Asymptomatic Bone Metastases Research Articles

Cost-Effectiveness of Prophylactic Radiation in Patients with Asymptomatic Bone Metastases

Radiation therapy represents a primary therapy for palliation of symptomatic bone metastases. Recently, a randomized trial found that radiation may prevent skeletal-related events (SREs) among patients with asymptomatic bone metastases. Skeletal-related events, such as pathologic fracture or spinal cord compression, cause considerable morbidity and decrements in quality of life. However, asymptomatic bone metastases are quite common and treating large numbers of these patients with radiation adds cost to the health care system. With this study we evaluated the cost-effectiveness of external beam radiation therapy for high-risk asymptomatic skeletal metastases. We built a microsimulation model for cancer patients with high-risk asymptomatic bone metastasis who received either prophylactic external beam radiation therapy or standard of care. The model incorporated costs, quality of life (measured by health utility), as well as the risk of skeletal-related events, and risk of death. We measured cost-effectiveness with the incremental cost-effectiveness ratio (ICER), with ICERs under $150,000 per quality-adjusted life-year (QALY) considered cost-effective. One way and probabilistic sensitivity analyses were used to test model uncertainty. Simulating the clinical course of 1,000,000 patients with asymptomatic bone metastases, we found that compared to standard of care, radiation therapy increased overall cost by $22,431 and improved effectiveness by 0.37 QALYs, resulting in an ICER of $60,400/QALY. The model was most sensitive to assumptions about survival and the monthly cost of cancer care. The base model assumed that prophylactic radiation reduced the risk of death by 50% (Hazard ratio [HR] 0.5). Prophylactic radiation remained cost-effective with HRs up to 0.98, though beyond an HR of 0.98 prophylactic radiation was no longer cost-effective. If the monthly cost of ongoing cancer care increased from our base estimate of $1917 to $5567, then prophylactic radiation was no longer cost effective. The model was not sensitive to assumptions about the cost of radiation, quality of life, or model time horizon. Probabilistic sensitivity analysis demonstrated that radiation therapy was cost-effective in >99% of iterations. This study found that prophylactic radiation may represent a cost-effective treatment option by reducing the risk of skeletal-related events among patients with asymptomatic bone metastases. Longer follow-up and additional research defining efficacy and optimal target populations who benefit most from prophylactic radiation will help confirm these findings.

Bilateral Thalamic Glioblastoma Multiforme with Synchronous Asymptomatic Bone Metastasis- A Rare Case Report

Bilateral Glioblastoma multiforme (GBM) at the thalamus is an extremely rare condition accounting for 1-2% of brain tumors. Extra-cranial metastases of GBM are rare due to the absence of lymphatics in the brain and the difficulty of tumors penetrating blood vessels. Moreover, these metastatic lesions remain asymptomatic and are often identified during autopsy. Hereby, a case of a rare presentation of bilateral thalamic GBM with synchronous asymptomatic bone metastasis to the humerus treated using Radiation therapy to both bilateral thalamic lesions and humerus bone metastasis with concurrent and adjuvant temozolomide-based chemotherapy is reported.

Time to Pain Relapse After Palliative Radiotherapy for Bone Metastasis: A Prospective Multi-institutional Study.

