Palliative Strahlentherapie von Knochenmetastasen Eine retrospektive Analyse von 176 Patienten

BACKGROUND: The effect of the palliative irradiation of bone metastases was explored in this retrospective analysis. The spectrum of primary tumor sites, the localization of the bone metastases and the fractionation schedules were analyzed with regard to palliation discriminating total, partial and complete pain response. PATIENTS AND METHODS: One hundred seventy-six patients are included in this retrospective quantitative study from April 1992 to November 1993. Two hundred fifty-eight localizations of painful bone metastases were irradiated. The percentage of bone metastases of the total irradiated localizations in our department of radiotherapy in the Charité-Hospital, the primary tumor sites, the localizations and the different fractionation schedules were explored. The total, partial and complete pain response was analyzed in the most often used fractionation schedules and by primary tumor sites. RESULTS: Eight per cent of all irradiated localizations in the observation period were bone metastases. There were irradiated bone metastases of 21 different tumor sites. Most of the primary tumor sites were breast cancer (49%), lung cancer (6%) and kidney cancer (6%). The most frequent site of metastases was the vertebral column (52%). The most often used fractionation schedules were: 4 x 5 Gy (32%), 10 x 3 Gy (18%), 6 x 5 Gy (9%), 7 x 3 Gy (7%), 10 x 2 Gy (5%) and 2 x 8 Gy. The total response rates in this fractionation schedules were 72%, 79%, 74%, 76%, 75% and 72%, the complete response rates were 35%, 32%, 30%, 35%, 33% and 33%. There were no significant differences between the most often irradiated primary tumor sites, the most frequent localizations and the palliation with regard to total, partial and complete pain response. CONCLUSION: There are no differences between the different fractionation schedules with regard to the pain effect of bone metastases. A palliation is ensured in 75% of all cases with a partial response of 42% and complete response of 33%. With regard to pain response these results do not justify a recommendation for a standard fractionation schedule. Current fractionation schedules such as 10 x 3 Gy for 2 weeks or 5 x 4 Gy for 1 week should be used. Another point is the recalcification in the palliative treatment of bone metastases in patients with better prognosis. The recalcification is the basis for stabilization and prevention of fractures. This aspect should be explored in prospective studies.     

The radiotherapeutic effect on bone metastases in relation to the frequency of metastases, sites of metastases and histology of the primary tumor

In a retrospective study on 239 patients irradiated for osseous metastases in 578 different skeletal areas, the therapy effect was evaluated in dependence on the frequency of metastases, the sites of metastases, and the histology of the primary tumors. Furthermore the duration of improved findings was verified. The primary tumor was a mammary carcinoma in 186 patients, a bronchial carcinoma in 21 patients, a renal cell carcinoma in 20 patients, and a prostatic carcinoma in 12 patients. In patients with bronchial carcinoma the relief of pain by radiotherapy was not as good as in other tumor types. However, a significant correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 55% of all irradiated skeletal areas and an unchanged X-ray picture of bone metastases in 35%. A dependence of the objective therapy effect from the histology of the primary tumor was not statistically demonstrated (recalcification rate in mammary carcinoma 62%, in prostatic carcinoma 57%, in bronchial carcinoma 28%, and in renal cell carcinoma 11%). Significant differences of remineralization were found in solitary bone metastases (68%) and in multiple skeletal metastases (56%). A significant correlation between sites of metastases and objective irradiation effect was proved by the fact that osteolytic destructions of spine and pelvis showed a better remineralization than lesions situated in the extremities. The average duration of the objective, radiologically verified amelioration of findings was 16 months in patients with mammary carcinomas and 12 months in patients with prostatic carcinomas, bronchial carcinomas, and renal cell carcinomas.     

