Osseous Metastases In Patients Research Articles

A case series of osseous metastases in patients with glioblastoma.

Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance. Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature. Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20-84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3-35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5-13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13-225). In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.

Intra-individual comparison of 18F-sodium fluoride PET–CT and 99mTc bone scintigraphy with SPECT in patients with prostate cancer or breast cancer at high risk for skeletal metastases (MITNEC-A1): a multicentre, phase 3 trial

Detection of skeletal metastases in patients with prostate cancer or breast cancer remains a major clinical challenge. We aimed to compare the diagnostic performance of 99mTc-methylene diphosphonate (99mTc-MDP) single-photon emission CT (SPECT) and 18F-sodium fluoride (18F-NaF) PET-CT for the detection of osseous metastases in patients with high-risk prostate or breast cancer. MITNEC-A1 was a prospective, multicentre, single-cohort, phase 3 trial conducted in ten hospitals across Canada. Patients aged 18 years or older with breast or prostate cancer with a WHO performance status of 0-2 and with high risk or clinical suspicion for bone metastasis, but without previously documented bone involvement, were eligible. 18F-NaF PET-CT and 99mTc-MDP SPECT were done within 14 days of each other for each participant. Two independent reviewers interpreted each modality without knowledge of other imaging findings. The primary endpoint was the overall accuracy of 99mTc-MDP SPECT and 18F-NaF PET-CT scans for the detection of bone metastases in the per-protocol population. A combination of histopathological, clinical, and imaging follow-up for up to 24 months was used as the reference standard to assess the imaging results. Safety was assessed in all enrolled participants. This study is registered with ClinicalTrials.gov, NCT01930812, and is complete. Between July 11, 2014, and March 3, 2017, 290 patients were screened, 288 of whom were enrolled (64 participants with breast cancer and 224 with prostate cancer). 261 participants underwent both 18F-NaF PET-CT and 99mTc-MDP SPECT and completed the required follow-up for statistical analysis. Median follow-up was 735 days (IQR 727-750). Based on the reference methods used, 109 (42%) of 261 patients had bone metastases. In the patient-based analysis, 18F-NaF PET-CT was more accurate than 99mTc-MDP SPECT (84·3% [95% CI 79·9-88·7] vs 77·4% [72·3-82·5], difference 6·9% [95% CI 1·3-12·5]; p=0·016). No adverse events were reported for the 288 patients recruited. 18F-NaF has the potential to displace 99mTc-MDP as the bone imaging radiopharmaceutical of choice in patients with high-risk prostate or breast cancer. Canadian Institutes of Health Research.

Disseminated Kaposi sarcoma with osseous metastases in patients with HIV infection. Case report

Background. Kaposi sarcoma is a low-grade vascular tumor affecting blood and lymphatic vessels associated with the human herpes virus type 8 (HHV-8). As a rule, the skin of the lower extremities is involved in the process first of all, and then other organs and lymph nodes are involved. There are 4 various types of the disease with different clinical picture: the classic, the endemic, the epidemic and immunosuppression subtype. The epidemic subtype is the most common and has the most aggressive course, with specific lesions of a multiple kind, including the skin, mucous membrane layers, the lymph nodes, the gastrointestinal tract, the lungs and the spleen. Osseous metastases are extremely rare.&#x0D; Aim. Show the case of Kaposi sarcoma with osseous metastases in patient with the human immunodeficiency virus (HIV) infection.&#x0D; Results. We observed a 43-year-old patient with HIV infection and stage 4b Kaposi sarcoma against the background of the irregular antiretroviral therapy in the progression stages. The duration of the anamnesis was 32 months. The clinical debut of the cancer process was noted with skin lesions on the shoulder. Histological and immunohistochemical analysis of skin biopsies showed the morphological picture of Kaposi sarcoma. HHV-8 was expressed in tumor cells. During the endoscopic examination the lesions of oral mucosa, stomach and proximal colon were confirmed morphologically, and spiral computed tomography of the chest revealed the lesions in the lungs. On this point, the patients received oxaliplatin-based chemotherapy and aetoposidum for 6 months and against the background of this treatment we observed the disease progression associated with the involvement of the retroperitoneal lymph nodes, the left adrenal gland and the penis. Circumcision was performed in the case associated with the involvement of the penis. The treatment was continued. The lytic left iliac bone lesion, the retroperitoneal lymph nodes, the iliac lymph node groups, as well as the left inguinal lymph nodes, the left adrenal gland and the lungs were characterized by a high F-18 FDG uptake after 3 months of the treatment, according to the results of Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT).&#x0D; Conclusion. Kaposi sarcoma in patients with HIV infection had an aggressively course with disseminated skin lesions and internal organ involvement, including bones as showed in this clinical case. In this case, the axial skeleton was more commonly involved. PET/CT is a diagnostic imaging method in the differential diagnosis and determination of the prevalence of the cancer process.

