Solitary Bone Metastasis Research Articles

Abstract P1-20-01: Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial

Abstract Background. The MF07-01 trial is a multicenter randomized study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone in de novo Stage IV breast cancer (BC) patients. Aim: To evaluate and finalize the survival data of LRT in patients with the diagnosis of de novo Stage IV BC. Methods. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Continuous and categorical variable differences between LRT and ST groups were analyzed using t-test and Chi-square test, respectively. Overall survival (OS) and 5-year survival rates were compared using Kaplan-Meier log-rank tests. Univariate and multivariate Cox models were used to estimate hazard ratios, and logistic regession model used to estimate odds ratio. Results. During more than 10 years follow-up, 23% of patients in LRT group and 8% of patients in ST group were alive. Median survival was 46 months for LRT (n=134) and 35 months for ST (n=131) [HR:0.71, 95%CI;0.59-0.86, p=0.0004]. Solitary bone metastasis patients’ median survival was 14 months longer in LRT group comparing ST group [HR:0.55, 95%CI; 0.35-0.86, p=0.008]; 16% of solitary bone metastasis patients in the LRT group were alive, but all patients died in the ST group. Patients younger than 55 lived longer compared the patients older than 55 [HR:0.67, 95%CI; 0.52-0.87, p=0.002], and 26% of hormone receptor positive patients were still alive in the LRT group comparing 10% in the ST group [HR:0.71, 95%CI; 0.58-0.88, p=0.002]. Regarding the patients who lived at least 5 years since randomization, LRT (p=0.003), hormone receptor positivity (p=0.004), Triple negative status (p=0.02), hormonotherapy (p=0.0001), bisphosphonates usage (p=0.03), and 2 or more organ metastases (p=0.004) were associated with OS in univariant analyses. However, in the multivariate model with significant baseline and clinical characteristics only LRT [OR= 1.58, p=0.03] was found to be significantly related with over 5 years of survival. Conclusion. In the current analysis, patients at the diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 58% higher chance to live at least 5 years compared to the patients who received only ST. Longer follow-up of the study discloses that LRT should be presented to patients when discussing treatment options. ClinicalTrials.gov identifier number is NCT00557986 Citation Format: Atilla Soran, Vahit Ozmen, Serdar Ozbas, Hasan Karanlik, Mahmut Muslumanoglu, Abdullah Igci, Zafer Canturk, Zafer Utkan, Cihangir Ozaslan, Turkkan Evrensel, Cihan Uras, Erol Aksaz, Aykut Soyder, Umit Ugurlu, Cavit Col, Neslihan Cabioglu, Ergun Erdem, Gunay Gurleyik, Efe Sezgin. Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-01.

310PD - The importance of primary surgery in patients with de novo stage IV BC surviving at least 5 years: Protocol MF07-01 randomized clinical trial

BackgroundThe MF07-01 trial is a multicenter randomized study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone in de novo stage IV breast cancer (BC) patients. The aim of this study is to evaluate the importance of LRT in patients who lived at least 5 years after the diagnosis of de novo Stage IV BC. MethodsAt initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Continuous and categorical variable differences between LRT and ST groups were analyzed using t-test and Chi-square test, respectively. Overall survival (OS) and 5-year survival rates were compared using Kaplan-Meier log-rank tests. Univariate and multivariate Cox models were used to estimate hazard ratios. ResultsDuring 124 months of follow-up, 26% of patients in LRT group and 11% of patients in ST group remained alive. Median survival was 46 months for LRT (n=134) and 35.5 months for ST (n=132) [HR:0.65, 95%CI;0.49-0.85, p=0.002]. Solitary bone metastasis patients’ median survival was 14.5 months longer in the LRT group compared with the ST group [HR:0.53, 95%CI; 0.29-0.98, p=0.04]; 22% of solitary bone metastasis patients in the LRT group and 5% in the ST group were alive. Regarding the patients who lived at least 5 years since randomization, LRT (p=0.004), hormone receptor positivity (p=0.007), hormonotherapy (p=0.0001), bisphosphonates usage (p=0.02), T2 tumor (p=0.0008) and 2 or more organ metastases (p=0.007) were associated with OS in univariate analysis, and in a multivariate Cox proportional model with a significant baseline and clinical characteristics, LRT [OR=1.75, p=0.05)], bisphosphonates usage [OR=1.93, p=0.05), T2 tumor [OR=3.5, p=0.003), and 2 or more organ metastases [OR=0.48, p=0.03] were found to be significantly related with OS. ConclusionsIn the current analysis, patients at the diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 75% higher chance to live at least 5 years compared with the patients who received only ST. Longer follow-up of the study discloses that LRT should be presented to the patient when discussing treatment options. Clinical trial identificationNCT00557986. Legal entity responsible for the studyTurkish Federation of Breast Diseases Societies. FundingTurkish Federation of Breast Diseases Societies. DisclosureAll authors have declared no conflicts of interest.