Low risk asymptomatic bone metastasis (LRABM) without gross osteolytic changes tends to be out of indication for radiotherapy. The aim of this study was to evaluate the time between the end of palliative radiotherapy of bone metastasis (BM) until the start of new pain, in patients with painful BM. Patients with BM were prospectively assessed for location and strength of pain every month for one year after radiotherapy. The correlation of pain relapse at irradiated site, and pain onset outside the irradiated site was evaluated with sex, age, primary tumor, pathology of tumor, visceral metastases, baseline scores for Eastern Cooperative Oncology Group performance status (PS), and baseline verbal rating scale (VRS). A hundred and thirty-two patients were included (79 males and 53 females). Median age was 66 years. Primary sites were lung (n=60), breast (n=17), colon (n=12), prostate (n=11), and others (n=33) (one patient had two primary sites). Median follow-up was 185 days. Pain relief was observed in 92 patients (86.0%). Out of them, pain progression was observed in 69.6%. Median time to pain progression was 75.5 days. Pain onset outside the irradiated site was observed in 57 patients (43.2%). Median time to pain onset was 109 days. Out of the 57 patients, 13 (22.8%) had LRABM which existed before the start of radiotherapy. There were 54 patients with LRABM in this study and because many patients had more than one LRABM, the total LRABM sites were 123. Out of them, pain onset was observed within one year after irradiation in 44 (36%) lesions. Median time to pain onset was 67 days, which was the shortest of the three: irradiated site, out of the irradiated site, and LRABM site. Risk factors for high probability of pain onset within one year in LRABM lesions were female sex (showing a trend in univariate analysis), and pelvic, skull and spine metastasis (significant in multivariate analysis). Time to pain onsets in LRABM are relatively short, especially in female patients with pelvic, skull and spine metastasis. In these patients, prophylactic radiotherapy could be an option to consider.

Benefits of Radiation Therapy for High-Risk, Asymptomatic Bone Metastases

Benefits of Radiation Therapy for High-Risk, Asymptomatic Bone Metastases

Prophylactic Radiation Therapy vs. Standard-of-Care for Patients with High-Risk, Asymptomatic Bone Metastases: A Multicenter, Randomized Phase II Trial

<h3>Purpose/Objective(s)</h3> External beam radiotherapy (RT) is standard-of-care (SOC) for pain relief of symptomatic bone metastases. We aimed to test whether radiation for asymptomatic bone metastases prevents skeletal-related events (SRE). <h3>Materials/Methods</h3> We conducted a multicenter, randomized phase 2 trial (NCT03523351) of prophylactic RT to high-risk, asymptomatic bone metastases vs SOC. Patients were eligible if they were at least 18 years old with a metastatic solid tumor malignancy and more than 5 metastatic lesions, including at least one asymptomatic high-risk bone lesion, defined as: bulky disease (≥2cm in longest diameter), junctional spine or posterior spinal element disease, disease involving hip or sacroiliac joint, or disease in long bone involving 1/3-2/3 cortical thickness. Patients were stratified by histology and planned SOC (systemic therapy or observation) and randomly assigned in a 1:1 ratio to RT to all enrolled high-risk bone metastases or SOC alone. The primary outcome of SRE (defined as fracture, cord compression, or intervention with surgery or radiation) was analyzed from randomization to death or 12 months. A sample size of 66 was deemed necessary to achieve 80% power to detect a difference of 30% (experimental arm) versus 60% (SOC arm) using a two-sample, one-sided proportion test with alpha<0.05. We used the log-rank test for time-to-event analyses and Wilcoxon rank sum test to compare hospitalizations, brief pain inventory and quality of life (using EQ-5D-5L) between arms. <h3>Results</h3> Between May 8, 2018 and August 9, 2021, 78 patients with 122 bone metastases were enrolled and randomized to prophylactic RT (n=39) or SOC (n=39). The most common primary cancer types were lung (27%), breast (24%), and prostate (22%). Seventy-one patients (91%) were evaluable for the primary endpoint. At one year, SRE occurred in 1 of 62 lesions (1.6%) in the RT arm and 14 of 49 lesions (29%) in the SOC arm (p<0.001). There was a significant difference in time-to-SRE by type of high-risk feature (p=0.016), with most events occurring in junctional spine and bulky disease. There were significantly fewer patients hospitalized for SRE in the RT arm compared to the SOC arm (4 vs 0, p=0.045). At a median follow-up of 2.4 years, overall survival was significantly longer in the RT arm (HR 0.50, 95% CI 0.28, 0.91; p=0.02). Median OS among 11 patients with an SRE was 1.1 years compared to 1.5 years among 67 patients without an SRE. Pain was reduced at 3 months in the RT arm (p<0.05) compared to the SOC arm. EQ-5D-5L was similar between the groups at all time points. <h3>Conclusion</h3> Radiation delivered prophylactically to asymptomatic, high-risk bone metastases reduced skeletal-related events, meeting the primary endpoint of the study. Importantly, we observed an improvement in overall survival, with potential mechanisms of palliation or debulking warranting further investigation in a phase 3 trial.