The utility of a deep learning-based algorithm for bone scintigraphy in patient with prostate cancer

Bone scintigraphy has often been used to evaluate bone metastases. Its functionality is evident in detecting bone metastasis in patients with malignant tumor including prostate cancer, as appropriate treatment and prognosis are dependent on the presence and degree of bone metastasis. The development of a deep learning-based algorithm in the field of information processing has been remarkable in recent years. We hypothesized that a deep learning-based algorithm is useful in diagnosing osseous metastases in patients with prostate cancer using bone scintigraphy. Thus, this study aims to examine the utility of deep learning-based algorithm in detecting bone metastases in patients with prostate cancer, as compared with nuclear medicine specialists. In total, 139 serial patients with prostate cancer, who underwent whole-body bone scintigraphy, were enrolled in this study. Each scintigraphy examination was evaluated visually and independently by nuclear medicine specialists; this was also analyzed using a deep learning-based algorithm. The number of abnormal uptakes was assessed by the nuclear medicine specialists and with a software which used the deep learning-based algorithm, and the per-patient detection rate and the per-region detection rate were then calculated. The software automatically analyzed bone scintigraphy for the presence or absence of osseous metastasis in individual patients, for the 12 body regions. The detection rates analyzed separately by the nuclear medicine specialists and using the software were then compared. The sensitivity, specificity, and accuracy by the specialist and with the software were calculated. The sensitivity, specificity, and accuracy by the nuclear medicine specialists were 100%, 94.9% and 97.1%. On the other hand, they with the software were 91.7%, 87.3% and 89.2%. No statistically significant difference was determined between the per-patient detection rates assessed by the specialists versus the software. In regional assessment, there was also no statistically significant difference between most of the per-region detection rates (10 of 12 regions) by the specialists versus the results obtained by the software. The software with the deep learning-based algorithm might be used as diagnostic aid in the evaluation of bone metastases for prostate cancer patients.

Observer agreement and accuracy of 18F-sodium fluoride PET/computed tomography in the diagnosis of skull-base bone invasion and osseous metastases in newly diagnosed nasopharyngeal carcinoma.

To evaluate the interobserver agreement and the diagnostic performance in F-sodium fluoride (F-NaF) PET/computed tomography (CT) for the detection of skull-base bone invasion (SBBI) and osseous metastases in patients with newly diagnosed nasopharyngeal carcinoma (NPC). One hundred seventeen patients with newly diagnosed NPC between 2017 and 2019 who underwent F-NaF PET/CT was in included. Two experienced observers independently evaluated the F-NaF PET/CT of SBBI and osseous metastases on a patient level using a two-category scale present on a dichotomous scale, respectively. On a patient level, the diagnostic performance was calculated using a sensitivity analysis. The interobserver agreement on a patient level of SBBI and osseous metastases were perfect on a patient-level (κ: 0.85), (κ: 0.808), respectively. On a lesion level of detection of osseous metastases, the observers agreed on the number as well as the location of osseous metastases in 101 (86.3%) patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of detection of SBBI and osseous metastases were ranged 0.911-0.962, 0.921-0.974, 0.932-0.957, 0.962-0.986, and 0.841-0.923, and ranged 0.917-0.958, 0.899-0.957, 0.906-0.949, 0.863-0.936, and 0.939-0.970, respectively. The interobserver agreement of F-NaF PET/CT for the detection of SBBI and osseous metastases in patients with NPC were both very high among trained observers. Moreover, the diagnostic performance of NaF PET/CT was satisfactory, rendering NaF PET/CT a robust tool in the diagnostic armamentarium.

