Strontium and samarium therapy for bone metastases from prostate carcinoma

A review was performed of all patients who received strontium-89 chloride or samarium-153 ethylenediamine-tetramethylenephosphonate for prostate cancer metastatic to bone at the Royal Brisbane Hospital between 1992 and 1997. There were 57 patients, 38 treated with strontium-89 and 19 with samarium-153. Forty patients had radionuclide therapy alone, and 28/40 (or 70%) responded in terms of experiencing a beneficial effect on pain. In the other 17 patients, the effect of the radionuclide on pain could not be assessed because they received external beam radiotherapy concomitant with a therapeutic radionuclide. There was no difference in response rates between the samarium and strontium groups as measured by the effect on pain or in the time to progression. The median time to progression for all patients was 2-3 months. The present study confirms that following administration of a therapeutic radionuclide, a high proportion of patients experienced improvement of pain, but the time to progression is not long, so that the overall degree of benefit is modest.     

Osteoblastic metastases from breast carcinoma with false-negative bone scan

 The authors report a case of metastatic breast carcinoma that on investigation was shown to have a negative bone scan in spite of multiple densely sclerotic metastases on radiography and CT and a positive bone biopsy. The literature is reviewed with regard to the subject of negative bone scans in this situation.     

Expanding osteolytic bone metastases from carcinoma of the breast: An unusual appearance

Two cases of carcinoma of the breast are reported with the unusual radiographic finding of expansile osteolytic bone metastases. It is stressed that when an osteolytic expansile bone lesion is seen in patients with known breast cancer, the most likely cause is a metastasis from the carcinoma of the breast.     

MRI and PET/CT of patients with bone metastases from breast carcinoma

3.0Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45-85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.     

Parotid metastases from carcinoma of the breast

Two patients are described in whom a parotid metastasis occurred 10 years after initial treatment for carcinoma of the breast. The parotid is a very unusual site of metastasis and in both patients it was only one detectable. Parotidectomy with post-operative radiotherapy is advocated in this situation not only to obtain local tumour control but to exclude a primary parotid tumour.     

Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma

The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n = 11), TAE followed by radiotherapy (group B, n = 17), or radiotherapy alone (group C, n = 11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief.     

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.     

Targeted radionuclide therapy for bone metastases

Recent advances in targeted radiotherapy offer a new approach for the management of metastatic bone pain. This paper will review the scientific basis for radionuclide therapy and will examine the evidence for clinical efficacy. The therapeutic potential of targeted radiotherapy can only be appreciated by comparison with established treatments. Alternative treatment options will, therefore, be discussed, to bring the potential advantages and hazards of targeted radiotherapy into perspective and to define its place in routine management.     

Sclerotic bone metastases from sarcomatoid renal cell carcinoma

We present a case of sarcomatoid renal cell carcinoma with multiple sclerotic skeletal metastatic lesions. Renal cell carcinoma is frequently metastatic at presentation, with a high incidence of skeletal involvement, classically described as osteolytic. However, sclerotic or osteoblastic metastatic skeletal lesions from renal cell carcinoma are rare, with only two previous reports identified in the literature, neither of which involved the sarcomatoid variant of renal cell carcinoma. In our case the sclerotic metastases were characterized by bone scan, computed tomography (CT), magnetic resonance imaging (MRI), and histologic analysis. Received: 8 April 1999 Revision requested: 27 May 1999 Revision received: 24 June 1999 Accepted: 29 June 1999     

Radiopharmaceutical therapy for palliation of bone pain from osseous metastases.

Bone metastasis occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. The process is mediated by parathyroid hormones, cytokines, and tumor-derived factors. Several sequelae occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. Pain associated with osseous metastasis is thought to be distinct from neuropathic or inflammatory pain. Several mechanisms-such as invasion of tumor cells, spinal cord astrogliosis, and sensitization of nervous system-have been postulated to cause pain. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. These drugs are associated with side effects, and tolerance to these agents necessitates treatment with other modalities. Bisphosphonates act by inhibiting osteoclast-mediated resorption and have been increasingly used in treatment of painful bone metastasis. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. (32)P has been used for >3 decades in the treatment of multiple osseous metastases. The myelosuppression caused by this agent has led to the development of other bone-seeking radiopharmaceuticals, including (89)SrCl, (153)Sm-ethylenediaminetetramethylene phosphonic acid ((153)Sm-EDTMP), (179m)SnCl, and (166)Ho-Labeled 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylenephosphonate ((166)Ho-DOTMP). (89)Sr is a bone-seeking radionuclide, whereas (153)Sm-EDTMP is a bone-seeking tetraphosphonate; both have been approved by the Food and Drug Administration for the treatment of painful osseous metastases. While both agents have been shown to have efficacy in the treatment of painful osseous metastases from prostate cancer, they may also have utility in the treatment of painful osseous metastases from breast cancer and perhaps from non-small cell lung cancer. This article illustrates the salient features of these radiopharmaceuticals, including the approved dose, method of administration, and indications for use. We conclude with recommended guidelines for therapy and follow-up.     