Patterns of bone metastases from head and neck squamous cell carcinoma

ObjectiveTo report clinical features of bone metastases (BM) from head and neck squamous cell carcinoma (HNSCC). MethodsAmong 772 patients with HNSCC diagnosed at our hospital over 9 years, 30 patients (3.9%) had clinical evidence of BM (24 men and 6 women; mean age: 63 years). We assessed the time interval from the primary diagnosis to BM development, symptoms attributable to BM, presence of distant metastases to other organs, number of BM, sites of BM, morphologic changes on computed tomography (CT) images, treatment for BM, and overall survival (OS). ResultsBM at the initial stage were found in 9 patients with HNSCC (30%), and in 21 patients (70%) with HNSCC during the course of the disease. In the later patients, the median time interval from the primary diagnosis was 11.5 months. Nineteen patients (63%) did not have BM-related symptoms, 6 (20%) had pain, 3 (10%) had neurologic symptoms resulting from vertebral or skull metastases, and 2 (7%) had hypercalcemia. Seventeen patients (57%) showed bone-exclusive metastases, and 13 (43%) had distant metastases in other organs. Eleven patients (37%) had monostotic metastases (solitary BM), and 19 patients (63%) had polyostotic metastases (multiple BM). When combined, 9 patients (30%) showed bone-exclusive and monostotic metastases. The most commonly affected site was the thoracolumbar spine, accounting for 34% of total BM, followed by the pelvis (24%), shoulder and thorax (21%), and the extremities (17%). Notably, metastases to bones above the clavicle (craniofacial bones and cervical spine) accounted for only 3% of all bone lesions. CT images showed variable morphologic patterns with osteolytic type in 17 patients (57%), intertrabecular in 7 (23%), osteoblastic in 4 (13%), and mixed in 2 (7%). Systematic chemotherapy for BM was performed in 19 patients and radiotherapy in 18. The median survival time for patients with bone-exclusive and monostotic metastases was significantly longer than that for patients with multi-organ metastases or polyostotic metastases at 18.2 months vs. 5.7 months (p=0.02). Neither chemotherapy nor radiotherapy extended OS. ConclusionThirty percent of BM cases from HNSCC showed bone-exclusive and monostotic metastases. These patients tended to show a more favorable prognosis than patients with multi-organ metastases or polyostotic metastases.

Hip Pain Revealing Metastatic Prostate Cancer

Background: Prostate cancer is the most common malignant tumor and the second most common cause of cancer associated mortality in males. Bone metastasis is frequent, usually multiple and osteoplastic. Presentation of a pure osteolytic and solitary metastasis from a prostate carcinoma is extremely rare.Methodology: We report a case of prostate cancer in a 54-year-old man who presented with progressive severe right hip pain and stiffness with no urinary symptom. An MRI of the pelvis revealed a metastasis to the right hip. A prostate biopsy revealed prostate adenocarcinoma.Results: In the literature, there are few cases of a solitary osteolytic bone metastasis from carcinoma of the prostate, and especially in the pelvis. only one such case seems to be reporting.

