Bone metastases: pathophysiology and management policy.

Abstract

The pathophysiology and options for management of bone metastases as well as criteria for determining response to therapy are reviewed. Bone metastases are frequently one of the first signs of disseminated disease in cancer patients. In the majority of patients, the primary tumor is in the breast, prostate, or lungs. Although almost all patients will die of their disease, a proportion of the patients will survive for several years. Treatment is primarily palliative: the intention is to relieve pain, prevent fractures, maintain activity and mobility, and, if possible, to prolong survival. Therapeutic options include local treatment with radiotherapy and/or surgery, and systemic treatment using chemotherapy, endocrine therapy, radioisotopes, agents such as diphosphonates, which inhibit resorption of bone, as well as analgesic and antiinflammatory drugs. The mechanisms by which pain is relieved by several of these therapies remain unclear but actions beyond a simple tumoricidal effect appear to be important. There have been few randomized trials comparing the therapeutic options, and the criteria for assessing response to therapy have, in general, been poorly defined. There is a need for rigorous clinical investigations that assess the efficacy of the various therapeutic possibilities by using well-defined and validated criteria of response.

Impact of18F-Fluoride PET on Intended Management of Patients with Cancers Other Than Prostate Cancer: Results from the National Oncologic PET Registry

“…For many nonprostate cancer patients, evidence from other types of advanced imaging (CT, MR imaging, or 18 F-FDG PET) (26,27) is routinely available from staging evaluations, and those studies may provide the first evidence of osseous metastasis. However, the tendency of different cancer types to produce osteoblastic versus osteolytic metastases affects the relative cancer-specific sensitivity of these different modalities (2,8). Generally, when the primary clinical motivation for an imaging study is to assess osseous metastasis, bone-specific methods are preferred.…”

“…For many years, the dominant effective method for whole-body imaging has been conventional BS. This modality has variable sensitivity by cancer type, reflecting differences in the dominant osseous pathobiology-predominant osteoblastic disease in prostate cancer versus predominant osteolytic disease in breast, lung, and most other solid tumors (2,5,8). One alternative to conventional BS is NaF PET, with or without integrated CT.…”

Tratamiento quirúrgico de las metástasis del cáncer renal

“…En grandes lesiones osteolíticas o aplastamientos vertebrales con compresión neuroló-gica, es posible realizar laminectomías o incluso vertebrectomías con fijación anterior a base de injertos de hueso iliaco y fijación posterior con placas metáli-cas. Se han llegado a realizar intervenciones mucho más radicales y complejas como hemipelvectomías en focos metastáticos iliacos 28 .…”

Biodistribution of samarium-153-EDTMP in rats treated with docetaxel

“…The resulting bone pain interferes with the patient's quality of life and requires effective treatment. Unfortunately, various non-radiotherapeutic modalities such as analgesics, hormone therapy, orchidectomy, cytostatic and cytotoxic drugs, bisphosphonates, and surgery are not effective in all cases, especially in the late stage of the disease 1,2 . Systemic radionuclide therapy using boneseeking radiopharmaceuticals is considered a valuable and effective method for treating patients with widespread skeletal metastases and increased bone turnover, especially in patients with bone metastases from prostate and breast cancer 3,4,5 .…”

“…Bone metastases patients often present with severe bone pain, especially in the advanced stage of disease 1,2 . The major pain mechanism of small metastases appears to be the stimulation of nerve endings in the endosteum by a variety of chemical mediators.…”