Abstract
Introduction: Despite the lack of good clinical evidence post operative radiotherapy is standard practice following non radical surgical treatment of skeletal metastases in long bones There is little in the literature about the size of radiation field and whether the whole bone, the nail or just the area of the metastatic deposit should be covered.
Methods: We present two cases where the metastases were treated by intramedullary nailing and were subsequently irradiated. In each case the tip of the intramedullary nail was outside the radiotherapy field.
Results: Subsequent second metastasis formation occurred at the tip of the nail compounded by pathological fracture. Salvage surgery was achieved in one case with a total femoral replacement and in the other by bi-columnar plating of the humerus with cement augmentation.
Discussion: Intramedullary nailing of a metastasis will seed the tumour to the tip of the nail. It is therefore essential that the tip of the nail be included in the radiotherapy field post-operatively as salvage surgery for subsequent pathological fracture is technically demanding. The aim of any surgery for skeletal metastases is that the reconstruction should outlast the patient. Communication between surgeon and radiation oncologist is essential.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