Prognosis of renal cell carcinoma with bone metastases: Experience from a large cancer centre

BackgroundBone metastases (BMs) are associated with significant morbidity and shorter survival in renal cell carcinoma (RCC). Our purpose was to identify prognostic factors for overall survival (OS) in RCC patients with BMs. MethodsData from patients with BMs from RCC treated at Gustave Roussy between April 1992 and March 2016 were retrospectively collected. Age, sex, Eastern Cooperative Oncology Group-Performance Status, Memorial Sloan-Kettering Cancer Center (MSKCC) risk groups, histology, number and site of bone lesions, concomitant metastases (presence and sites), therapy for BMs (radical resection or palliative surgery, radiotherapy and other local and systemic treatments) and time from diagnosis to BMs were analysed. Synchronous solitary bone metastasis (SSBM) was defined as a single BM without concomitant visceral lesions at the initial diagnosis of RCC. OS was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan–Maier method and modelled with Cox regression analysis. ResultsFrom 1750 patients with diagnosis of RCC followed at Gustave Roussy Cancer Campus, 300 patients with BMs were identified. Median time from diagnosis to BMs was 32.4 months (range 0–324 months). In 64 patients (21%), bone was the only metastatic site, and 22 patients (7%) had an SSBM and 236 patients (79%) had concomitant metastases in other sites. Median OS was 23.2 months (95% confidence interval 19.9–26.2). SSBM patients had better OS than those with concomitant metastases (40 vs 20 months; P < 0.001). At multivariate analysis, concomitant metastases remained predictor of poor prognosis, while MSKCC risk group, radical resection and SSBM were predictors of better OS. ConclusionsThis study suggests that MSKCC score, numbers of BMs and radical resection are important prognostic factors for RCC patients with BMs. Additionally, in the presence of solitary BM without concomitant metastases at the initial diagnosis of RCC, bone surgery should be considered to achieve local tumour control and likely increase OS.

Skeletal muscle and solitary bone metastases from malignant melanoma: multimodality imaging and oncological outcome.

Malignant melanoma solitary metastases to bone or skeletal muscle occur in 0.8% of patients. The aim of this study was to evaluate features of skeleton and muscle metastases with multimodality imaging and review the oncological outcome. Thirteen patients with melanoma metastases from January 2006 to February 2016 were included. Histologic confirmation was obtained. Imaging studies included computed tomography (CT), MRI, and/or positron emission tomography/CT. Treatment received and BRAF status were recorded. Differences in BRAF status and overall survival (OS) were analyzed using the χ2-test. Associations between OS and metastases were analyzed using Cox proportional models. Nine (69%) patients showed osseous involvement. Lower extremity bones were affected in three (23%) patients: first toe, right calcaneal spurs, and knee. The spine was involved in three (23%) patients. In two (15%) patients, the pelvic bones were involved. In one (8%) patient, the temporal bone was affected. Nine (70%) patients had a history of malignant melanoma, with a median time to progression of 28 months. The median OS was 18 months: 24 months in patients with a history of melanoma and 3 months in patients with metastases at first diagnosis. The median follow-up duration was 28 months. BRAF mutant versus wild-type tumors showed significant differences in OS (P=0.03). The hazard ratio for death in the metastatic group at diagnosis was 6.83, 95% confidence interval: 1.060–144.072 (P=0.04). Solitary metastases from melanoma to the skeleton and muscle are rare. CT, MRI, and positron emission tomography/CT are useful for the evaluation of musculoskeletal findings. Image findings are not definitive for diagnosing a malignant solitary lesion; thus, a pathologic confirmation with a biopsy is recommended.

“Miner's cap-like” solitary frontal bone metastasis from rectal adenocarcinoma on 18F-FDG PET/CT