Remineralisation und Schmerzlinderung von Knochenmetastasen nach unterschiedlich fraktionierter Strahlentherapie (10mal 3 Gy vs. 1mal 8 Gy) Eine prospektive Studie

BACKGROUND: In a prospective randomized trial we examined pain relief and recalcification following radiotherapy for bone metastases. PATIENTS AND METHOD: One hundred and seven patients with histologically proven breast, lung, prostate or kidney cancer and radiologically confirmed bone metastases were included in this trial. They were stratified to primary tumor sites and randomized in 2 different fractionation schedules: 1 x 8 Gy vs 10 x 3 Gy. Pain relief was registered using of pain score, analgesic usage and subjective perception of pain. The recalcification was measured at the computertomograph. Pain status and recalcification were assessed before, day after, 6 weeks, 3 and 6 months after radiotherapy. RESULTS: There was no significant difference in overall (81% vs 78%) and complete (33% vs 31%) pain response. In the single dose group (1 x 8 Gy) the pain response was measured a little rarer. The recalcification showed a significant difference between patients in the fractionated group (173%) and the single dose group (120%, p < 0.0001). In the fractionated group there was a significant difference between patients with breast and lung cancer (p = 0.015). There was a slight trend favoring 10 x 3 Gy in recalcification for all primary tumor sites but only a significant difference in breast cancer (p < 0.001). CONCLUSION: The basis of pain response and recalcification is different. In mere consideration of pain a short-course fractionation is recommendable. This fractionation schedule is effective, well tolerable and short. In consideration of recalcification a more fractionated schedule is recommendable because the biological efficacy is higher and this leads to better stabilisation.     

89Sr versus 153Sm-EDTMP: comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma

BACKGROUND AND AIM: Painful bone metastases are most frequent in patients with advanced prostate or breast carcinoma. The aim of this study was to compare the analgesic effect of radionuclide therapy using Sr and Sm-EDTMP in patients with painful bone metastases of these tumours. MATERIAL AND METHODS: One hundred patients treated with radionuclide bone palliation therapy were analysed. The study population consisted of 60 male patients with advanced prostate carcinoma and 40 female patients with advanced breast carcinoma. Fifty patients (30 men and 20 women) were treated with Sr (150 MBq). The other 50 patients were treated with Sm-EDTMP (37 MBq x kg). The treatment efficacy was evaluated by a visual analogue scale (VAS), Karnofsky performance scale, and dosage of analgesic drugs used. RESULTS: Complete pain relief was found in 40% of women and 40% of men treated using Sm-EDTMP and in 25% of women and 33% of men treated with Sr. No analgesic effect occurred in 20% of patients. A better analgesic effect was found in cases of osteoblastic metastases compared to mixed metastases. Statistically significant reduction of pain intensity, use of analgesic drugs and improvement of performance in Karnofsky scale was found in cases of both radionuclides. CONCLUSIONS: The analgesic effects of Sr and Sm-EDTMP was similar in both prostate and breast carcinoma. However, the effect was dependent on the type of metastases; better response was observed in cases of osteoblastic metastases than in patients with mixed metastases. Severe adverse reactions after this therapy were rare.     

The effectiveness of radiation therapy in the treatment of bone metastases from breast cancer

The authors studied 75 patients with 158 areas of bone metastases from breast cancer treated by radiation therapy. The treatment regimen used was usually 2000 to 2500 rads delivered over a period of 2 weeks. Both subjective and objective responses were evaluated. This dose schedule proved to be highly effective in symptomatic relief and in healing osteolytic lesions; various levels of pain relief for about one year were observed in 96% (151/158 treatment areas), and radiographic evidence of recalcification was observed in 78% (73/94 treatment areas examined by serial radiography). After cases from previous studies were incorporated, the subjective response rate of the overall group was 91% (191/212) for a mean duration of 12 months, and the objective response rate was 75% (151/202) for a mean duration of 9 months.     

Palliative Strahlentherapie von Knochenmetastasen Eine retrospektive Analyse von 176 Patienten

