Bone metastases: an overview

Abstract

Bone is a frequent site of metastases and typically indicates a short-term prognosis in cancer patients. Once cancer has spread to the bones it can rarely be cured, but often it can still be treated to slow its growth. The majority of skeletal metastases are due to breast and prostate cancer. Bone metastasis is actually much more common than primary bone cancers, especially in adults. The diagnosis is based on signs, symptoms and imaging. New classes of drugs and new interventions are given a better quality of life to these patients and improved the expectancy of life. It is necessary a multidisciplinary approach to treat patients with bone metastasis. In this paper we review the types, clinical approach and treatment of bone metastases.

Bone as a Preferential Site for Metastasis

“…Metastasis to the bone occurs in approximately 60% of patients with metastatic breast or prostate cancer and to a lesser extent in other cancers, including lung and melanoma . The bone microenvironment provides a uniquely fertile soil for the homing of DTCs for several reasons.…”

Dramatic bone remodeling following larotrectinib administration for bone metastasis in a patient with TRK fusion congenital mesoblastic nephroma

“…Assessing the response of bone metastases to therapy is usually difficult, with a slow and subtle healing process. Sclerosis of lytic lesions usually begins to appear 3–6 months after the start of effective therapy and can take more than 1 year to mature . In this case the dramatic response observed to larotrectinib, a highly selected TRK inhibitor, promoted significant robust bone healing and obviated the need for surgical resection or amputation.…”

Outcome of Wilms tumor patients with bone metastasis enrolled on National Wilms Tumor Studies 1‐5: A report from the Children's Oncology Group

“…While x-ray, CT, and MRI have a high specificity for diagnosing bone metastasis, bone scintigraphy has a low specificity and was used as the sole diagnostic means in 5 cases. 30 In the 3 cases where method of WTBM diagnosis was unclear, location was clearly documented. Strengths include the relatively large size of this very rare population, and central review of all cases, augmenting consistency in classification and pathological diagnostic expertise.…”