Performance of 18F-fluciclovine PET/MR in the evaluation of osseous metastases from castration-resistant prostate cancer.

18F-Fluciclovine is indicated for evaluation of suspected prostate cancer (PCa) biochemical recurrence. There are few studies investigating fluciclovine with PET/MR and none evaluated osseous metastases. Our aim was to assess the performance of 18F-fluciclovine PET/MR (fluciclovine-PET/MR) for detecting osseous metastases in patients with castration-resistant prostate cancer (CRPC). We also investigated possible correlations between SUVmax and ADCmean. We evaluated 8 patients with CRPC metastatic to bones, some before and some after radium therapy, who underwent 13 fluciclovine-PET/MR studies. We analyzed the performance of radionuclide bone scan (RBS), MR alone, fluciclovine-PET alone, and fluciclovine-PET/MR in detecting osseous metastases. Lesion size, characteristics (early sclerotic, late sclerotic, mixed, lytic), SUVmax, and ADCmean were assessed. The reference standard was a combination of clinical information and correlation with both prior and follow-up imaging. Of 347 metastatic bony lesions in 13 studies, 238/347 (68%) were detected by fluciclovine-PET alone, 286/347 (82%) by RBS, 344/347 (99%) by MR alone, and 347/347 (100%) by fluciclovine-PET/MR. Fluciclovine-PET/MR and MR had the best performance (p < 0.001). There was no statistically significant difference between fluciclovine-PET/MR and MR alone (p = 0.25). Fluciclovine-PET had a lower detection rate especially with late sclerotic lesions (p < 0.001). There was a moderate inverse correlation between lesion SUVmax and ADCmean (r = - 0.49; p < 0.001). This study suggests that fluciclovine-PET/MR and MR have high sensitivity for detecting osseous metastases in CRPC. Fluciclovine-PET alone underperformed in detecting late sclerotic lesions. The inverse correlation between SUVmax and ADCmean suggests a possible relationship between tumor metabolism and cellularity.

18F-FDG PET-CT versus MRI for detection of skeletal metastasis in Ewing sarcoma

ObjectiveTo determine the level of discrepancy between magnetic resonance imaging (MRI) and 18F-FDG PET-CT in detecting osseous metastases in patients with Ewing sarcoma.MethodsTwenty patients with histopathologically confirmed Ewing sarcoma between 2000 and 2017 who underwent 18F-FDG PET-CT and MRI within a 4-week range were included. Each imaging modality was evaluated by a separate observer. Reference diagnosis of each lesion was based on histopathology or consensus of an expert panel using all available data, including at least 6 months’ follow-up. Sensitivity, specificity, and predictive values were determined. Osseous lesions were analyzed on a patient and a lesion basis. Factors possibly related to false-negative findings were evaluated using Pearson’s Chi-squared or Fisher’s exact test.ResultsA total of 112 osseous lesions were diagnosed in 13 patients, 107 malignant and 5 benign. Seven patients showed no metastases on either 18F-FDG PET-CT or MRI. Forty-one skeletal metastases (39%) detected with MRI did not show increased 18F-FDG uptake on 18F-FDG PET-CT (false-negative). Lesion-based sensitivities and specificities were 62% (95%CI 52–71%) and 100% (48–100%) for 18F-FDG PET-CT; and 99% (97–100%) and 100% (48–100%) for MRI respectively. Bone lesions were more likely to be false-negative on 18F-FDG PET-CT if hematopoietic bone marrow extension was widespread and active (p = 0.001), during or after (neo)-adjuvant treatment (p = 0.001) or when the lesion was smaller than 10 mm (p < 0.001).ConclusionAlthough no definite conclusions can be drawn from this small retrospective study, it shows that caution is needed when using 18F-FDG PET-CT for diagnosing skeletal metastases in Ewing sarcoma. Poor contrast between metastases and active hematopoietic bone marrow, chemotherapeutic treatment, and/or small size significantly decrease the diagnostic yield of 18F-FDG PET-CT, but not of MRI.

