Spinal Bone Metastases Research Articles

Prognostic factors for survival of women with unstable spinal bone metastases from breast cancer.

BackgroundBone metastases are an important clinical issue in women with breast cancer. Particularly, unstable spinal bone metastases (SBM) are a major cause of severe morbidity and reduced quality of life (QoL) due to frequent immobilization. Radiotherapy (RT) is the major treatment modality and is capable of promoting re-ossification and improving stability. Since local therapy response is excellent, survival of these patients with unstable SBM is of high clinical importance. We therefore conducted this analysis to assess survival and to determine prognostic factors for bone survival (BS) in women with breast cancer and unstable SBM.MethodsA total population of 92 women with unstable SBM from breast cancer who were treated with RT at our department between January 2000 and January 2012 was retrospectively investigated. We calculated overall survival (OS) and BS (time between first diagnosis of bone metastases until death) with the Kaplan-Meier method and assessed prognostic factors for BS with a Cox regression model.ResultsMean age at first diagnosis of breast cancer was 60.8 years ± SD 12.4 years. OS after 1, 2 and 5 years was 84.8, 66.3 and 50 %, respectively. BS after 1, 2 and 5 years was 62.0, 33.7 and 12 %, respectively. An age > 50 years (p < .001; HR 1.036 [CI 1.015–1.057]), the presence of a single bone metastasis (p = .002; HR 0.469 [CI 0.292–0.753]) and triple negative phenotype (p < .001; HR 1.068 [CI 0.933–1.125]) were identified as independent prognostic factors for BS.ConclusionsOur analysis demonstrated a short survival of women with breast cancer and unstable SBM. Age, presence of a solitary SBM and triple-negative phenotype correlated with survival. Our results may have an impact on therapeutic decisions in the future and offer a rationale for future prospective investigations.

SP-0002: The role of radiotherapy for the treatment of brain metastases

Background: External beam radiotherapy is an effective, time-efficient, safe, and cost effective palliative treatment for patients with painful bone metastases. The importance of this therapeutic approach, coupled with complexities of multidisciplinary care, has led to three International Consensus Conference Workshops on Palliative Radiotherapy beginning in 1990 and reconvening every ten years since. The Third International Consensus Conference Workshop was convened in San Diego, California in 2010, and it and paved the way for the publication of the American Society for Radiation Oncology Bone Metastases Guidelines that confirmed the pain relief equivalency between 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, or a single 8 Gy fraction. Methods: Given the rapid rate of advancements in the management of these patients, the decision was made to shorten the interval between conferences and to host the Fourth International Consensus Conference Workshop at the 2015 European Society for Radiation Oncology Meeting. This group will have the opportunity to discuss research updates that have been published since the 2010 International Conference. Results: The recent update on the systemic review of palliative radiotherapy trials for bone metastases by Chow et al confirms previous conclusions regarding the most appropriate fractionation schema. The re-analysis of Radiation Therapy and Oncology Group 97-14 data by Howell et al helps allay fears about late spinal cord toxicity for patients who receive a single 8 Gy fraction for spine bone metastases. The first prospective, randomized data about the safety and efficacy of re-treatment with external beam radiotherapy published by Chow et al provides guidance for the management of patients with recurrent pain to the same skeletal site. Additionally, the growing data for the most appropriate use of highly conformal therapy allows for updated recommendations for the treatment of spine bone metastases, especially in the setting of patients with more favorable prognoses and oligometastases. Lastly, a growing body of data helps to more accurately define the effective combination of external beam radiotherapy with radionuclides, bone strengthening agents, and kyphoplasty or vertebroplasty. Conclusion: The results of the 2015 ESTRO International Consensus Conference Workshop will help to shape the pathways for palliative radiotherapy investigation in the coming years, and it will set the stage for the Fifth Conference to be held in 2020. SP-0002 The role of radiotherapy for the treatment of brain metastases D. Rades University of Lubeck, Radiation Oncology, Lubeck, Germany