Ziel: Die Effizienz der palliativen Strahlentherapie bei ossärer Metastasierung wird in dieser retrospektiven Studie untersucht. Das Spektrum der den Knochenmetastasen zugrundeliegenden unterschiedlichen Primärtumoren und Lokalisationen wird analysiert. Zusätzlich werden die in dieser retrospektiven Studie eingesetzten Fraktionierungsschemata im Hinblick auf die Palliation (Schmerzremission) analysiert. Dabei soll zwischen globaler Ansprechrate und partieller sowie kompletter Schmerzremission differenziert werden. Patienten und Methode: Diese retrospektive quantitative Analyse umfaßt 176 Patienten, bei denen im Zeitraum von April 1992 bis November 1993 258 Lokalisationen mit Knochenmetastasen bestrahlt wurden. Der prozentuale Anteil ossärer Metastasen im Verhältnis zur Gesamtpatientenzahl, die zugrundeliegenden Primärtumoren, Lokalisationen und unterschiedlichen Fraktionierungsregime wurden quantifiziert. Bei den häufigsten Fraktionierungsregimen und Tumorentitäten wurde die Palliation (Schmerzremission) als globale Ansprechrate und differenziert in Form der partiellen bzw. kompletten Schmerzremission analysiert. Ergebnisse: Knochenmetastasen machten 8% aller bestrahlten Lokalisationen in der Strahlenklinik der Charité innerhalb des 19monatigen Beobachtungszeitraums aus. Es wurden insgesamt 21 unterschiedliche Tumorentitäten bestrahlt. Ossäre Metastasen traten am häufigsten beim Mammakarzinom (49%), Bronchialkarzinom (15%) und Nierenzellkarzinom (6%) auf. Der Prädilektionsort der ossären Metastasen war die Wirbelsäule in 52%. Von den 19 unterschiedlichen Fraktionierungsregimen wurden am häufigsten die folgenden eingesetzt: 4mal 5 Gy (32%), 10mal 3 Gy (18%), 6mal 5 Gy (9%), 7mal 3 Gy (7%), 10mal 2 Gy (5%) und 2mal 8 Gy. Die globalen Ansprechraten betrugen dementsprechend: 72%, 79%, 74%, 76%, 75% und 72%, die kompletten Remissionen: 35%, 32%, 30%, 35%, 33% und 33%. Ein Unterschied zwischen den häufigsten Tumorentitäten sowie den verschiedenen Lokalisationen und der Palliation konnte weder in den globalen Ansprechraten noch in den differenzierteren Endpunkten der partiellen bzw. kompletten Schmerzremissionen quantifiziert werden. Schlußfolgerung: Die verschiedenen Fraktionierungsregime unterscheiden sich nicht signifikant hinsichtlich ihrer Effizienz bei ossären Metastasen. Die Palliation ist in ca. 75% aller Fälle gewährleistet mit einer Rate von 33% kompletten und 42% partiellen Schmerzremissionen. Unter alleiniger Berücksichtigung der Schmerzreduktion rechtfertigen diese Resultate nicht die Empfehlung einer Standardfraktionierung. Aus klinisch pragmatischen Gründen sollten gängige Fraktionierungsschemata wie 10mal 3 Gy über zwei Wochen oder 5mal 4 Gy in einer Woche eingesetzt werden. Neben der Palliation sollte jedoch auch - insbesondere bei Patienten mit längerer Prognose - die Remineralisation als Voraussetzung der Stabilisierung und Frakturprävention und als der einzige objektivierbare Parameter des Strahlentherapieerfolgs in zukünftige prospektive Analysen einfließen. Background: The effect of the palliative irradiation of bone metastases was explored in this retrospective analysis. The spectrum of primary tumor sites, the localization of the bone metastases and the fractionation schedules were analyzed with regard to palliation discriminating total, partial and complete pain response. Patients and Methods: One hundred seventy-six patients are included in this retrospective quantitative study from April 1992 to November 1993. Two hundred fifty-eight localizations of painful bone metastases were irradiated. The percentage of bone metastases of the total irradiated localizations in our department of radiotherapy in the Charité-Hospital, the primary tumor sites, the localizations and the different fractionation schedules were explored. The total, partial and complete pain response was analyzed in the most often used fractionation schedules and by primary tumor sites. Results: Eight per cent of all irradiated localizations in the observation period were bone metastases. There were irradiated bone metastases of 21 different tumor sites. Most of the primary tumor sites were breast cancer (49%), lung cancer (6%) and kidney cancer (16%). The most frequent site of metastases was the vertebral column (52%). The most often used fractination schedules were: 4 2 5 Gy (32%), 10 2 3 Gy (18%), 6 2 5 Gy (9%&), 7 2 3 Gy (7%), 10 2 2 Gy (5%) and 2 2 8 Gy. The total response rates in this fractionation schedules were 72%, 79%, 74%, 76%, 75% and 72%, the complete response rates were 35%, 32%, 30%, 35%, 33% and 33%. There were no significant differences between the most often irradiated primary tumor sites, the most frequent localizations and the palliation with regard to total, partial and complete pain response. Conclusion: There are no differences between the different fractionation schedules with regard to the pain effect of bone metastases. A palliation is ensured in 75% of all cases with a partial response of 42% and complete response of 33%. With regard to pain response these results do not justify a recommendation for a standard fractionation schedule. Current fractionation schedules such as 10 2 3 Gy for 2 weeks or 5 2 4 Gy for 1 week should be used. Another point is the recalcification in the palliative treatment of bone metastases in patients with better prognosis. The recalcification is the basis for stabilization and prevention of fractures. This aspect should be explored in prospective studies.     

