[Diagnosis and treatment of metastatic bone cancer of the extremities].

Eight hundred and thirty-six patients with metastatic cancer in the bone excluding autopsy findings, occurring between January, 1976 and December, 1985 were reviewed. The most frequent site of primary focus was the breast (33.2%), followed by lung (24.6%). Three hundred and forty-two patients (40.9%) were male and 494 (59.1%) female. Diagnosis of bone metastasis was based on abnormal accumulation in the bone scintigram and abnormal findings in the bone X-ray at the same site. Out of 836 patients, 285 had metastatic skeletal lesion including extremities and 43 had a solitary lesion of the extremity. The most frequent site of bone metastases in the extremity was proximal femur and involvement of the femur was 65.2% and that of humerus was 25.6%. The majority of the patients were treated by irradiation (24.9%), irradiation with chemotherapy and/or hormone therapy (21.1%), chemotherapy (18.6%) and chemotherapy with hormone therapy (17.2%), on the other hand, only 25(8.8%) of 285 patients were treated by surgical procedures. Cumulative survival rate after diagnosis of bone metastasis varied with site of primary focus and 5 year survival rate of all cases was 6.1%. Clinical courses after skeletal metastasis were separated into two types, and one type was breast type which was slow and other type was lung type which was rapid. The most important factor for the prognosis of the patients with bone metastasis is thought to be the primary site of origin.