Diagnosis of asymptomatic bone metastases from breast cancer.

e13042 Background: The purpose of this study was to analyze the prognostic value of blood levels of fibrinogen (F) in bone metastases from breast cancer (BC). Methods: The study included 160 patients with nodular BC pT2-3N0-1M0-1, including 48 patients in a prospective group (PG) and 112 patients in a retrospective group (RG). All patients underwent initial clinical and laboratory examinations, including determination of alkaline phosphatase (AP) activity (Cobas Integra 4000 plus, Switzerland) and parameters of coagulation hemostasis (STA Compact, France). Bone scintigraphy was performed for complaints of bone pain and/or in cases of elevated AP activity, regardless of SXCT data. Results were considered statistically significant at p &lt; 0.05. Results: Patients in PG were divided into two subgroups depending on F levels: in 31 (64.6%) patients F = 3.67±0.5 g/L, insignificantly exceeding the norm (2.8±0.3 g/L); in 17 (35.4%) patients F = 6.9±0.3 g/L, being 1.9 and 2.5 times (p &lt; 0.05) higher than in subgroup 1 and the norm, respectively. AP activity exceeded the norm by 26% and 40%, respectively (p &lt; 0.1). Bone metastases were detected before treatment in 24 (21.4%) women of RG with pain syndrome; all these patients showed increased blood levels of F, on average up to 7.86±0.8 g/L, similarly to patients in subgroup 2 of PG. F levels in other 88 (78.6%) patients in RG were 3.4±0.6 g/L. The nature and severity of AP changes in RG patients and in both PG subgroups were similar. Initially elevated F levels in 17 PG patients remained unchanged after antitumor treatment (6.2±0.6 g/L). AP activity values were stable after treatment being only 36% and 28% (p &lt; 0.1) higher than the norm, respectively. None of the patients with high F levels complained about bone pain. Unscheduled bone scintigraphy was appointed to 17 patients of PG without clinical symptoms or x-ray (SXCT) signs of pathology but with initially high F which did not decline after treatment. Bone scintigraphy showed metastases to the spine and pelvic bones in 12 of 17 (70.5%) patients 1 month after treatment, subsequently confirmed by MRI results. Conclusions: Initial levels of F within 6.9±0.6 g/L which do not decline after the special treatment allow predicting unfavorable BC course and the presence of metastases to the spine and/or pelvic bones without clinical signs of progression. The proposed method allows diagnosis of advanced tumor process in the absence of clinical signs of the disease with an accuracy of 87.8%, and allows timely corrections to the treatment plan.

Palliative Radiotherapy to Asymptomatic Bone Metastasis: Is It Beneficial or Not? Single Institution Experience

Background: Bone metastases are believed to be the complications of cancer occurring in 20-75% of patients with advanced tumors. External beam radiation therapy (EBRT) is recommended in case of symptomatic bone metastases. Preventing skeletal-related events (SREs) and pain through early treatment of bone metastases is to be studied. We conducted the present study to investigate EBRT in asymptomatic bone metastases. Method: A retrospective cohort study for patients with bone metastases without symptoms, who were treated with EBRT, formed group A. Group B comprised the patients who did not receive EBRT. The time from diagnosis to onset of the 1st SRE was recorded for both groups. The follow-up period was three years. Pain was moderate to severe when rated as 5/10. Results: Asymptomatic bone metastases were found in 200 patients. They were free from pain or pathological fractures. They were divided into two groups of A and B. The overall demographics and disease characteristics were well-balanced for the two groups. The two groups were more or less similar concerning the mean age and sex, with no statistically significant differences; the mean age in groups A and B was 57 years. For both groups, the mean time from the occurrence of asymptomatic bony metastases to the onset of SRE were about 33 and 19 months for groups A and B, respectively, which is statistically significant. Conclusion: Prophylactic EBRT of metastatic breast and prostate cancer patients should be considered in order to delay the onset of SREs and improve the quality of life.

