Team Approach: The Treatment of Metastatic Tumors of the Femoral Diaphysis.

T hedifferential diagnosis for an adult patient presenting with an aggressive-appearing bone lesion includes metastatic disease, multiple myeloma, lymphoma, chondrosarcoma, osteosarcoma, nonneoplastic conditions such as infection, and metabolic bone diseases such as Paget disease of bone. An accurate diagnosis is critical as it will guide the treatment and goals of care. The true prevalence of osseous metastasis is unknown. In theUnited States alone, estimates have indicated that 280,000 to 330,000patients are livingwith osseous metastasis. Patients with metastatic disease substantially outnumber those with primary malignant bone neoplasms, with an estimated 3,300 patients beingdiagnosedwith such lesions per year. It has been estimated that 80% of skeletal metastases are secondary to breast, prostate, lung, kidney, and thyroid adenocarcinomas, with the femur and spine representing the 2 most common sites of involvement.