The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice

Bone Metastases in Neuroendocrine Neoplasms: From Pathogenesis to Clinical Management

“…Different from the studies mentioned above, Kavecansky et al reported a lower frequency of SREs (35%), because they evaluated only spinal cord compression and pathological fractures, without including bone pain [11]. In the recent study by Alexandraky et al, SREs were reported in only 9% of the patients [18]. This discrepancy could be due to the use of more advanced imaging procedures, which allowed an earlier diagnosis of BMs, preventing the development of SREs.…”

“…All these results were confirmed by a very recent multicenter study by Alexandraki et al, which found the pancreas and the small intestine to be the most common primary tumor sites (30% and 27%, respectively). Moreover, the majority of patients with BMs presented with associated liver metastases [18]. Different from the Swedish Cancer Registry [9], none of the abovementioned studies found significant differences in BMs frequency according to gender, although bone lesions were slightly more frequent in male patients [10,11,12].…”

“…In conclusion, BMs were reported in 4–12% of patients, representing the third site of metastases in NEN patients. The most common primary tumor sites were pancreatic, small intestine, and lung NENs [7,9,10,11,12,13,14,16,18]. However, the natural history of BM is still disputed, and data regarding the development of synchronous or metachronous metastases are contradictory [11,14,18].…”

“…In NEN patients, BMs are the third most common site of metastasis after the liver and other intra-abdominal sites and are frequently associated with liver metastases [9]. The most frequent sites of BMs in NEN patients are the axial skeleton, mostly at vertebra levels, followed by the pelvic region and ribs, whereas only a small percentage of patients have BMs at the appendicular skeleton, which are often associated with axial BMs [10,11,18,41]. Moreover, BMs occur more frequently as multiple lesions and only in a small percentage of cases as a single metastasis [18].…”

“…In 20%–40% of cases, BMs are asymptomatic and are detected during tumor staging and follow-up [12,41], whereas only a small percentage of cases are diagnosed after developing serious complications [18,60]. Therefore, the management of BMs was considered only as a palliative treatment for a long time.…”