The goals of the study are to characterize imaging properties in 2D PET images reconstructed with the iterative algorithm Ordered-Subset Expectation Maximization (OSEM) and to propose a new method for the generation of synthetic images.The noise is analyzed in terms of its magnitude, spatial correlation, and spectral distribution through standard deviation, Autocorrelation Function, and Noise Power Spectrum (NPS), respectively. Their variations with position and activity level are also analyzed. This noise analysis is based on phantom images acquired from 18F uniform distributions. Experimental Recovery Coefficients of hot spheres in different backgrounds are employed to study the spatial resolution of the system through Point Spread Function (PSF). The NPS and PSF functions provide the baseline for the proposed simulation method: convolution with PSF as kernel and noise addition from NPS.The noise spectral analysis shows that the main contribution is of random nature. It is also proven that attenuation correction does not alter noise texture but it modifies its magnitude. Finally, synthetic images of two phantoms, one of them an anatomical brain, are quantitatively compared with experimental images showing a good agreement in terms of pixel values and pixel correlations. Thus, the Contrast to Noise Ratio for the biggest sphere in the NEMA IEC phantom is 10.7 for the synthetic image and 8.8 for the experimental image.The properties of the analyzed OSEM-PET images can be described by NPS and PSF functions. Synthetic images, even anatomical ones, are successfully generated by the proposed method based on the NPS and PSF.Los objetivos del trabajo son caracterizar las propiedades de la imagen 2D PET reconstruida mediante el algoritmo Ordered-Subset Expectation Maximization (OSEM) y proponer un nuevo método de generación de imágenes sintéticas.El ruido se analiza en términos de magnitud, correlación espacial y distribución espectral a través de la desviación estándar, la función de autocorrelación y el espectro de potencias de ruido (Noise Power Spectrum, NPS), respectivamente. También se estudian sus variaciones con la posición y la cantidad de actividad. Este análisis del ruido se realiza sobre imágenes de maniquí a partir de distribuciones de actividad de 18F homogéneas. Para estudiar la resolución espacial del sistema a través de Point Spread Function (PSF) se emplean los coeficientes de recuperación medidos en esferas calientes en diferentes entornos radiactivos. Las funciones PSF y NPS proporcionan la base del método de simulación propuesto: convolución con la PSF como núcleo y adición de ruido a partir del NPS.El análisis del ruido espectral muestra que la principal contribución es de naturaleza aleatoria. También se observa que la corrección de atenuación no altera la textura del ruido pero sí modifica su magnitud. Finalmente, las imágenes sintéticas de dos maniquíes, uno de ellos un cerebro anatómico, son comparadas cuantitativamente con las imágenes experimentales, encontrando un buen acuerdo en términos de valores de píxel y correlaciones entre píxeles. Así, la razón contraste-ruido para la esfera más grande del maniquí NEMA IEC es 10,7 en la imagen sintética y 8,8 en la imagen experimental.las propiedades de las imágenes PET-OSEM pueden ser descritas por las funciones NPS y PSF. Las imágenes simuladas, incluyendo regiones anatómicas, son generadas satisfactoriamente mediante el método propuesto basado en las funciones NPS y PSF.

P2.01-026 Distribution of Metastatic Disease in Survival Outliers with Stage IV Non-Small Cell Lung Cancer

Lung cancer is the leading cause of cancer deaths among men and women in Canada. Many non-small cell lung cancer (NSCLC) patients have metastatic disease at the time of diagnosis, which is associated with poor survival outcomes. However, there appears to be a small subset of patients with advanced disease that live substantially longer than anticipated. Studies have examined the association of various clinical parameters, such as metastatic disease, with survival in cancer patients. Our study aims to determine the impact of metastatic disease burden and distribution on survival in survival outliers with stage IV NSCLC. Data on stage IV NSCLC patients diagnosed 1999-2011 was obtained from the Glans Look Lung Cancer database. Survival outliers were defined as patients who lived >5 years, or >2 standard deviations from mean survival (adenocarcinoma, 47.5 months; squamous cell carcinoma, 57.4 months); patients not meeting survival outlier criteria were defined as average survivors. Clinical characteristics such as age, gender, smoking history, and treatments were compared between survival outliers and patients with average survival. Metastatic disease was evaluated by comparing differences in organ sites, number of metastatic sites, and local versus distant metastases. Fisher's exact test was used to analyze categorical factors, and Wilcoxon rank-sum test was performed to study continuous factors. Statistical analyzes were implemented by R v3.3.0. 1803 stage IV NSCLC patients (1291 adenocarcinoma and 512 squamous cell carcinoma) were identified. In the adenocarcinoma group, there were 29 patients who lived >5 years, and 49 who lived >47.5 months. There were 13 squamous cell carcinoma patients who lived greater than 5 years and >57.4 months. Survival outliers tended to be younger, and had a smaller smoking history. Metastatic disease distribution differed significantly between adenocarcinoma and SCC survival outliers. Among adenocarcinoma patients, longer survival was associated with local metastatic disease (stage M1a), ≤1 site of metastasis at diagnosis, the presence of solitary bone metastasis, and the absence of liver metastasis (all p-values <0.05). In comparison, M1a disease, and the presence of solitary bone metastasis and solitary brain metastasis was associated with longer survival in SCC patients (all p-values <0.05). Survival outliers with local metastatic disease lived longer than patients with distant metastases. There were marked differences in the sites of distant metastases between adenocarcinoma and squamous cell carcinoma patients, and this was associated with differences in survival outcomes. The present study helps us better understand the role of metastatic disease distribution on survival, in hopes of determining important prognostic factors for lung cancer patients in the future.