Serum bone-specific alkaline phosphatase as a biomarker for osseous metastases in patients with malignant carcinomas: a systematic review and meta-analysis.

Bone metastasis was common in patients with malignant tumors. The purpose of this study was to investigate the serum bone-specific alkaline phosphatase (B-ALP) as a biomarker in the diagnosis of osseous metastases in patients with cancers. We searched the databases of Pubmed, Cochrane Library, Medline, CNKI and Wanfang to screen the relevant articles about the serum B-ALP detection in the diagnosis of osseous metastases in patients with malignant carcinomas. The pooled sensitivity, specificity, summary receiver operating characteristic (SROC) curve were calculated by STATA12.0 software. Nineteen trials with 3 268 subjects were finally included in this study. The mean level of serum B-ALP was 41.50 ± 26.61 μg/L (216.90 ± 139.00U/L) in patients with osseous metastases and 14.49 ± 5.52 μg/L (103.30 ± 39.44 U/L) in patients without osseous metastases. The serum level of B-ALP was significant higher in the osseous metastases group than that in the control group (P < 0.05); The pooled sensitivity and specificity for diagnosis of osseous metastases were 0.74 with its 95% confidence interval (95% CI) of 0.62-0.83 and 0.80 (95% CI: 0.67-0.89), respectively. The area under the SRCO was 0.86 (95% CI: 0.83-0.89). Serum B-ALP can be a promising biomarker for detection of osseous metastases in patients with cancers.

18F Sodium Fluoride PET/CT Detects Osseous Metastases From Breast Cancer Missed on FDG PET/CT With Marrow Rebound

Intense FDG uptake by bone marrow following recent chemotherapy limits evaluation for osseous metastases. The impact of marrow rebound on accuracy of (18)F-fluoride PET/CT is unclear. A 73-year-old woman with breast cancer presented for restaging FDG PET/CT, which showed intense activity throughout almost the entire axial skeleton and no osseous metastases. An (18)F-fluoride PET/CT performed 7 days later identified multiple osseous metastases in the spine, ribs, and pelvis. This case demonstrates that (18)F-fluoride PET/CT should be considered for the evaluation of osseous metastases in patients with rebound marrow uptake on FDG PET/CT.

Samarium-153 effectiveness in the quality of life of bone metastatic cancer patients.

e20635 Background: Osseous metastases in patients suffering from cancer, is a multifactor symptom which affects quality of life. Methods: The Samarium group (SG) n=53 patients received a single bolus infusion of (153)Sm (37 MBq/kg), and we compared with a Control group(CG) n=37. Both groups of patients who had metastatic bone cancer requiring analgesia answered the following questionnaires: Greek Brief Pain Inventory (GBPI), Brief Multidimensional Life Satisfaction Scale (BMLSS), Hospital Anxiety Depression Scale (HADS), ECOG/WHO/Zubrod score and Hospital Satisfaction Scale (HSS),day 0 and 30±3 days after the intervention start.There was no statistically significant(SS) difference for the variables(V-) sex, age, pain’s localization and lodging. Results: Pain severity and pain interference change over time was the same for both groups P= 0.0005. For the V- HADS-anxiety, SG showed no SS improvementP= 0.397, something which was achieved for the CG,P= 0.031. The V- HADS improved SS for both groups P= 0.031 and P= 0.003 respectively which changed over time with the same way. This may show the strong relation between pain and depression. The V- ECOG also changed over time in the same way for both SG(P=0.005) and CG (P=0.014). The percentage of patients who changed scale towards improvement for their quality of life was 24,3% for the CG and 15,1% for the SG. The V-BMLSS change over time was similar for both groups. There was no SS difference for the V-HSS towards medical and nursing personnel for both groups (P=1.000). Myelotoxicity for the SG was moderate and reversible, as well as the side effects for the CG. Finally an equivalence test between the two groups, showing that both treatment regimens were equivalent for all variables: Pain severity=0.034, Pain interference=0.009, HAD-anxiety P=0.048, HAD-depression=0.033, BMLSS=0.016, ECOG=0.0005. During our study among the patients of the SG in some cases the stabilization of bone lesions was observed, and in one case partial and/or complete remission. Conclusions: Administration of (153)Sm is another equivalent option for those patients who are intolerant or resistant to medication treatment having a better cost-effectiveness result.