Molecular imaging of bone metastases using tumor-targeted tracers

Bone metastasis is a disastrous manifestation of most malignancies, especially in breast, prostate and lung cancers. Since asymptomatic bone metastases are not uncommon, early detection, precise assessment, and localization of them are very important. Various imaging modalities have been employed in the setting of diagnosis of bone metastasis, from plain radiography and bone scintigraphy to SPECT, SPECT/CT, PET/CT, MRI. However, each modality showed its own limitation providing accurate diagnostic performance. In this regard, various tumor-targeted radiotracers have been introduced for molecular imaging of bone metastases using modern hybrid modalities. In this article we review the strength of different cancer-specific radiopharmaceuticals in the detection of bone metastases. As shown in the literature, among various tumor-targeted tracers, 68Ga DOTA-conjugated-peptides, 68Ga PSMA, 18F DOPA, 18F galacto-RGD integrin, 18F FDG, 11C/18F acetate, 11C/18F choline, 111In octreotide, 123/131I MIBG, 99mTc MIBI, and 201Tl have acceptable capabilities in detecting bone metastases depending on the cancer type. However, different study designs and gold standards among reviewed articles should be taken into consideration.

Evaluation of asymptomatic skeletal metastasis by 99mTc MDP bone scans in NSCLC patients attending INMAS, Rajshahi

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;Lung cancer is the leading cause of cancer deaths worldwide. Lung cancer is often insidious, producing no symptoms until the disease is well advanced. In approximately 7-10% of cases, lung cancer is diagnosed in asymptomatic patients. Some patients are asymptomatic for skeletal metastasis and a recent prospective study showed that in staging of non-small cell lung cancer (NSCLC), failure to perform a bone scan could miss asymptomatic bone metastasis in 14–22% of patients. Radionuclide bone scintigraphy with &lt;sup&gt;99m&lt;/sup&gt; Tc MDP (Technetium-99mmethylene diphosphonate) is very useful nuclear imaging tool to detect skeletal metastasis with a sensitivity of 98.2% and a specificity of 95.2%. The aim of this study was to detect the asymptomatic skeletal metastasis of non-small cell lung cancer patients by &lt;sup&gt;99m&lt;/sup&gt;Tc MDP bone scan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Patients and methods:&lt;/em&gt;&lt;/strong&gt; It is a retrospective study, carried out from January 2015 to December 2016 in Institute of Nuclear Medicine and Allied Sciences, Rajshahi. Bone scan was performed by an intravenous bolus injection of 20 m Ci &lt;sup&gt;99m&lt;/sup&gt;Tc MDP. Bone phase images were taken at three hours after injection of the radiotracer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt; A total of 52 patients were enrolled in the study. The mean age of the patients was 57.6 ± 14.5 years (mean ± SD) with range from 36 to 75 years and 42 (80.77%) were male and 10 (19.23%) were female. Out of 52 patients, only 06 (11.54%) patients were diagnosed as positive and 46 (88.46%) were negative for bone metastasis. Out of 06 patients with positive skeletal metastasis 04 (66.67%) patients had multiple sites (two or more) and 02 (33.33%) patients had solitary site of bone involvement. Common sites of metastasis were in thoracic (83.33%) and lumbar spine (83.33%), ribs (50%), pelvic bones (33.33%), long bones (16.66%), skull (16.66%) and other bony sites including clavicle, sternum, scapula, sacrum (16.66%). Regarding staging prior to bone scan, out of 06 bone scan positive patients 03 (50%) patients were in stage III, 02 (33.33%) patients were in stage IV and 01(16.67%) patient was in stage II. On the basis of histopathology, out of 06 skeletal metastatic patients 04 (66.67%) patients had adenocarcinoma, 01 (16.67%) patient had squamous cell carcinoma and 01 (16.67%) had large cell carcinoma. The exclusion of bone metastasis is important in the initial staging of non-small cell lung cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion:&lt;/em&gt;&lt;/strong&gt; There is debate about whether bone scans should be performed routinely or restricted to patients who present with clinical or laboratory indicators suggesting skeletal metastasis. The present study indicates that if bone scans were done only in patients reporting skeletal symptoms an important number of patients (11.54%) would have been miss-staged due to asymptomatic bone metastasis. As bone scan is very cost effective in comparison to other imaging modalities (MRI / PET-CT), it can play a vital role in detecting asymptomatic skeletal metastasis in NSCLC patients.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(2): 110-114, July 2017&lt;/p&gt;