Diagnostic algorithm, prognostic factors and surgical treatment of metastatic cancer diseases of the long bones and spine.

Oncological management of skeletal metastases has changed dramatically in the last few decades. A significant number of patients survive for many years with their metastases.Surgeons are more active and the technical repertoire is broader, from plates to intramedullary devices to (tumour) endoprostheses.The philosophy of treatment should be different in the case of a trauma-related fracture and a pathological fracture. A proper algorithm for establishing a diagnosis and evaluation of prognostic factors helps in planning the surgical intervention.The aim of palliative surgery is usually to eliminate pain and to allow the patient to regain his/her mobility as well as to improve the quality of life through minimally invasive techniques using life-long durable devices.In a selected group of patients with an oncologically controlled primary tumour site and a solitary bone metastasis with positive prognostic factors, which meet the criteria for radical excision (approximately 10% to 15% of the cases), a promising three to five years of survival may be achieved, especially in cases of metastases from breast and kidney cancer.Spinal metastases require meticulous evaluation because decisions on treatment mostly depend on the tumour type, segmental stability, the patient’s symptoms and general state of health.Advanced radiotherapy combined with minimally invasive surgical techniques (minimally invasive stabilisation and separation surgery) provides durable local control with a low complication rate in a number of patients.Cite this article: EFORT Open Rev 2017;2:372-381.

Does Choline PET/CT Change the Management of Prostate Cancer Patients With Biochemical Failure?

The FDA approved C-11 choline PET/computed tomography (CT) for imaging patients with recurrent prostate cancer in 2012. Subsequently, the 2014 NCCN guidelines have introduced labeled choline PET/CT in the imaging algorithm of patients with suspected recurrent disease. However, there is only scarce data on the impact of labeled choline PET/CT findings on disease management. We hypothesized that labeled-choline PET/CT studies showing local or regional recurrence or distant metastases will have a direct role in selection of appropriate patient management and improve radiation planning in patients with disease that can be controlled using this mode of therapy. This retrospective study was approved by the Tel Aviv Sourasky and Sheba Medical Center's Helsinki ethical review committees. Patient characteristics including age, PSA, stage, prior treatments, and pre-PET choline treatment recommendations based on NCCN guidelines were recorded. Patients with biochemical failure and without evidence of recurrence on physical examination or standard imaging were offered the option of additional imaging with labeled choline PET/CT. Treatment recommendations post-PET/CT were compared with pre-PET/CT ones. Pathologic confirmation was obtained before prostate retreatment. A nonparametric χ test was used to compare the initial and final treatment recommendations following choline PET/CT. Between June 2010 and January 2014, 34 labeled-choline PET/CT studies were performed on 33 patients with biochemical failure following radical prostatectomy (RP) (n=6), radiation therapy (RT) (n=6), brachytherapy (n=2), RP+salvage prostate fossa RT (n=14), and RP+salvage prostate fossa/lymph node RT (n=6). Median PSA level before imaging was 2 ng/mL (range, 0.16 to 79). Labeled choline PET/CT showed prostate, prostate fossa, or pelvic lymph node increased uptake in 17 studies, remote metastatic disease in 9 studies, and failed to identify the cause for biochemical failure in 7 scans.PET/CT altered treatment approach in 18 of 33 (55%) patients (P=0.05). Sixteen of 27 patients (59%) treated previously with radiation were retreated with RT and delayed or eliminated androgen deprivation therapy: 1 received salvage brachytherapy, 10 received salvage pelvic lymph node or prostate fossa irradiation, 2 brachytherapy failures received salvage prostate and lymph nodes IMRT, and 3 with solitary bone metastasis were treated with radiosurgery. Eleven of 16 patients retreated responded to salvage therapy with a significant PSA response (<0.2 ng/mL), 2 patients had partial biochemical responses, and 3 patients failed. The median duration of response was 500±447 days. Two of 6 patients with no prior RT were referred for salvage prostatic fossa RT: 1 received dose escalation for disease identified in the prostate fossa and another had inclusion of "hot" pelvic lymph nodes in the treatment volume. These early results suggest that labeled choline PET/CT imaging performed according to current NCCN guidelines may change management and improve care in prostate cancer patients with biochemical failure by identifying patients for referral for salvage radiation therapy, improving radiation planning, and delaying or avoiding use of androgen deprivation therapy.

