Abstract
BackgroundTo compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases. Secondly, to evaluate an association of BTM to local response, skeletal-related events (SRE), and number of metastases.MethodsIn this randomized trial, 60 patients were allocated from September 2011 to March 2013 into one of the two arms: resistance training (Arm A) or passive physical therapy (Arm B) with thirty patients in each arm during RT. Biochemical markers such as pyridinoline (PYD), desoxy-pyridinoline (DPD), bone alkaline phosphatase (BAP), total amino-terminal propeptide of type I collagen (PINP), beta-isomer of carboxy-terminal telopeptide of type I collagen (CTX-I), and cross-linked N-telopeptide of type I collagen (NTX) were analyzed at baseline, and three months after RT.ResultsMean change values of PYD and CTX-I were significantly lower at 3 months after RT (p = 0.035 and p = 0.043) in Arm A. Importantly, all markers decreased in both arms, except of PYD and CTX-I in arm B, although significance was not reached for some biomarkers. In arm A, the local response was significantly higher (p = 0.003) and PINP could be identified as a predictor for survivors (OR 0.968, 95%CI 0.938–0.999, p = 0.043). BAP (OR 0.974, 95%CI 0.950–0.998, p = 0.034) and PINP (OR 1.025, 95%CI 1.001–1.049, p = 0.044) were related with an avoidance of SRE.ConclusionsIn this group of patients with spinal bone metastases, we were able to show that patients with guided resistance training of the paravertebral muscles can influence BTM. PYD and CTX-I decreased significantly in arm A. PINP can be considered as a complementary tool for prediction of local response, and PINP as well as BAP for avoidance of SRE.Trial registrationClinical trial identifier NCT 01409720. August 2, 2011.
Highlights
To compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases
From September 2011 to March 2013, consecutive 80 patients with a histologically confirmed cancer of any primary and spinal bone metastases of the thoracic or lumbar segments, or of the sacral region were considered in the Radiooncology Department of the Heidelberg University Clinic
Mean change values of PYD and CTX-I were significantly lower at 3 months after RT (p = 0.035 and p = 0.043) in arm A
Summary
To compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases. The two most clinically relevant markers of bone turnover in patients with skeletal metastases are bonespecific alkaline phosphatase (BAP) and N-terminal telopeptide of collagen type I (NTX). Total amino-terminal propeptide of type I collagen (PINP) and BAP are markers of bone formation; BAP has a linear relationship with osteoblast and osteoblastic precursor activity. C-terminal cross-linking telopeptide of type I collagen (CTX-I) can be considered a complementary tool for prediction of clinical outcome as a marker of resorption. Questions remain as to how clinicians should best use these markers to select and time appropriate treatments among patients with bone metastases. The use of these markers may, in the future, better allow physicians to selectively treat patients with bone metastases
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