Surgical and additional treatment options for long bone metastases: literature review

Gintas Vaiciekauskas1, Aurelija Bartašiūtė1, Mantas Giedraitis2

1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania

2Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Department of Orthopedics and Traumatology, Kaunas, Lithuania


Background.  Advanced cancer is one of the most common causes of death in the world and bones are among the main sites for malignant metastases. Surgical treatment still plays the main role in managing mobility disorders, pain, and pathological fractures.


Aim. To review the scientific literature on surgical and additional treatment of long bone metastases.

Methods. A literature review was conducted by using “PubMed” and “Cochrane Library” databases. The following keywords were used: “long bone metastases“, “metastatic bone disease“, “treatment“, “surgical treatment”, “pain management”. 307 articles were found. Inclusion criteria were: studies written in English, published between 2012 – 2022 and analyzing the treatment of long bone metastases. Articles about metastases in other organs or short bones were excluded. 45 studies were selected and literature review was done.

Results. Lesions of proximal and distal bone parts are managed with endoprostheses. Diaphyseal lesions are usually managed with locking intramedullary nails. Bone defects can be filled with bone cement. Mirel‘s score is used in order to assess the need of prophylactic treatment. Tumor resection can be used only for oligometastases. For additional treatment physicians can use analgesics, bisphosphonates, radiotherapy, ablation, preoperative embolization. Theranostics is one of the latest treatment options.


Conclusions. Treatment for long bone metastases is considered in multidisciplinary team. Main treatment options are prophylactic fixation, fixation of pathological fractures, tumor resection and endoprosthesis. The main goal of additional treatment is pain control.


Keywords. Long bone metastases, metastatic bone disease, treatment, surgical treatment, pain management.