P-0028 Bones Metastases in Gastric Cancer Patients: Review of 12 Cases

Abstract

ABSTRACT Introduction Bone metastases (BM) are a common event in advanced cancers of the breast, lung, prostate, kidney and thyroid. In gastric cancer, metastases are considered to be mainly to the peritoneum, liver, or lymph nodes; while BM occur only rarely and they are known to have a very poor prognosis. The clinicopathological manifestations and treatment outcomes of BM of gastric cancer are largely unknown. This retrospective study aimed to evaluate clinical, radiological and therapeutic features in BM of gastric cancer, and to examine their correlation with histology and lymph node extension of the gastric tumor. Then, we review the possible mechanisms and risk factors underlying this rare condition. Methods Between April 2007 and October 2011, 12 patients were collected in the department of medical oncology at Hassan II university hospital and were retrospectively analyzed in terms of Clinicopathological features of the gastric Cancer and bone metastasis. Results From April 2007 to October 2011, we retrospectively reviewed 12 patients with bone metastases from gastric cancer, 8 men and 4 women (sex-ratio: 2).The mean age at the time of diagnosis of gastric cancer was 50 years (range: 30-77 years). BM were synchronous to gastric cancer in 9 patients; in 3 patients, bone involvement occurs over a period ranging from 2 to 15 months after primary tumor diagnosis. Concerning the histological types of gastric tumor, undifferentiated histology was predominant, it was observed in 6 cases (50%); there were 4 cases (33.3%) of moderately differentiated carcinoma and 2 cases (16.6%) of poorly differentiated carcinoma. Positive nodal status was found in 9 cases (75%). BM were associated to: lung metastases in 5 cases (41.6%), to liver metastases in 2 cases (16.6%) and pancreatic metastases in one case (8.3%); Peritoneal dissemination was noted in 2 cases (16.6%). Only one patient had BM without other distant dissemination. Diagnosis of BM was made in 8 patients (66.6%) by computed tomography (CT) only, in 2 patients (16.6%) by CT and magnetic resonance imaging (MRI); and two patients were diagnosed by bone scintigraphy. All patients had diffuse and osteolytic bone lesions; the area of BM was in the order of the vertebrae (9 cases, 75%), costa (7 cases, 58.3%) and extremities (5 cases, 41.6%). 10 patients had symptoms related to bone involvement: bone pain in 10 patients (83.3%), spinal cord compression in 2 patients (16.6%) and hypercalcemia in 2 patients (16.6%). Management of BM included analgesic agent in 10 cases, palliative chemotherapy in 11 cases, radiotherapy in 1 case and bisphosphonates in 2 cases. As it has been reported in other series of BM caused by gastric cancer, all our patients died within period ranging from 1 to 4 months from the diagnosis of BM. Conclusion These data confirmed that the prognosis of BM from gastric cancer is uniformly poor. Hence, tests to assess for bone metastasis are required for gastric cancer patients at the time of the initial diagnosis and the postsurgical follow-up observation mainly in the setting of undifferentiated tumor and nodal involvement.