Hip Fractures, Neoplasms, Bone Tissue, Pain, Intractable
Conditions
Keywords
Implantable device, Hip fractures
Brief summary
Bone metastases appear in many cancers. They are associated with severe pain that is refractory to standard treatment. Improving the quality of life and better pain relief is therefore an essential goal of the treatment of metastatic disease. The most common site of long bone metastases is the superior femoral epiphysis. The usual management of patients with bone metastases in the superior femoral epiphysis is based on gamma implant osteosynthesis when there is a known risk of fracture (Mirels score\> 8). Nonetheless this surgery is only accessible to a few patients because of the associated morbidities. Percutaneous cementoplasty has been developed to treat patients who are not eligible for conventional surgery. It consists in a filling of the bone cavity created by metastasis using an acrylic resin. However, these approaches do not completely prevent the risk of upper femoral epiphyseal fracture due to the low mechanical resistance of the resin to shear movements. The Y-STRUT® implantable medical device was developed to overcome this risk of superior femoral epiphyseal fracture by the biomechanical strengthening of the proximal femur in addition to cementoplasty. It has been successfully tested in more than 70 patients with cancer but access to reimbursement and the APHP market have been postponed due to lack of sufficient clinical evidence. The investigators propose this prospective phase 2a study in order to provide evidence of the performance of the Y-STRUT® implant.
Detailed description
The design consists in a multicenter national open simple arm trial. All eligible patients with a lytic bone metastases of the superior femoral epiphysis will be included. The main objective of this study is to describe the impact of the Y-STRUT® implant on the quality of life of patients with lytic bone metastases of the femoral neck by comparing quality of life scores before and one month after the intervention of implantation of the implant.
Interventions
DEVICEImplantation
Implantation of Y-Strut + cementoplasty in the femoral neck
Sponsors
Hyprevention
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age \>= 18 years * patient with a lytic or mixed matrix bone metastasis of the superior femoral epiphysis visualized in imaging * MIRELS score ≥8 within 20 days prior to inclusion, * ECOG-PS 2 or 3 within 20 days prior to inclusion, * Cervico-diaphyseal angle between 115 ° and 135 ° inclusive, * Length of the proximal part of the femur greater than or equal to 90 mm * Patient refusing gamma nail * Life expectancy greater than 6 months
Exclusion criteria
* Act of general anesthesia impossible, * ECOG \<2 (patients eligible for nailing treatment), * INR \<0.7 in the 24 hours preceding the intervention, * Platelets \<70000 / mm3 within 24 hours of surgery, * Allergy previously known by the patient to PEEK and / or PMMA, * Patient who previously had a cementoplasty of the target lesion, * Osteolysis of the target epiphyseal cortex\> 2/3 of the circumference of the epiphyseal cortex, * Pre-fracture lesions of the underlying ipsilateral diaphysis or ipsilateral acetabulum * Patient unable or unwilling to give written consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measure of Quality of Life for each patient within one month after the implantation | 30 days | Measure of the Quality of Life score using the questionary of quality of life of the European Organization for Research and Treatment of Cancer BM-22. Patients answer at 22 questions to describe their quality of life during the past week. For each question, patient must choose between 1.not at all, 2.a little, 3.enough, 4.a lot. A global score is calculated by adding the 22 score of each questions. The higher value of this global score represents the better outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| AE/SAE imputable to the implatation (number) within 2 months after the implantation | 2 months | Number of AE/SAE imputable to the implatation |
| Morphinic mean dose per day within one month after the implantation | 30 days | Consumption of morphinic mean dose per day during the month after the procedure |
| Target lesion fracture within one month after the implantation | 30 days | Number of target lesion fracture |
| Target lesion fracture within 2 months after the implantation | 2 months | Number of target lesion fracture |
| Non-target femoral fracture within 2 months after the implantation | 2 months | Number of Non-target femoral fracture |
| Non-target femoral fracture within one month after the implantation | 30 days | Number of Non-target femoral fracture |
| Analgesic medication needs (type and dose) within one month after the implantation | 30 days | Consumption of analgesic medication |
| Analgesic medication needs (type and dose) within 2 months after the implantation | 2 months | Consumption of analgesic medication |
| AE/SAE imputable to the implatation (number) within one month after the implantation | 30 days | Number of AE/SAE imputable to the implatation |
| total AE/SAE within 2 months after the implantation | 2 months | Number of AE/SAE |
| AE/SAE imputable to the device (number) within one month after the implantation | 30 days | Number of AE/SAE imputable to the device |
| AE/SAE imputable to the device (number) within 2 months after the implantation | 2 months | Number of AE/SAE imputable to the device |
| Morphinic mean dose per day within 2 months after the implantation | 2 months | Consumption of morphinic mean dose per day during the 2 months after the procedure |
| Quality of Life score (EORTC QLQ BM-22) within 2 months after the implantation | 2 months | Measure of the Quality of Life score using the questionary of quality of life of the European Organization for Research and Treatment of Cancer BM-22. Patients answer at 22 questions to describe their quality of life during the past week. For each question, patient must choose between 1.not at all, 2.a little, 3.enough, 4.a lot. A global score is calculated by adding the 22 score of each questions. The higher value of this global score represents the better outcome. |
| Pain score at target site within 2 months after the implantation: VAS | 2 months | Use of Visual Analog Scale (VAS) to evaluate the pain at target site (between 0: no pain to 10: intolerable pain) |
| Length of stay within 2 months after the implantation | 2 months | Length of stay at hospital |
| Exit mode of hospital within 2 months after the implantation | 2 months | at home, re-education unit |
| total AE/SAE within one month after the implantation | 30 days | Number of AE/SAE |
Contacts
Primary ContactOlivier Pellerin, MD, PhD
Backup ContactCarole Dean, PhD
Outcome results
None listed