帕米膦酸二钠治疗癌症骨转移性疼痛疗效观察

目的：观察帕米膦酸二钠治疗转移性骨肿瘤疼痛的比较。方法：对32例癌症骨转移痛患者给予帕米膦酸二钠45mg/d,静脉滴注,连用2 d后停用26 d,28 d为1周期,连续4周期。结果：止痛显效13例（40.6%）,有效14例（43.8%）,无效5例（15.6%）,总有效率84.4%。结论：帕米膦酸二钠治疗癌症骨转移性疼痛的疗效肯定。     

Diagnostic imaging of bone metastases

PURPOSE: To present an "algorithm" for detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic cancer patients. MATERIAL AND METHODS: February to March 1999 we randomly selected and retrospectively reviewed the clinical charts of 100 cancer patients (70 women and 30 men; mean age: 63 years, range: 55-87). All the patients had been staged according to TNM criteria and had undergone conventional radiography and bone scan; when findings were equivocal, CT and MRI had been performed too. RESULTS: The primary lesions responsible for bone metastases were sited in the: breast (51 cases), colon (30 cases: 17 men and 13 women), lung (7 cases: 6 men and 1 woman), stomach (4 cases: 2 men and 2 women), skin (4 cases: 3 men and 1 woman), kidney (2 men), pleura (1 woman), and finally liver (1 men). The most frequent radiographic pattern was the lytic type (52%), followed by osteosclerotic, mixed, lytic vs. mixed and osteosclerotic vs lytic patterns. The patients were divided into two groups: group A patients were asymptomatic and group B patients had local symptoms and/or pain. DISCUSSION: Skeletal metastases are the most common malignant bone tumors: the spine and the pelvis are the most frequent sites of metastasis, because of the presence of high amounts of red (hematopoietic active) bone marrow. Pain is the main symptom, even though many bone metastases are asymptomatic. Pathological fractures are the most severe consequences. With the algorithm for detection and diagnosis of skeletal metastases two different diagnostic courses are available for asymptomatic and symptomatic patients. Bone scintigraphy remains the technique of choice in asymptomatic patients in whom skeletal metastases are suspected. However this technique, though very sensitive, is poorly specific, and thus a negative bone scan finding is double-checked with another physical examination: if the findings remain negative, the diagnostic workup is over. On the contrary, in patients with a positive bone scan or with local symptoms and pain, radiography and CT are used for screening of metastatic lesions: results may be negative (for low sensitivity of conventional radiology) or questionable (in which case bone biopsy is necessary), or else symptoms may be due to different causes than metastatic lesions (i.e., osteoarthritis). Before bone biopsy is made, MRI must be performed, because it is the only technique that allows to distinguish between bone marrow components. The limitation of MRI is the poor specificity of its findings, which may provide misleading findings.     

