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Current Concepts Review   |    
Current Concepts Review - Treatment of Metastatic Adenocarcinoma of the Pelvis and the Extremities*
ALAN D. AARON, M.D.†, WASHINGTON, D.C.
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*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
J Bone Joint Surg Am, 1997 Jun 01;79(6):917-32
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Cancer is the second leading cause of death in the United States; in 1991, 23.7 per cent (514,657) of the total number of deaths were cancer-related126. The rate of survival has improved over the last three decades; the five-year rate of survival from the time of diagnosis has increased by 20 and 30 per cent for breast and prostate carcinoma, respectively, since 1963126. Bone is the third most common site for distant metastases from adenocarcinoma, second only to the lung and the liver. Bone metastases were the first presentation of carcinoma in 23 per cent of 429 previously undiagnosed patients19. Although not always clinically evident, there is bone involvement at the time of autopsy in as many as 85 per cent of patients who die from carcinoma of the breast, prostate, or lung66,114. Breast (32 per cent), prostate (36 per cent), and lung carcinoma (14 per cent) are the most commonly reported types in the United States126. Of these adenocarcinomas, lung cancer contributes to 33 per cent of the deaths of men and to 24 per cent of those of women126. Radionuclide imaging demonstrated bone metastases in 590 (63 per cent) of 933 patients diagnosed with a primary adenocarcinoma, with 789 (85 per cent) of these patients having metastases secondary to breast, lung, or prostate carcinoma115. The most frequent sites of bone metastases are the vertebrae, pelvis, ribs, femora, and skull.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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