Salvage Radiotherapy for Solitary Metachronous Bone Metastasis in Patients with Breast Cancer.

We assessed the efficacy and toxicity of salvage radiotherapy for solitary metachronous bone metastasis (SMBM) in patients with breast cancer. We retrospectively analyzed 17 patients with SMBM who were treated with salvage radiotherapy. First failure was detected as SMBM in all patients. Salvage radiotherapy using three-dimensional treatment planning was performed at a median total dose of 50 Gy. Median daily dose was 2.0 Gy. Median follow-up was 40 months. Local recurrence of SMBM was noted in only two patients. The 3-year overall survival, progression-free survival, and local control rates were 93%, 51%, and 85%, respectively. Median overall and progression-free survival were 74 and 30 months, respectively. Toxicities were mild, and bone fractures were not observed. Salvage radiotherapy for SMBM was able to achieve higher local control rates without severe toxicity, as well as to provide longer progression-free survival; therefore, this may be an effective modality.

151P - Predictors of survival in patients with bone metastasis of lung cancer

Background: In non-small cell lung cancer patients (NSCLC), median survival from the time patients develop bone metastasis is classically described being inferior to 6 months. We investigated the subcategory of patients having skeletal-related-event revealing NSCLC. The purpose of this study was to assess the impact of bone involvement on overall survival and to determine biological and tumoral prognosis factors on OS. Methods: We assessed the survival rates after bone metastasis and prognostic factors in 28 patients with bone metastases from lung cancer. We first assessed the survival rates and explored various prognostic factors of 28 patients with bone metastasis from lung cancer. We then preliminarily ascertained in a small group of patients whether treatment with an EGFR inhibitor had the potential to influence survival. Results: The cumulative survival rates after bone metastasis from lung cancer were 59.9% at 6 months, 31.6% at 1 year, and 11.3% at 2 years. The mean survival was 9.7 months (median, 7.2 months; range, 0.1–74.5 months). A favorable prognosis was more likely in women and patients with adenocarcinoma, solitary bone metastasis, no metastases to the appendicular bone, no pathologic fractures, performance status 1 or less, use of systemic chemotherapy, and use of an epithelial growth factor receptor inhibitor. Conclusions: Bone metastases are a common problem in advanced lung cancer. While the benefits of bone-targeted therapies have been demonstrated, their use is limited in non-trial populations. If better predictive markers of individual risk were available this might increase the appropriate use of bone-targeted agents. Legal entity responsible for the study: S. Jagadeesan Funding: N/A Disclosure: The author has declared no conflicts of interest.

Prognosis of renal cell carcinoma with bone metastases: Experience in 300 consecutive patients.