原发性肝癌骨转移患者预后相关影响因素分析

 目的 分析原发性肝癌(primary hepatic carcinoma,PHC)骨转移患者预后相关影响因素。方法 回顾性分析福建省立医院收治的112例PHC骨转移患者行外照射治疗的临床效果,对PHC骨转移的疼痛进行分级,分别记录1、2、3年生存率,及放疗后疼痛改善情况,对性别、骨转移病灶、肝内病灶、骨转移时AFP水平、r-GT水平、骨转移是否伴有骨旁软组织或其他脏器转移,以及肝内灶是否手术治疗和肝内灶控制情况等影响PHC骨转移患者远期生存率的相关因素进行分析。运用Kaplan-Meier法进行生存分析,单因素分析采用Logrank法,多因素分析采用Cox回归模型。结果 112例PHC骨转移部位多见于腰椎(25.89%)、骶髂骨(19.64%)和胸肋骨(17.86%);肝癌确诊后3年生存率为15.18%,骨转移确诊后3年生存率为9.82%;肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗以及肝内病灶控制情况均为影响PHC骨转移患者3年生存率的独立危险因素(P<0.05),其余因素与生存率无明显相关。结论 外照射治疗可明显改善PHC骨转移患者疼痛症状,但远期生存率较低,肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗,以及肝内病灶控制情况均为影响患者远期生存率独立危险因素。
     

Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions

PURPOSE: It is well known that bone metastases from breast cancer usually show osteolytic changes. We retrospectively analysed the computed tomography (CT) appearance of bone metastases to quantify the distribution of lytic, mixed and sclerotic changes in a series of patients presenting with neoplastic bone involvement from breast cancer. MATERIALS AND METHODS: Between 1996 and 2005, 468 women with a diagnosis of breast cancer were referred to our department for staging or follow-up CT examinations. Staging CT examinations detected systemic metastases in 142/468 patients, 60 of which had bone involvement. Patients with a second primary tumour or bone metabolic disorders were excluded from this retrospective analysis. RESULTS: In patients with bone metastases, CT identified 18 with osteolytic lesions (30%), 32 with osteosclerotic lesions (53.3%) and ten with mixed lesions (16.7%). Analysis of the cases observed for the first time during the 1996-2000 period showed osteolytic lesions in 53.6% (15/28), osteosclerotic lesions in 32.1% (9/28) and mixed lesions in 14.3% (4/28). Results were 9.4% (3/32), 71.9% (23/32) and 18.7% (6/32), respectively, for the same groups in the 2001-2005 period. Histological analysis of all cases included 81.9% of infiltrative ductal carcinoma, 11.2% of infiltrative lobular carcinoma, 3.7% of ductal lobular mixed carcinoma and 3% of medullar carcinoma. We found no statistically significant correlation between histological type of breast cancer and radiological appearance of bone metastasis. A significant difference between patients treated with or without zoledronic acid was observed, with a higher prevalence of osteosclerotic lesions in the former group of patients (p<0.05). CONCLUSIONS: We observed an increasing prevalence of osteosclerotic bone metastasis when comparing the 1996-2000 period with the 2001-2005 period. The significance of these distribution changes is not clear. However, we found a significant correlation of osteosclerotic lesions with zoledronic acid treatment. The advent of third generation bisphosphonates may have changed the CT appearance of bone metastasis from breast cancer.     

FDG-avid sclerotic bone metastases in breast cancer patients: a PET/CT case series

Distant metastases from breast cancer most frequently occur in the skeleton. Although 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), with or without computed tomography (CT), is superior to bone scintigraphy for the detection of osteolytic bone metastases, it has been reported that sclerotic bone metastases frequently show no or only a low degree of FDG uptake on PET and PET/CT. Since both lytic and sclerotic metastases can occur in breast cancer patients, bone scintigraphy may remain of additional value in these patients. In this case series, we describe four breast cancer patients in whom FDG PET/CT has clearly visualized sclerotic bone metastases because of increased FDG uptake. Not so much the type of metastasis (sclerotic or lytic), but possibly the characteristics of the primary tumor or treatments prior to the FDG PET/CT scan might influence the degree of FDG uptake of bone metastases. The ability to detect sclerotic bone metastases based on increased FDG uptake supports the use of FDG PET/CT as a staging procedure in breast cancer patients, but knowledge of factors determining the visibility of bone metastases with FDG PET/CT is crucial.     

