AAOS Clinical Practice Guideline SummaryAAOS Clinical Practice Guideline Summary:Treatment of Metastatic Carcinoma and Myelomaof the FemurFelasfa Wodajo,MD DMatthew Colman,MDPatrick Getty,MD DABSTRACTThe Musculoskeletal Tumor Society,in partnership with AmericanSociety of Clinical Oncology and American Society for RadiationOncology,has developed a clinical practice guideline to assistproviders with the care of patients with metastatic carcinoma andmyeloma of the femur.The guideline was developed by an Expert Panelconsisting of representatives of all three organizations by AmericanAcademy of Orthopaedic Surgeons(AAOS)methodologists using theAAOS standardized guideline development process.A systematicreview of the available evidence was conducted,and the identifiedevidence was rated was rated for quality and potential for bias.Recommendations were developed based on this evidence in astandardized fashion.The guideline was approved by the guidelineapproval bodies of all three organizations.Thirteen recommendationswere synthesized covering relevant subtopics such as imaging,use ofbone-modifying agents,radiation therapy,and surgical reconstruction.The consensus of the expert panel was that bone-modifying agentsmay assist in reducing the incidence of femur fracture,regardless ofFrom the Rush University Medicaltumor histology.The panel recommended the use of radiation therapyCenter,Chicago,IL (Wodajo,Colman,and Getty),Virginia Commonwealth University,Richmond,to decrease the rate of femur fractures for patients considered atVA (Wodaio),Georgetown University VirginiaCancer Specialists Washington,DC (Wodajo).increased risk.The panel recommended arthroplasty be considered toand University Hospitals,Case Comprehensiveimprove patient function and decrease the need of postoperativeCancer Center Getty).Supplemental digital content is available for thisradiation therapy in patients with pathologic fractures in the femur.article.Direct URL citation appears in the printedtext and is provided in the HTML and PDFversions of this article on the joumal's Web sitewww.jaaos.org).Jointly prepared by the Musculoskeletal TumorSociety (MSTS),American Society for RadiationOverview and RationaleOnoology (ASTRO,and American Society ofClinical Onoology (ASCO).The skeleton is a frequent site of metastasis in patients with cancer.MultipleJAm Acad Orthop Surg 2023:31:e118-e129myeloma is a plasma cell malignancy in which 70%to 80%of patients presentD01:10.5435/JAA0S-D-21-00888with lyticlesions in the skeleton(Terpos).Bone lesions,whether from metastaticCopyright 2022 by the American Academy ofcarcinoma or multiple myeloma,not only can be painful and limit physicalOrthopaedic Surgeons.activity but also have the potential to result in pathologic fracture.Bonelesions,e118JAAOS February 1,2023,Vol 31,No 3 American Academy of Orthopaedic SurgeonsCopyright the American Academy of Orthopaedic Surgeons.Unauthorized reproduction of this article is prohibited.