Meta-analysis: Comparison of F-18 Fluorodeoxyglucose-Positron Emission Tomography and Bone Scintigraphy in the Detection of Bone Metastases in Patients With Breast Cancer

To evaluate the diagnostic properties of FDG-PET and bone scintigraphy in the detection of osseous metastases in patients with breast cancer. Studies evaluating the diagnostic accuracy of FDG-PET and bone scintigraphy in the diagnosis of osseous metastasis were systematically searched for in the MEDLINE, CINAHL, and EBM Review databases from January 1995 to November 2006. Two reviewers independently abstracted data including research design, sample size, imaging technique and technical characteristics, reference standard, method of image interpretation, and totals of true positives, false positives, true negatives, and false negatives. Per-patient and per-lesion pooled sensitivity and specificity, and area under summary receiver operating characteristic curves were calculated using Meta-Test software. The pooled patient-based sensitivity for FDG-PET was 81% (95% CI: 70%-89%), specificity was 93% (95% CI: 84%-97%), and the area under the curve (AUC) was 0.08. The pooled sensitivity of bone scan was 78% (95% CI: 67%-86%), specificity was 79% (95% CI: 40%-95%), and the AUC was 0.43. The pooled lesion-based sensitivity for FDG-PET was 69% (95% CI: 28%-93%), specificity was 98% (95% CI: 87%-100%), and the AUC was 0.09. The pooled sensitivity for bone scan was 88% (95% CI: 82%-92%), specificity was 87% (95% CI: 29%-99%), and the AUC was 0.81. It remains inconclusive whether FDG-PET or bone scintigraphy is superior in detecting osseous metastasis from breast cancer. However, FDG-PET does have a higher specificity and may better serve as a confirmatory test than bone scintigraphy and used to monitor response to therapy.

Technetium-99m Diphosphonate Imaging of Psammocarcinoma of Probable Ovarian Origin

Technetium-99m methylene diphosphonate (Tc-99m MDP) bone scans have long been used by clinicians to diagnose osseous metastases in patients with cancer. However, in several benign and malignant diseases, notably those characterized by extensive soft tissue calcification, Tc-99m MDP may be taken up by the tumor itself. We present a case of a stage IIIC psammoma-rich low-grade serous carcinoma of the ovary, whose identity and extent of disease were first suggested by Tc-99m MDP scintigraphy. The literature concerning this form of cancer, and the use of Tc-99m MDP bone scans to image soft tissue lesions, are reviewed.

Frequency and survival impact of osseous metastases in patients with untreated renal cell carcinoma

4631 Background: The impact of OM on survival in patients with RCC is controversial. In several recent database studies OM have been reported to have a negative effect on survival (Negrier, Ann Oncol. 2002; 13:1460, Atzpoodien, B J Cancer. 2003; 88:348), while in others it has been reported to have no effect (Motzer, J Clin Oncol. 2002; 20:289). Methods: We evaluated a database comprised of 309 previously untreated metastatic RCC patients entered into IRB approved clinical trials at our institution between 1987 and 2002. Univariable and multivariable analyses were performed to evaluate the association between OM and survival. Results: 95 patients (31%) had OM at the time of entry on study. Univariate analysis suggested a negative impact of OM on survival; median survival was 12.2 versus 16.3 months with OM present and absent, respectively (p=0.09). A multivariable analysis was performed to analyze the impact of OM while considering other important prognostic factors. This analysis adjusted for the number of poor risk factors present (Motzer, J Clin Oncol. 2002; 20:289), the number of metastatic sites present (Abou Jawde, ASCO Proceedings. 2003; #1545), and histology (clear cell versus non-clear cell). Motzer's poor risk factors include Karnofsky performance status (< 80%), hemoglobin (< 13.5 g/dL for males and < 12.0 g/dL for females), LDH (> 220 U/L), corrected calcium (> 10 mg/dL), and time from tumor diagnosis to metastases (< 1 year). In this analysis the number of poor risk factors present, the number of metastatic sites present, and histology were found to be independent predictors of survival (p < 0.001, p=0.002, and p < 0.001, respectively). Correcting for these factors the impact of OM was not statistically significant (p=0.33). Conclusions: Adjusting for other important predictors, the presence of OM does not have an impact on survival in previously untreated RCC patients. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene; Chiron