89锶内照射治疗多发转移性骨肿瘤的疗效分析

目的探讨放射性核素~(89)锶内照射治疗转移性骨肿瘤的临床应用价值。方法对178例转移性骨肿瘤患者采用~(89)锶内照射治疗,分别从缓解骨痛、病灶疗效评价和不良反应三方面进行密切观察、随访。结果~(89)锶缓解骨痛的总有效率为69.7%,对前列腺癌和乳腺癌转移性骨肿瘤患者有效率可达87.4%和75.6%,骨显像显示55.1%的患者原发病灶局限或改善。结论~(89)锶内照射治疗多发性骨转移癌有较好疗效。     

89Sr治疗乳腺癌和前列腺癌多发性骨转移的临床观察

目的 探讨放射性核素89Sr治疗乳腺癌和前列腺癌多发性骨转移患者的临床效果.方法 回顾性分析30例乳腺癌和40例前列腺癌多发性骨转移患者接受89Sr治疗的病例资料,采用Karnofsky评分量表和骨显像方法进行疗效评估.结果 乳腺癌组的止痛总有效率为79%,前列腺癌组的止痛总有效率为85%,两组患者之间差异无统计学意义(x2=0.78,P＞0.05).两组患者的生存质量均有明显改善,治疗前后两组患者的Karnofsky评分均有明显提高(t=2.46,P＜0.05;t=2.68,P＜0.05).治疗后两组患者均未见明显骨髓抑制与肝肾功能损伤.结论 89Sr治疗乳腺癌和前列腺癌多发性骨转移止痛效果良好,患者生存质量有明显提高.     

Results of a Nationwide Survey on Radiotherapy of Bone Metastases in Germany

BACKGROUND: Assuming interinstitutional differences in the treatment of bone metastases, a survey of German radiotherapy institutions was carried out. The goal was to demonstrate regional strategies in pretherapeutic diagnosis, radiation treatment, and follow-up. PATIENTS AND METHODS: A structured questionnaire (eleven multiple-choice questions, ten tables to complete) was sent to all institutions primarily performing radiotherapy. The reply rate was 63.7% (86/135). RESULTS: The estimated proportion of patients with irradiated bone metastases was 18.2% (5-60%). The overall number of treated patients with bone metastases has increased. 45% of all radiation treatments for bone metastases wer performed in patients with mammary carcinoma, followed by lung carcinoma (17%). Central beam dose calculation was performed in 72% of patients, in other cases computer-assisted planning (23%) and 3-D planning (5%) were carried out. Special techniques (individual shielding, special fixations) were used in 57 institutions in 19.8% of patients. The applied single dose varied between 1 and 10 Gy, and the total dose between 5 and 60 Gy. The majority of institutions vary their treatment schemes. In most institutions, the definitive result assessment followed 4-6 weeks after the end of irradiation. Conventional X-rays play the most important role in evaluation of the radiation result. Approximately a quarter of patients are permanently included in the radiation oncological follow-up. CONCLUSIONS: The therapeutic variety corresponds with the greatly varying recommendations in the literature. There were no major differences between private practices, hospitals and university facilities. Considering the standards of diagnosis, treatment, and results assessment, a high quality of palliative treatment can be assumed.     

87例肺癌患者核素骨显像结果分析

目的：通过对87例肺癌患者放射性核素全身骨显像结果进行分析，探讨肺癌骨转移的特点和规律。方法：回顾性分析了经临床病理证实的87例肺癌患者的全身骨显像表现。结果：肺癌骨转移率为63．2％，发生骨转移最常见的部位为肋骨，其次为脊椎骨、盆骨、四肢骨、肩胛骨、颅骨和胸锁骨。在不同病理类型的肺癌中，腺癌和鳞癌较其它类型更易发生骨转移。结论：肺癌骨转移比较常见，所以肺癌患者应常规作全身核素骨扫描，以帮助临床制订正确的治疗方案。     

The appearance of breast cancer metastases on dry bone: Implications for forensic anthropology

