and intractable pain. Chemotherapy and radiotherapy are usually effective, but surgical intervention may sometimes be required.
We analyzed the surgical technique and the functional and oncological outcomes of patients with multiple myeloma who underwent surgery in our services between 1993-2004.
There were 19 males and 15 females (age range 49– 75 years) who had destructive bone lesions located at the humerus (n=17), acetabulum (n=5), femur (n=5), or tibia (n=7). Indications for surgery included pathological fracture (n=20), impending pathological fracture (n=11), and intractable pain (n=3). Nineteen patients underwent marginal tumor resection, reconstruction with cemented hardware, and adjuvant radiation therapy and 15 patients underwent wide tumor resection with endoprosthetic reconstruction. All patients reported immediate and substantial postoperative pain relief. Function was good/excellent in 23 patients (68%), moderate in eight (23%), and poor in three (9%). Two patients (5.9%) had local tumor recurrence treated with local excision and adjuvant radiotherapy, with no evidence of further recurrence at 21 and 26 months, respectively. Thirty one (91%) patients survived > 1 year, 23 (68%) > 2 years, and 15 (44%) > 3 years postoperatively. All reconstructions remained stable at the most recent follow-ups.
The relatively prolonged survival of patients with multiple myeloma justifies an aggressive surgical approach, which is safe and associated with good local tumor control and functional outcome.
Correspondence should be addressed to: Orah Naor, IOA Secretary and Co-ordinator (email: ioanaor@netvision.net.il)