Frequency and survival impact of osseous metastases in patients with untreated renal cell carcinoma

4631 Background: The impact of OM on survival in patients with RCC is controversial. In several recent database studies OM have been reported to have a negative effect on survival (Negrier, Ann Oncol. 2002; 13:1460, Atzpoodien, B J Cancer. 2003; 88:348), while in others it has been reported to have no effect (Motzer, J Clin Oncol. 2002; 20:289). Methods: We evaluated a database comprised of 309 previously untreated metastatic RCC patients entered into IRB approved clinical trials at our institution between 1987 and 2002. Univariable and multivariable analyses were performed to evaluate the association between OM and survival. Results: 95 patients (31%) had OM at the time of entry on study. Univariate analysis suggested a negative impact of OM on survival; median survival was 12.2 versus 16.3 months with OM present and absent, respectively (p=0.09). A multivariable analysis was performed to analyze the impact of OM while considering other important prognostic factors. This analysis adjusted for the number of poor risk factors present (Motzer, J Clin Oncol. 2002; 20:289), the number of metastatic sites present (Abou Jawde, ASCO Proceedings. 2003; #1545), and histology (clear cell versus non-clear cell). Motzer's poor risk factors include Karnofsky performance status (< 80%), hemoglobin (< 13.5 g/dL for males and < 12.0 g/dL for females), LDH (> 220 U/L), corrected calcium (> 10 mg/dL), and time from tumor diagnosis to metastases (< 1 year). In this analysis the number of poor risk factors present, the number of metastatic sites present, and histology were found to be independent predictors of survival (p < 0.001, p=0.002, and p < 0.001, respectively). Correcting for these factors the impact of OM was not statistically significant (p=0.33). Conclusions: Adjusting for other important predictors, the presence of OM does not have an impact on survival in previously untreated RCC patients. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene; Chiron

Treatment of osseous metastases in patients with renal cell carcinoma.

The records of 99 patients treated at one institution for osseous metastases secondary to renal cell carcinoma were reviewed. Patients were followed up for at least 24 months or until death. Survival was analyzed with respect to age, gender, disease-free interval, location of osseous metastases, number of osseous metastatic sites, resection of osseous metastases, and primary tumor resection. The mean age of the 72 men and 27 women was 60 years (range, 34-82 years) and the mean followup was 20 months (range, 2-81 months). Twenty-six patients (26%) had a solitary osseous metastasis, 47 patients (48%) had multiple osseous metastases, and 26 patients (26%) had additional visceral involvement such as the lung and brain at the time of diagnosis. In 49 patients (49%), the renal cell carcinoma was diagnosed concurrently with detection of the osseous metastasis. The presence of one osseous renal carcinoma metastasis, wide resection of the lesion, and a history of nephrectomy were identified as independent predictors of survival in patients with renal cell carcinoma. The eight patients who had wide resection of a solitary osseous metastasis in combination with a nephrectomy had a disease-specific survival rate of 100% (mean followup, 69 months; range, 24-76 months). Patients who present with these characteristics are candidates for aggressive surgical treatment with curative intent.

METASTATIC RENAL CELL CARCINOMA OF BONE: INDICATIONS AND TECHNIQUE OF SURGICAL INTERVENTION

We describe the efficacy of surgical excision of metastatic renal cell carcinoma of bone for achieving local tumor control, pain control and functional outcome with emphasis on the indications and techniques of surgical intervention as well as oncological outcome. Between 1980 and 1997 we performed surgery on 45 patients (56 lesions) with metastatic renal cell carcinoma of bone. Indications for surgery were solitary bone metastasis, intractable pain, or impending or present pathological fracture. Surgery involved wide excision in 29 cases, marginal excision with adjunctive liquid nitrogen in 25 and amputation in 2. None of the patients had significant bleeding intraoperatively. Mean hospital stay was 9.8 days, during which there was no flap necrosis, deep wound infection, nerve palsy or thromboembolic complication. Postoperatively pain was significantly relieved in 91% of patients, while 89% achieved a good to excellent functional outcome, and 94% with metastatic lesions of the pelvic girdle and lower extremities were ambulatory. Local recurrence developed in only 4 of the 56 lesions (7.1%), including 3 after marginal resection. Survival was more than 2 years in 22 patients (49%) and more than 3 in 17 (38%). Surgical excision is safe and reliable for restoring mechanical bone stability, relieving pain and providing good function in most patients with metastatic renal cell carcinoma who meet the criteria for surgical intervention. Relatively prolonged survival in these cases justifies considering surgical intervention when feasible.

