Skeletal related events in breast cancer patients with metastatic bone diseas

Abstract

713 Background: In breast cancer patients with bony metastasis Bisphosphonate therapy is established to be of benefit in reducing the skeletal related events (SRE's). It is not known whether the postmenopausal or the premenopausal patients benefit more. This study was done to assess the implication of menopausal status modifying the SRE's and response to Clodronate (Bonefos) therapy. Methods: Fifty breast cancer patients with metastatic bone disease categorised in two groups were followed up on Clodronate therapy over one year for SRE's. Group A constituting twenty-five pre and Group B twenty-five postmenopausal breast cancer patients. Patients with the visceral spread, arthritis, osteoporosis, hormone therapy and less than one year since last menstrual cycle were excluded. Intravenous infusion of Clodronate 1500mg was given at monthly intervals. Patients were followed up at monthly interval with emphasis on history and scoring for skeletal pain, radiographic studies when required and check for serum calcium level. Isotope bone scanning and radiological survey was done on initial diagnosis, at six months and end of one year. Results: Forty-two patients were available for evaluation completing one year on therapy. In twenty evaluable in Group A, eight complained of skeletal pain and two of them had pathological fracture and were given radiation. In the rest of six two had significant pain relief (> 50% on pain score) with Clodronate, while four required radiotherapy for pain control. In Group B, twenty two evaluated for SRE's, four had pathological fracture and pain thus requiring radiation. Twelve complained of skeletal pain only with two requiring radiotherapy to relieve pain and remaining ten had significant pain relief with Clodronate therapy. Hypercalcemia was seen in one in group A and three in group B before beginning of therapy, all became normocalcemic with single infusion of Clodronate. Conclusions: In a follow up of one year postmenopausal breast cancer patients with bony metastasis have higher rate of SRE's and tend to benefit more than in premenopausal patients with Clodronate therapy. No significant financial relationships to disclose.