463 Background: Bone metastases (BMs) are associated with significant morbidity and shorter survival in metastatic renal cell carcinoma (mRCC). Our purpose was to identify prognostic factors for mRCC patients (pts) with BMs. Methods: Data from mRCC pts with BMs, treated at Gustave Roussy between April 1992 and March 2016, were retrospectively collected. Age, sex, ECOG-Performance Status (PS), Memorial Sloan-Kettering Cancer Center (MSKCC) score, histology, number and site of BMs, concomitant metastases (presence and sites), therapy for BMs (radical resection or palliative surgery, radiotherapy, other local and systemic treatments), time to BMs, and outcome were analyzed. Synchronous solitary bone metastasis (SSBM) was defined as a single bone metastasis without concomitant visceral lesions at the initial diagnosis of RCC. Overall survival (OS) was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan-Maier method and modelled with Cox-regression analysis. Results: Three hundred pts were identified. Median time to BMs was 32.4 months (range 0–324 months). In 64 pts (21%), bone was the only metastatic site and 22 of them (7%) had a SSBM; 236 pts (79%) had concomitant metastases in other sites. Median OS was 23.22 months. SSBM pts had better OS then those with concomitant metastases (40 vs. 20 months; p&lt;0.001). At univariate analysis, number of BMs (p&lt;0.0001), spinal column as site of BMs (p&lt;0.005), concomitant metastases (p&lt;0.0001), Fuhrman grade (p&lt;0.001), non-clear cell histology (p&lt;0.003), and MSKCC score (p&lt;0.001) were significantly associated with poor prognosis. At multivariate analysis, concomitant metastases remained predictor of poor prognosis while good MSKCC, radical resection, and SSBM were predictors of better OS. Conclusions: To our knowledge,this is the largest single-institution experience evaluating prognosis in pts with BMs from RCC. This study suggests that MSKCC score, number of BMs (1 vs. &gt;1) and radical resection are prognostic factors. Additionally, in presence of solitary bone metastasis without other concomitant metastases at the initial diagnosis of RCC, bone surgery should be considered to achieve local tumor control and increase survival.

Therapy for non-small cell lung cancer patients with solitary bone metastases

The therapeutic approaches for non-small cell lung cancer (NSCLC) patients with solitary bone metastases include surgery, radiotherapy, chemotherapy and so on. Recently, molecular targeted therapy such as the Denosumab has become a new option. Though there are so many options, the outcomes of the NSCLC with bone metastases are not so good. But for those with solitary bone metastases, radical treatment is necessary to improve the survival time and prognosis. Key words: Bone neoplasms; Carcinoma, non-small-cell lung; Radiotherapy; Antineoplastic agents; Surgical procedures, operative

Massive Skull Metastasis From Follicular Thyroid Carcinoma − How Ignorance Can Harm Your Health

We report a 70 years old female, who presented with huge swellings over the left forehead, left clavicular region, anterior neck, occipital region and the right side of the scalp. The first swelling appeared 8 years back. She had deranged thyroid function tests and highly raised serum thyroglobulin levels. Her T3 level was 300.75 ng/dl (normal range: 40–181 ng/dl); T4 level was 6.7 µg/dl (normal range: 5–10.7 µg/dl) and thyroid stimulating hormone (TSH) level was 0.09 µIU/ml (normal range: 0.5–8.9 µIU/ml). Her serum thyroglobulin level was 30,000 ng/ml (normal range: 0.73–84 ng/ml). We have reported this case due to the unusual presentation of the patient with massive metastatic lesions from a primary thyroid cancer with highly raised serum thyroglobulin levels. Metastatic tumors to the skull are most often from breast, lung and prostate malignancies. In thyroid cancer, Nagamine et al. reported skull metastasis in only 2.5% of the cases. Along with radioactive iodine therapy, curative resection of solitary bone metastasis, wherever possible, is associated with improved survival, especially in younger patients of metastatic thyroid cancer. Only the light of knowledge and health education can dispel the darkness of ignorance. This rare case report highlights the importance of educating the masses, especially the people living in villages, so that it does not take 8 years, as in our case, to present oneself to a tertiary health care facility.

Thyroid papillary carcinoma presenting with femoral neck metastasis: a case report

&lt;p&gt;Thyroid carcinoma is relatively uncommon, accounting for 2% of all cancers. Although they usually present as a neck lump, occasionally they may be presented with a distant metastasis. In this study, a 65 year-old woman was referred to our clinic with a pain on her left hip at both rest and walking. A lytic area at the inferior femoral neck was found with plain radiography. To clarify the characteristics of the lesion, left hip magnetic resonance imaging (MRI) had been performed displaying 3×5 cm hyperintense lesion extending from medial part of the left femoral neck to the left femoral head. Laboratory findings were normal. An open biopsy had then been performed from the left femoral neck with a suspicion of a metastatic tumor. After Immunohistochemical assesment diagnosis was consistent with metastatic thyroid papillary cancer. Proximal femoral resection with clear margins were achieved by proximal femur tumor endoprosthesis. In conclusion, papillary thyroid cancer have an excellent prognosis and doesn’t tend to metastese. But rarely, as seen in our case it can even present with syptoms of metastasic disease. Management strategy is the same as other solitary bone metastasis. Papillary thyroid cancer must be kept in mind as a differential diagnosis in solitary bone metatasis.&lt;/p&gt;

Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis.