Frequency and Site of Skeletal Metastatic Lesion Detected by Bone Scintigraphy in Newly Diagnosed Asymptomatic Cancer Patients

&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; Bone is one of the most common organ for metastasis. Bone scintigraphy is widely used for staging of cancer patients before initiation of chemotherapy and adjuvant therapy and it can detect both symptomatic and asymptomatic bone metastases. The purpose of this study was to determine the frequency and site of metastatic bone lesion detected by bone scintigraphy in newly diagnosed asymptomatic cancer patients who werwe referred to National Institute of Nuclear Medicine &amp;amp; Allied Sciences (NINMAS) for bone scintigraphy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This cross sectional observational type of study was carried out in NINMAS from July 2015 to June 2016. A total of 116 newly diagnosed asymptomatic cancer patients referred for the first time bone scintigraphy were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the total 116 patients (57 male and 59 female; mean age: 54.8 ± 14.0 years), 46 (39.7%) patients had carcinoma breast, 30 (25.9%) patients had carcinoma prostate, 12(10.3%) patients had carcinoma lung, 8(6.9%) patients had carcinoma urinary bladder, 4(3.4%) patients had renal cell carcinoma and 16(13.8%) patients had other cancer. Bone scan was found positive for metastatic disease in 44.8% patients. Most common sites of bone metastases in different types of cancer in newly diagnosed asymptomatic cancer patients were rib, then hip bone, vertebral column (lumbar vertebra, thoracic vertebra respectively), sternum and skull.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; In this study, it was revealed that newly diagnosed asymptomatic cancer patients are frequently associated with metastatic bone disease, those can be detected by bone scintigraphy.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(1): 14-18, January 2017&lt;/p&gt;

145: Treating asymptomatic bone metastases in patients with lung cancer with denosumab can improve QOL

145: Treating asymptomatic bone metastases in patients with lung cancer with denosumab can improve QOL

Radium-223 with concomitant bone-targeting agents in metastatic castration-resistant prostate cancer (CRPC) patients treated in an international early access program (EAP)