Breast carcinoma is a major cause of morbidity and mortality in women. The study of bone pathologies presents considerable potential in anthropology, paleopathology, forensic science and medicine. In this paper, we present and discuss metastatic lesions found in the skeletons of known individuals from the CAL Milano Cemetery Skeletal Collection, clinically diagnosed with breast cancer during life. Fourteen skeletons from a contemporary and identified collection were macroscopically studied and metastases were identified by comparison with clinical literature. As a result, bone metastases were observed in 43% of the study sample. They were located most commonly on the ribs (28.1%), pelvic girdle (19.8%), vertebrae (15.6%), skull (15.6%), scapulae (10.2%) as well as proximal segment of the femora (8.4%) and humeri (2.4%) respectively, favoring sites of high vascularization. The majority of the lesions were osteolytic, although osteoblastic and mixed metastases did occur. Osteolytic metastases appear as coalescent porosity or round to oval perforating lesions on bones with denticulated margins and pitted surrounding bone, whereas osteoblastic metastases thickened the existing trabecula (spongiosclerosis). Mixed metastases were perforating lytic lesions exposing the osteoblastic activity in the underlying trabecular bone. These results, consistent with the data from the literature, strengthen the diagnostic criteria for metastases and illustrate the aspect of bone metastases in breast carcinoma.     

FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy

Purpose To assess ¹⁸F-fluorodeoxyglucose (FDG) uptake in bone metastases in patients with and without previous treatment, and compare positive positron emission tomography (PET) with osteolytic or osteoblastic changes on computed tomography (CT).Methods One hundred and thirty-one FDG-PET/CT studies were reviewed for bone metastases. A total of 294 lesions were found in 76 patients, 81 in untreated patients and 213 in previously treated patients. PET was assessed for abnormal FDG uptake localised by PET/CT to the skeleton. CT was evaluated for bone metastases and for blastic or lytic pattern. The relationship between the presence and pattern of bone metastases on PET and CT, and prior treatment was statistically analysed using the chi-square test.Results PET identified 174 (59%) metastases, while CT detected 280 (95%). FDG-avid metastases included 74/81 (91%) untreated and 100/213 (47%) treated lesions (p<0.001). On CT there were 76/81 (94%) untreated and 204/213 (96%) treated metastases (p NS). In untreated patients, 85% of lesions were seen on both PET and CT (26 blastic, 43 lytic). In treated patients, 53% of lesions were seen only on CT (95 blastic, 18 lytic). Of the osteoblastic metastases, 65/174 (37%) were PET positive and 98/120 (82%), PET negative (p<0.001).Conclusion The results of the present study indicate that when imaging bone metastases, prior treatment can alter the relationship between PET and CT findings. Most untreated bone metastases are PET positive and lytic on CT, while in previously treated patients most lesions are PET negative and blastic on CT. PET and CT therefore appear to be complementary in the assessment of bone metastases.     

Pain as an indicator of bone metastasis

Patients with breast or prostate cancer routinely referred for bone scintigraphy were evaluated for the presence of skeletal pain, as determined by a self administered questionnaire. Pain was a common finding, whether or not metastatic disease was present, and occurred in over half of patients. Although most patients with bone metastases did report bone pain, a significant fraction (21% of breast and 22% of prostate patients) were asymptomatic. A distinct minority of individual anatomic regions of metastasis were painful: pain was reported in 23% of sites of breast metastases and 15% of metastatic prostate cancer sites. Of all sites at which pain was present, metastases were demonstrated in only about one half. These results indicate that pain is not a reliable indicator of the presence of location of metastatic bone disease.     