We evaluated the prognostic roles of local therapy to bone metastasis (BM) in metastatic renal cell carcinoma (mRCC) patients with BM. This retrospective study included 71 mRCC patients with BM. Local therapy to BM included en bloc resection, curettage, and radiotherapy (RT). RT was classified into RT with biological effective dose (BED) ≥85Gy and <85Gy by its therapeutic intensity. Local therapy to BM was given for 64 patients (90%): en bloc resection, curettage, and RT for 16, 10, and 38 patients, respectively. Fifteen patients received RT with BED ≥85Gy. The median overall survival (OS) was 25months (median follow-up 16months). For 46 patients with solitary BM, patients treated with en bloc resection, curettage, and RT with BED ≥85Gy showed significantly better OS than those treated with RT with BED <85Gy or no local therapy (P=0.006). Because OS was comparable among patients treated with en bloc resection, curettage, and RT with BED ≥85Gy, these three treatment modalities were defined as "intensive local therapy". Intensive local therapy to BM was also associated with favorable OS with marginal significance (P=0.052) in a cohort of 25 patients with multiple BM. A multivariate analysis in the whole cohort revealed that intensive local therapy to BM was independently associated with favorable OS (hazard ratio 0.23, P<0.001) along with Memorial-Sloan Kettering Cancer Center risk category (P<0.001). Thus, intensive local therapy to BM might improve OS in mRCC patients with BM including multiple BM.

간세포암의 근치적 치료 후 발생한 단독 뼈 전이에 대해 다학제적 치료로 완전반응을 얻은 1예

간세포암의 근치적 치료 후 발생한 단독 뼈 전이에 대해 다학제적 치료로 완전반응을 얻은 1예

Effect of synchronous solitary bone metastasectomy and lung cancer resection on non-small cell lung cancer patients.

Lung cancer is the most frequent cause of cancer-associated mortality among men and women globally. The skeleton is one of the most common metastatic sites. The majority of patients exhibiting bone metastases are treated using systemic therapy or symptom-based palliative approaches without surgery. The present study attempted to improve the therapeutic effects of synchronous surgeries in resectable non-small cell lung cancer patients exhibiting solitary bone metastasis. A total of 5 patients underwent synchronous lung cancer resections and solitary bone metastasectomies between October 2009 and November 2011 in the Department of Cardiothoracic Surgery, Shanghai Sixth People's Hospital (Shanghai, China). All patients had received fluorodeoxyglucose positron emission tomography-computed tomography or bone scintigraphy to demonstrate the presence of solitary bone metastasis and to exclude the presence of metastases at alternative sites. The patients received standard lung cancer and mediastinal lymph node resections. In addition, bone lesions were assessed by orthopedists and operated on synchronously with standard procedures. Following surgery, all patients were administered standard chemotherapeutic regimens. Perioperative indicators, including time for thoracic drainage, length of hospital stay, incidence of post-operative complications and progression-free survival (PFS) time, were observed. The average time for post-operative drainage was 4.6±1.1 days, and the average length of post-operative hospitalization was 8.8±2.2 days. All procedures were performed safely with no serious complications. The PFS of the patients was 13.2±7.7 months. While 2 patients presenting with spinal metastases succumbed at ~1 year post-surgery, the remaining 3 patients presenting with limb bone metastases survived for >16 months post-surgery, and were alive at the last follow-up. In conclusion, the present study indicated that a synchronous metastasectomy and lung tumor resection is a safe method of treatment. The PFS time and survival results demonstrated that on the rare occasion that a patient exhibits solitary bone metastasis, aggressive surgical treatment may be a potential therapeutic option.

Solitary bone and brain metastasis in a patient with papillary thyroid carcinoma mimicking cavernous angioma

Solitary bone and brain metastasis in a patient with papillary thyroid carcinoma mimicking cavernous angioma