Background: The bone-targeting agents (BTAs) denosumab and bisphosphonates (BPs) are widely used in the supportive care of patients (pts) with CRPC and bone metastases. We present data on pts treated with radium-223 dichloride (Ra-223) with or without a concomitant BTA in an international EAP.Methods: This was a prospective single-arm phase IIIb study of CRPC pts with symptomatic or asymptomatic bone metastases (no visceral disease) recruited from 14 countries. Pts received Ra-223 55 kBq/kg (iv injection) every 4 weeks for 6 cycles. Co-primary endpoints were safety and overall survival (OS). Exploratory analyses investigated the effects of concomitant denosumab (no BPs) or BPs (no denosumab) on OS and symptomatic skeletal events (SSE). Results: 696 pts received at least one Ra-223 cycle. Of those, 127 (18%) pts were treated with concomitant denosumab (no BPs) and 435 (63%) without any concomitant BTAs. Key baseline characteristics are reported in pts treated with Ra-223 with or without a concomitant BTA (Table). Median OS (mOS) and median time to first SSE (mSSE) were longer in pts treated with Ra-223 and denosumab versus pts without a concomitant BTA (Table). While key baseline characteristics in pts treated with Ra-223 and denosumab were similar to pts treated with Ra-223 and BPs, adding BPs to Ra-223 did not appear to improve mOS. However, mSSE was prolonged in pts receiving Ra-223 and BPs versus pts who received Ra-223 without a concomitant BTA (Table). Conclusions: In this EAP, pts treated with Ra-223 and a concomitant BTA appeared to have longer time to first SSE than those treated without a concomitant BTA. However, improvement in OS was observed with denosumab but not with BPs. Prospective randomized controlled studies are required to confirm the benefit of this specific treatment combination in metastatic CRPC.Table: B7DenosumabBPsNo denosumab/ no BPsN = 127N = 125N = 435Baseline characteristicsECOG PS, n (%)058 (46%)55 (44%)144 (33%)155 (43%)54 (43%)234 (54%)≥214 (11%)16 (13%)57 (13%)Pain, n (%)123122413Mild75 (61%)72 (59%)218 (53%)Moderate-severe19 (15%)24 (20%)113 (27%)None29 (24%)26 (21%)82 (20%)ALP (U/L), n127125433Median121.0137.0168.0PSA (µg/L), n127124433Median91.2118.5174.6Efficacy outcomeOverall survivalMedian, monthsNR12.713.495% CINA10.9–NA11.7–NAHazard ratio (95% CI)0.630 (0.431– 0.922)0.846 (0.584– 1.226)-Time to first SSEMedian, months17.0NR15.895% CI17.0–17.5NA10.9–19.1Hazard ratio (95% CI)0.761 (0.493– 1.173)0.498 (0.294– 0.845)-NR/A = not reached/available. Open table in a new tab NR/A = not reached/available.

Clinical Significance of Zoledronic Acid and Strontium-89 in Patients With Asymptomatic Bone Metastases from Non–Small-Cell Lung Cancer

BackgroundThe purpose of this study was to clarify the treatment value of zoledronic acid (ZA) and/or strontium-89 (Sr-89) in patients with non–small-cell lung cancer (NSCLC) with asymptomatic bone metastases (BMs). Patients and MethodsEligible patients were those with resectable NSCLC and asymptomatic BMs. These candidates were randomized into 4 groups: group A was treated with ZA and Sr-89 simultaneously, group B was treated with ZA, group C was treated with Sr-89, and group D was untreated. Patients were monitored and analyzed for the first skeletal-related event (SRE), overall survival (OS), and annual incidence of SREs. ResultsOne hundred eighty patients were enrolled. Time to first SRE in group A was 15 months (95% confidence interval [CI], 14.0-16.0 months), in group B it was 12 months (95% CI, 11.1-13.0 months), in group C it was 9 months (95% CI, 8.5-9.5 months), and in group D it was 8 months (95% CI, 7.1-8.9 months) (P = .000). The overall survival (OS) in group A was 17 months (95% CI, 16.0-18.1 months); in group B, it was 16 months (95% CI, 14.2-17.8 months); in group C, it was 12 months (95% CI, 11.1-12.9 months); and in group D, it was 12 months (95% CI, 10.8-13.2 months). The annual incidence of SREs in group A was 24.4%; in group B, it was 55.6%; in group C, it was 75.6%; in group D, it was 91.1% (P = .000). ConclusionsTreatment with ZA and/or Sr-89 significantly extended the time to first SRE as well as survival time and reduced the annual incidence of SREs. Treatment with the combined use of ZA and Sr-89 was safe and well tolerated and achieved the best effect on asymptomatic BMs of NSCLC.

ACR Appropriateness Criteria® Non-Spine Bone Metastases

Bone is one of the most common sites of metastatic spread of malignancy, with possible deleterious effects including pain, hypercalcemia, and pathologic fracture. External beam radiotherapy (EBRT) remains the mainstay for treatment of painful bone metastases. EBRT may be combined with other local therapies like surgery or with systemic treatments like chemotherapy, hormonal therapy, osteoclast inhibitors, or radiopharmaceuticals. EBRT is not commonly recommended for patients with asymptomatic bone metastases unless they are associated with a risk of pathologic fracture. For those who do receive EBRT, appropriate fractionation schemes include 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, or a single 8 Gy fraction. Single fraction treatment maximizes convenience, while fractionated treatment courses are associated with a lower incidence of retreatment. The appropriate postoperative dose fractionation following surgical stabilization is uncertain. Reirradiation with EBRT may be safe and provide pain relief, though retreatment might create side effect risks which warrant its use as part of a clinical trial. All patients with bone metastases should be considered for concurrent management by a palliative care team, with patients whose life expectancy is less than six months appropriate for hospice evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