Surgical Treatment of Osseous Metastases in Patients With Renal Cell Carcinoma

Forty-five patients who underwent surgical treatment for osseous metastases secondary to renal cell carcinoma between 1980 and 1998 were reviewed. The diagnosis was confirmed histologically in all patients. The mean age of the 34 men was 61.5 +/- 9 years and of the 11 women 55.2 +/- 17.6 years. The most common locations of the metastases were the spine (15 patients), the pelvis (eight patients), and the femur (11 patients). In 21 patients, the renal cell carcinoma was diagnosed when the osseous metastasis was detected. The time from diagnosis of the primary tumor to metastasis in the remaining patients ranged from 0 to 23 years (mean, 3 +/- 5 years). At presentation, 19 patients had a singular lesion. Nine patients had multiple osseous metastases and 17 patients had additional visceral involvement. In seven patients, a wide or radical resection was done; in 35 patients, a palliative procedure was done; and in three patients, only a diagnostic procedure was done. For the whole group, the survival was 49% after 1 year, 39% after 2 years, and 15% after 5 years. Only the extent of the disease and the latency period between primary tumor diagnosis and first detection of osseous metastasis could be identified as independent factors of survival. Nine patients with solitary metastasis to the bone more than 12 months after resection of the primary tumor showed a 5-year survival of 54%.

Value of routine radionuclide bone scans in renal cell carcinoma

Radionuclide bone scans were obtained as part of the routine evaluation of 85 patients with renal cell carcinoma. Twenty-nine patients (34 %) were found to have metastatic disease at presentation. Bone scans were abnormal in 27 of these 29 patients for a sensitivity of 93 per cent; of the remaining 56 without metastatic disease, 48 had normal bone scans for a specificity of 86 per cent. In all patients whose abnormal bone scans indicated metastatic disease, there were either clinical signs (bone pain), laboratory findings (elevated alkaline phosphatase), or routine radiographic procedures (chest roentgenogram, intravenous pyelogram, or angiogram) suggesting disease metastatic to bone. Although bone scanning was useful for confirming clinically or radiographically suspected metastatic disease, it did not influence the staging of the renal cell carcinoma in any patient. We therefore conclude that bone scans should be used to confirm the presence and to detrmine the extent of osseous metastases in patients with renal cell carcinoma but are as cessary as a routine staging procedure.

An assessment of bone scans for monitoring osseous metastases in patients being treated for prostate carcinoma

The National Prostatic Cancer Project held a workshop in March 1980 to examine procedures used to evaluate bone metastases. Variations in techniques used by each of 9 treatment centers, as well as the National Cancer Institute, were compared. One center in particular had developed procedures for quantitating bone scans in addition to the customary qualitative evaluation. Changes in bone scan assessments were also related to changing levels of isoenzymes of acid and alkaline phosphatase. Most consistently correlated with disease changes were prostatic acid phosphatase, as determined by counter-immunoelectrophoresis, and the isoenzyme of bone alkaline phosphatase. Gamma cameras were recommended over rectilnear scanners as were multiple spot films to concentrate on problem areas. Bone scans must be performed prior to therapy and for best assessment no sooner than 3 months to avoid the flair phenomenon. Consistency of both machine settings and patient position are paramount, as are quality of equipment and review of past scans and X-ray films where appropriate to obtain the best assessment of disease status.

Human plasma lipoproteins. II. The effect of osseous metastases in patients with advanced carcinoma of the breast.

Human plasma lipoproteins. II. The effect of osseous metastases in patients with advanced carcinoma of the breast.