Radiographic manifestations of bone metastases from renal carcinoma.

From 1964 to 1974, 1,668 patients with renal carcinoma were seen at the Mayo Clinic. Bone metastases were present in 167 of these patients (only lung metastatic involvement ranked higher in frequency). More than one-third of the patients with bone metastasis from renal carcinoma had this as a presenting lesion of occult renal tumor. This group constituted 4% of all patients with renal carcinoma evaluated during the study period. While most bone lesions were in the pelvis and lower lumbar spine, any bone may be involved. All patients with bone metastases from renal carcinoma have a poor prognosis. However, some bone lesions appeared as long as 10 or more years after the initial tumor. The most common radiographic features are a lytic destructive process with indistinct margins, erosion of the cortex, and frequent expansion into the soft tissues. Pathological features are common in the long bones, and calcifications are occasionally seen. The synovial joints are not affected. A well defined sclerotic margin is a common finding after radiation treatment, although it is not a reliable indicator of the stability of the lesion.     

乳腺癌骨转移临床相关因素的研究

目的 研究乳腺癌骨转移的临床和影像学资料,寻找影响骨转移的相关因素,为早期诊断提供依据.方法 对334例乳腺癌患者全身骨显像、临床分期、病理、免疫组织化学及血清学检-查结果进行回顾性分析,并对数据行χ2检验.结果 有淋巴结转移者骨转移率71.0%（152/214）,没有淋巴结转移者骨转移率为22.5%（27/120）,两者比较差异有统计学意义（χ2=72.80,P=0.000） 浸润性非特殊性癌骨转移率69.0%（203/294）,浸润性特殊性癌骨转移率41.7%（5/12）,两者比较差异有统计学意义（χ2=3.97,P=0.046） 骨转移中碱性磷酸酶（ALP）升高者占28.5%（51/179）,非骨转移中ALP升高者占14.9%（11/74）,两者比较差异也有统计学意义（χ2=5.25,P=0.022） 而骨转移中肿瘤标志物[癌胚抗原（CEA）、糖类抗原（CA）15-3、CA125、CA19-9]升高者占68.7%（123/179）,非骨转移中肿瘤标志物升高者占27.0%（20/74）（χ2=37.03,P=0.000）.结论 乳腺癌骨转移的发生率与原发灶的病理类型、发病时有无淋巴结转移有关,浸润性非特殊性癌或有淋巴结转移者骨转移率较高.动态监测血清ALP、CEA、CA15-3、CA125、CA19-9有助于早期诊断.     

乳腺癌骨转移临床相关因素的研究

Objective To study the clinical and imaging features of patients with bone metastases from breast cancer and identify the factors related to the incidence of bone metastases. Methods Three hundred and thirty-four patients with breast cancer were recruited into this study. Whole-body 99Tcm-methylene disphosphonate (MDP) bone scan, clinical staging, pathological, immunohistochemical and serological test results were analyzed retrospectively. χ2 test was used for statistical analysis. Results The incidence rate of bone metastases for patients with and without lymph node metastases was 71% (152/214) and 22. 5% (27/120), respectively (χ2 =72.80, P =0.000). The incidence rate of bone metastases from infiltrated non-specified and specified breast cancer was 69% (203/294) and 41.7% (5/12), respectively (χ2 =3. 97, P=0.046). Alkaline phosphatase (ALP) was elevated in 28.5% (51/179) and 14.9%(11/74) of patients with and without bone metastases, respectively (χ2 = 5. 25, P = 0.022 ). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, CA19-9 increased in 68.7% ( 123/179) and 27.0% (20/74) of patients with and without bone metastases, respectively (χ2 = 37. 03, P =0. 000). Conclusions The incidence of bone metastases from breast cancer is correlated to pathological types of primary tumor and lymph node metastases. Bone metastases occurs more frequently in patients with infiltrated, non-specified, primary cancer and with lymph node metastases. Serum ALP, CEA, CA15-3,CA125, CA19-9 might be the tumor makers for early diagnosis of bone metastases from breast cancer.     