5034 POSTER Baseline Characteristics, Disease Pattern and Outcome of Breast Cancer Patients With Asymptomatic Bone Metastasis

5034 POSTER Baseline Characteristics, Disease Pattern and Outcome of Breast Cancer Patients With Asymptomatic Bone Metastasis

Retrospective Analysis of an Oral Combination of Dexamethasone, Uracil plus Tegafur and Cyclophosphamide for Hormone-refractory Prostate Cancer

To evaluate the clinical utility of an oral combination of dexamethasone, uracil plus tegafur and cyclophosphamide as a treatment for patients with hormone-refractory prostate cancer. Fifty-seven patients with hormone-refractory prostate cancer were treated with an oral administration of dexamethasone (1.0 mg/day), uracil plus tegafur (400 mg/day) and cyclophosphamide (100 mg/day). The median patient age was 71 years. Sixteen patients had symptomatic bone metastasis, 31 had asymptomatic bone metastasis and 8 showed lymph node metastasis. Eight patients presented with only biochemical progression as evaluated by serum prostate-specific antigen levels. Thirty-six (63%) of 57 patients demonstrated a ≥50% decline in serum prostate-specific antigen levels. The median time to prostate-specific antigen progression was 7.2 months. In patients with a prostate-specific antigen decline of ≥50%, the median time to progression was 13.3 months. With respect to pre-treatment markers, the duration of response to initial hormonal treatment was associated with the time to prostate-specific antigen progression. In 11 of 16 (69%) patients who complained of bone pain, the pain improved and became stable in 5 of those patients (31%). Most adverse events were mild and only three (5%) patients showed neutropenia of Grade 3 or higher. The combination of dexamethasone, uracil plus tegafur and cyclophosphamide is an effective and well tolerated regimen for hormone-refractory prostate cancer. To evaluate the survival benefits, further randomized studies are required.

Bisphosphonates in Lung Cancer: More Than a Palliative Therapy?

Bone metastases are a common complication in patients with advanced lung cancer, and most patients with bone metastases from lung cancer develop skeletal-related events (SREs). Skeletal-related events adversely impact patient quality of life and clinical outcome and are associated with increased costs of clinical management, underscoring the need for SRE prevention. Because current practice guidelines do not recommend pretreatment bone scans for all patients at initial presentation, skeletal involvement is not detected in a proportion of patients with early stage asymptomatic bone metastases. In addition, there are no uniform guidelines outlining treatment for patients with bone metastases. Although many bisphosphonates have not been investigated in this setting, zoledronic acid has proven efficacy in delaying the onset and reducing the risk of SREs in patients with bone metastases from lung cancer. Further, recent exploratory analyses in patients with bone metastases from solid tumors suggest that, in addition to normalizing biochemical markers of bone metabolism, zoledronic acid may improve survival in specific patient subsets, including those with lung cancer. Accordingly, several prospectively designed clinical trials assessing anticancer activity of zoledronic acid in the adjuvant setting are ongoing. New insights into the clinical relevance of bone-conserving therapy in patients with lung cancer are discussed.