SPECT/CT超级骨显像影像学特征、临床表现、年龄及实验室检查指标的分析

目的 探讨99Tcm-亚甲基二膦酸盐（MDP） SPECT/CT超级骨显像患者的影像学特征、临床表现、年龄及实验室检查结果的差异。 方法 收集2012年6月至2021年7月于宁夏医科大学总医院行99Tcm-MDP SPECT/CT显像的47 671例患者中呈超级骨显像的97例患者,其中男性54例、女性43例,年龄25~85（62.4±14.3）岁,回顾性分析97例患者的临床表现资料、影像学资料、年龄及实验室检查资料。根据病因不同,将患者分为骨转移瘤组（71例）与代谢性骨病组（26例,包括甲状旁腺瘤9例、肾性骨病6例、骨质疏松症11例）。根据原发肿瘤不同,将71例骨转移瘤组患者分为4个亚组[前列腺癌组（40例）、乳腺癌组（15例）、肺癌组（8例）、消化系统恶性肿瘤组（8例,包括胃癌4例、直肠癌2例、食管癌1例、原发性肝癌1例）]。统计分析骨转移瘤组与代谢性骨病组以及骨转移瘤组4个亚组之间99Tcm-MDP SPECT全身骨显像的特征、SPECT/CT融合显像的特征、临床表现、年龄和实验室检查[血钙、血磷、碱性磷酸酶（ALP）、乳酸脱氢酶（LDH）]结果的差异。计量资料的组间比较采用独立样本t检验、单因素方差分析、Wilcoxon秩和检验及Kruskal-Wallis H检验;分类变量资料的组间比较采用χ2检验。 结果 骨转移瘤（73.2%,71/97）是导致超级骨显像的最常见病因[在其原发肿瘤中,前列腺癌较常见（56.3%,40/71）],其次为代谢性骨病（26.8%,26/97）。骨转移瘤组以灶性散在分布型（Ⅱ型）为主（85.9%,61/71）,代谢性骨病组主要呈均匀对称型（ Ⅰ型）（61.5%,16/26）,2组比较差异有统计学意义（χ2=21.84,P<0.001）。骨转移瘤组以成骨型（74.6%,53/71）和混合型（19.7%、14/71）骨质破坏为主,而代谢性骨病组以溶骨型（73.1%,19/26）骨质破坏为主,差异均有统计学意义（χ2=39.76、15.95,均P<0.001）。所有患者均以骨痛为初发症状,局部骨痛为主要临床表现（56.7%,55/97）。骨转移瘤组以腰痛最常见（60.0%,24/40）,代谢性骨病组多为肋骨痛（40.0%,6/15）,2组比较差异有统计学意义（χ2=11.11,P<0.05）。骨转移瘤组患者的年龄和ALP、LDH水平均高于代谢性骨病组,而血钙水平则低于代谢性骨病组,差异均有统计学意义（t=4.89,Z=?2.28、?3.65,t=?5.96,均P<0.05）;而2组患者在血磷水平上的差异无统计学意义（t=0.01,P>0.05）。骨转移瘤组4个亚组在SPECT全身骨显像的显像模式、SPECT/CT融合显像中的骨质破坏类型、临床表现、局部骨痛部位间的差异均无统计学意义（χ2=2.71~13.07,均P>0.05） 。骨转移瘤组4个亚组间进行比较,乳腺癌组患者年龄最小、前列腺癌组患者年龄最大,乳腺癌组患者血钙水平最高,肺癌组患者LDH水平最高,且差异均有统计学意义（F=14.43、5.13,H=13.47,均P<0.05）;血磷和ALP水平的差异均无统计学意义（F=2.41,H=6.28,均 P>0.05）。 结论 超级骨显像病因中以骨转移瘤最常见,其次为代谢性骨病。2种病因超级骨显像患者在99Tcm-MDP SPECT全身骨显像、病灶处99Tcm-MDP SPECT/CT融合显像、临床表现、年龄及实验室检查结果方面均有差异,99Tcm-MDP SPECT/CT在2种病因超级骨显像的鉴别中有一定价值。     

186Re-HEDP for metastatic bone pain in breast cancer patients

Two-thirds of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer-related pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pain palliation with bone-seeking radiopharmaceuticals has proven to be an effective treatment modality in patients with metastatic bone pain. These bone-seeking radiopharmaceuticals are extremely powerful in treating scattered painful bone metastases, for which external beam radiotherapy is impossible because of the large field of irradiation. (186)Re-hydroxyethylidene diphosphonate (HEDP) is a potentially useful radiopharmaceutical for this purpose, having numerous advantageous characteristics. Bone marrow toxicity is limited and reversible, which makes repetitive treatment safe. Studies have shown encouraging clinical results of palliative therapy using (186)Re-HEDP, with an overall response rate of ca. 70% in painful bone metastases. It is effective for fast palliation of painful bone metastases from various tumours and the effect tends to last longer if patients are treated early in the course of their disease. (186)Re-HEDP is at least as effective in breast cancer patients with painful bone metastases as in patients with metastatic prostate cancer. It is to be preferred to radiopharmaceuticals with a long physical half-life in this group of patients, who tend to have more extensive haematological toxicity since they have frequently been pretreated with bone marrow suppressive chemotherapy. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life.