99mTc-tetrofosmin uptake in bone metastases from breast cancer

^99mTc-tetrofosmin myocardial imaging was performed in a 62-year-old woman who had undergone standard radical mastectomy for right breast cancer 6 years ago. Although the result was negative for the ischemic heart disease, it showed abnormal accumulation corresponding to the bone metastases in the spine. We believe that^99mTc-tetrofosmin imaging is helpful in detecting bone metastases from breast cancer.     

Preoperative embolization of bone metastases from renal cell carcinoma

The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone metastases from renal cell carcinoma. Twenty-eight preoperative embolizations in 26 patients with renal cell carcinoma metastatic to bone were retrospectively evaluated and divided into two groups: Group A included the embolizations that resulted in complete devascularization of the lesion as defined by the post-embolization arteriograms, and group B included those with an incomplete result. The two groups were compared with regard to blood loss and transfusion requirement during surgery, by unpaired two-tailed Student's t-test. Where complete embolization was effected (group A, 10 cases), there was a mean blood loss of 535 ± 390 ml. When a less than complete embolization was achieved (group B, 18 cases), the mean blood loss was 1.247 ± 1.047 ml (p = 0.049). The red blood cell transfusion in group A was 1.3 ± 1 units, whereas in group B it was 2.4 ± 1.2 (p = 0.03). Preoperative embolization of bone metastases from renal cell carcinoma with subsequent complete devascularization leads to significant reduction of blood loss during surgery. Interventional radiologists should pursue and embolize every feeder to the metastasis, because any less than complete devascularization increases the amount of blood loss and the amount of red blood cell transfusion during surgery. Received: 23 June 1998; Revised: 20 November 1998; Accepted: 24 February 1999     

Radioisotope therapy of bone metastases

Radionuclide therapy has been an integral part of systemic treatment of patients with advanced and disseminated cancer for 50 years. Specific radioisotopes (b- or a-emitters) with selective concentration at sites of bone cancer damage are used in the treatment. Radioisotopes are an important addition to the armamentarium of clinicians who take care of patients with advanced cancer and painful cancer bone metastases (especially osteoblastic and mixed type). They offer a high degree of efficacy with minimal toxicity and simple administration, fulfilling the fundamental criteria for palliative treatment that should combine minimal patient discomfort and toxicity with maximal clinical effect.     

Radiation therapy for brain metastases from breast cancer by histological classification

One hundred thirteen patients with metastatic brain tumor from breast cancer who were treated with external irradiation between 1989 and 1997 at Cancer Institute Hospital were studied. The patients were all histopathologically proven to have invasive ductal carcinoma (scirrhous type 54 cases, papillotubular type 18, solid-tubular type 41). The patients were evaluated for efficacy and histopathological subtypes. The time interval between the diagnosis of breast cancer and brain metastases was 53.6 months for the scirrhous type, 75.0 months for the papillotubular type, and 35.5 months for the solid-tubular type. The time interval between the diagnosis of initial distant metastases and brain metastases was 14.3 months for the scirrhous type, 22.5 months for the papillotubular type, and 12.5 months for the solid-tubular type. Efficacy rates (CR + PR) for external irradiation of the brain metastases were 40.0% for the scirrhous type, 66.7% for the papillotubular type, and 36.6% for the solid-tubular type. The papillotubular type had a favorable efficacy rate compared with the other two types. Median survival time (MST) from the start of treatment for brain metastases and one-year survival rate were 5 months and 11.1% for the scirrhous type, 7 months and 41.5% for the papillotubular type, and 4 months and 28.3% for the solid-tubular type, respectively. No statistically significant difference between survival rates was observed among the histopathological types. Univariate analysis showed performance status, number of metastatic tumors, and existence of extracranial metastases without bony metastasis to be significantly related to prognosis. Multivariate analysis showed only extracranial metastases without bony metastases to be related to prognosis.