Clinical and prognostic analysis of bone metastases of non-small-cell lung cancer

Objective:To study the clinical features and prognostic factors of bone metastases of non-small-cell lung cancer.Methods:The clinical data of 174 patients with bone metastases of non-small-cell lung cancer,who were treated in our hospital during April 1999 to June 2006,were retrospectively analyzed.Kaplan-Meier analysis was used to estimate the 1-and 2-year survival rates of patients.Log-rank test was used to screen the factors influencing the survival of patients and Cox regression was used to further confirm the independent factors.Results:The predilection sites of bone metastases of non-small-cell lung cancer were chest(38.1%),spine(32.8%),pelvis(16.3%),extremities(8.7%),and skull(4.1%),with the ribs(30.7%),lumber vertebrae(17.3%),and thoracic vertebra(13.1%) ranking the top three.The median survival time of the 174 patients was 10.73 months;Kaplan-Meier analysis showed that the 1-and 2-year survival rates were 47.1% and 17.8%,respectively.It was also showed that the PS Score,bone pain,asymptomatic bone metastases,solitary bone metastasis,serum AKP,LDH,and CEA were associated with the prognosis of patients(P0.05).Multivariate analysis showed that PS score,solitary bone metastasis and single bone metastasis were the independent factors of prognosis.Conclusion:The predilection sites of bone metastasis of non-small-cell lung cancer include chest part(ribs),spine(lumber/thoracic vertebrae),pelvis(ilium),etc.PS score,asymptomatic bone metastases,and solitary bone metastasis have great influence on the prognoses of patients.

Can clinical factors be determinants of bone metastases in non-small cell lung cancer?

OBJECTIVE:The aim of this study was to investigate the correlations among symptoms, laboratory findings of bone metastasis and whole body bone scanning (WBBS) and the frequency of occurrence of bone metastasesMATERIALS AND METHODS:Hundred and six patients who were diagnosed with non-small cell lung cancer (NSCLC) between June 2001 and September 2005 were investigated retrospectively. Bone pain, detection of bone tenderness on physical examination, hypercalcemia and increased serum alkaline phosphatase were accepted clinical factors of bone metastases. Presence of multiple asymmetric lesions in WBBS was also accepted as bone metastases. Subjects whose clinical factors and WBBS indicated doubtful bone metastases were evaluated with magnetic resonance and/or biopsy.RESULTS:Occurrence of bone metastases was 31.1% among all patients. Bone metastases were determined in 21 (52.5%) of 40 patients who had at least one clinical factor. Asymptomatic bone metastases without any clinical factors were established in 11.3% of all NSCLC patients and 15.3% of 26 operable patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the clinical factors of bone metastases were 63.6, 73.9, 52.5, 81.8 and 70.7% respectively. There was no significant relationship between histologic type and bone metastases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WBBS in detection of bone metastases were 96.9, 86.3, 76.2, 98.4, 89.6% respectively.CONCLUSION:Sensitivity and specificity of the clinical factors of bone metastases are quite low. Routine WBBS prevented futile thoracotomies. Therefore, routine WBBS should be performed in all NSCLC patients, even in the absence of bone-specific clinical factors.

Diagnostic value of nuclide bone imaging for bone metastasis from lung cancer and clinic analysis

Bone metastasis is very common in lung cancer patients. Metastasis to spine can lead to paralysis and fracture, deteriorate the quality of patient's life. The objective of this study is to investigate the diagnostic values of bone scanning (NBS), MRI, CT and X-ray examination to discover bone meastasis of lung cancer, and the therapy of bone metastasis and the prognostic factors. About 561 consecutive NSCLC cases were analyzed with NBS and compared with other radiological examinations (MRI, CT and X-ray). Out of the 455 positive patients by NBS, 300 cases were confirmed to be with bone metastases by dynamic follow-up, MRI, CT and X-ray, and 5 cases were false negative.The sensitivity and specificity of NBS was 98.36% and 39.45% respectively. The accuracy of NBS was 71.48%. Among the 305 patients with bone metastases, 23 patients had no records, 138 patients had bone pain, the incidence of asymptomatic bone metastasis was 47.21%. Multivariables analysis showed that asymptomatic bone metastasis, flat bone metastases, therapy with disodium pamidronate were significantly good prognostic factors, respectively (P < 0.05). A whole body NBS examination is preferred for the staging of NSCLC. NBS is necessary for patients with NSCLC. In order to exclude the possible false positive or false negative diagnosis by NBS, CT or MRI could be selected according to the sites of lesions.