A prospective evaluation of the functional status and quality of life of patients undergoing surgery for long bone and acetabular metastases was performed. Sixty-nine patients were enrolled in the study. IM nailing and prosthetic replacement were the most common methods of treatment. Results were assessed using the MSTS 1987, MSTS 1993, TESS and SF-36 pre-op and then at six and twelve weeks post-op. There was a significant improvement in all of these parameters. The need for pain medication also decreased significantly. These results show surgical treatment of bone metastases can be benificial to patients with a short life expectancy.

The purpose of this study was to objectively assess the benefits of surgical treatment of bone metastases in the first three months post-operatively.

This is the first prospective study to evaluate the impact of surgery on the quality of life and function of patients burdened by metastases to the appendicular skeleton.

Sixty-nine patients gave their informed consent to be followed prospectively. Patients were administered the SF-36, MSTS 1987, MSTS 1993 and TESS questionnaires pre-op, at six weeks and three months post-op.

Average age was sixty-one years. Average follow-up was six months with 71% of patients deceased at the latest follow-up. Thirty-five patients had a pathological fracture and thirty-four had an impending fracture. IM Nailing was performed in thirty-six patients, prosthetic replacement in twenty and various other methods of stabilization in the thirteen other cases. Complications occurred in 25% of patients. There was a statistically significant improvement in the MSTS 1987 (from 13,6 to 22,8), MSTS 1993 (21,7 to 51,7), TESS (37,7 to 67,7) and pain medication use in the first three months post-op. SF-36 physical component scores improved significantly at six and twelve weeks while mental component scores improved significantly only at twelve weeks post-op.

Our data shows that surgical treatment of metastatic disease to long bones improves functional status and quality of life in a relatively short time frame. This is significant in a group of patients suffering from advanced neoplasia.

This study suggest interesting benefits in the overall well-being of patients treated surgically for bone metastases.

Funding: Funding was received from CHIR and FREOM.

Introduction Morbidity associated with wound complications may translate into disability and quality-of-life disadvantages for patients treated with radiotherapy (RT) for soft tissue sarcoma (STS) of the extremities. Functional outcome and health status of extremity STS patients randomized in a phase III trial comparing pre-operative versus post-operative RT is described.

Methods One hundred and ninety patients with extremity STS were randomized after stratification by tumor size dichotomized at 10 cm. Function and quality of life were measured by the Musculoskeletal Tumor Society Rating Scale (MSTS), the Toronto Extremity Salvage Score (TESS), and the Short Form-36 (SF-36) at randomization, six weeks, and three, six, 12, and 24 months after surgery. One hundred and eighty-five patients had function data.

Results Patients treated with post-operative RT had better function with higher MSTS (25.8 v 21.3, P < .01), TESS (69.8 v 60.6, P =.01), and SF-36 bodily pain (67.7 v 58.5, P =.03) scores at six weeks after surgery. There were no differences at later time points. Scores on the physical function, role-physical, and general health sub-scales of the SF-36 were significantly lower than Canadian normative data at all time points. After treatment arm was controlled for, MSTS change scores were predicted by a lower-extremity tumor, a large resection specimen, and motor nerve sacrifice; TESS change scores were predicted by lower-extremity tumor and prior incomplete excision. When wound complication was included in the model, patients with complications had lower MSTS and TESS scores in the first two years after treatment.

Conclusions The timing of RT has minimal impact on the function of STS patients in the first year after surgery. Tumor characteristics and wound complications have a detrimental effect on patient function.