Towards adaptive IMRT sequencing for the MR-linac

The MRI linear accelerator (MR-linac) that is currently being installed in the University Medical Center Utrecht (Utrecht, The Netherlands), will be able to track the patient’s target(s) and Organ(s) At Risk during radiation delivery. In this paper, we present a treatment planning system for intensity-modulated radiotherapy (IMRT). It is capable of Adaptive Radiotherapy and consists of a GPU Monte Carlo dose engine, an inverse dose optimization algorithm and a novel adaptive sequencing algorithm. The system is able to compensate for patient anatomy changes and enables radiation delivery immediately from the first calculated segment. IMRT plans meeting all clinical constraints were generated for two breast cases, one spinal bone metastasis case, two prostate cases with integrated boost regions and one head and neck case. These plans were generated by the segment weighted version of our algorithm, in a 0 T environment in order to test the feasibility of the new sequencing strategy in current clinical conditions, yielding very small differences between the fluence and sequenced distributions. All plans went through stringent experimental quality assurance on Delta4 and passed all clinical tests currently performed in our institute. A new inter-fraction adaptation scheme built on top of this algorithm is also proposed that enables convergence to the ideal dose distribution without the need of a final segment weight optimization. The first results of this method confirm that convergence is achieved within the first fractions of the treatment. These features combined will lead to a fully adaptive intra-fraction planning system able to take into account patient anatomy updates during treatment.

Molecular phenotype is associated with survival in breast cancer patients with spinal bone metastases.

To aid in therapy selection for patients with spinal bone metastases (SBM), predictive models have been developed. These models consider SBM from breast cancer a positive predictive factor, but do not take phenotypes based on estrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) receptors into account. The aim of this study was to ascertain whether receptors are associated with survival, when the disease has progressed up to SBM. All patients who were treated for SBM from breast cancer between 2005 and 2012 were included in this international multi-center retrospective study (n = 111). Reports were reviewed for ER, PR and HER2 status and subsequently subdivided into one of four categories; luminal A, luminal B, HER2 and triple negative. Survival time was calculated as the difference between start of treatment for SBM and date of death. Analysis was performed using the Kaplan-Meier method and log-rank tests. Median follow-up was 3.7 years. Survival times in the luminal B and HER2 categories were not significantly different to the luminal A category and were joined into a single receptor positive category. Eighty-five patients (77 %) had a receptor positive phenotype and 25 (23 %) had a triple negative phenotype. Median survival time was 22.5 months (95 %CI 18.0-26.9) for the receptor positive category and 6.7 months (95 %CI 2.4-10.9) for the triple negative category (p < 0.001). Patients with SBM from breast cancer with a triple negative phenotype have a shorter survival time than patients with a receptor positive phenotype. Models estimating survival should be adjusted accordingly.

Spinal bone metastases in gynecologic malignancies: a retrospective analysis of stability, prognostic factors and survival.

BackgroundThe aim of this retrospective study was to evaluate the stability of spinal metastases in gynecologic cancer patients (pts) on the basis of a validated scoring system after radiotherapy (RT), to define prognostic factors for stability and to calculate survival.MethodsFourty-four women with gynecologic malignancies and spinal bone metastases were treated at our department between January 2000 and January 2012. Out of those 34 were assessed regarding stability using the Taneichi score before, 3 and 6 months after RT. Additionally prognostic factors for stability, overall survival, and bone survival (time between first day of RT of bone metastases and death from any cause) were calculated.ResultsBefore RT 47% of pts were unstable and 6 months after RT 85% of pts were stable. Karnofsky performance status (KPS) >70% (p = 0.037) and no chemotherapy (ChT) (p = 0.046) prior to RT were significantly predictive for response. 5-year overall survival was 69% and 1-year bone survival was 73%.ConclusionsRT is capable of improving stability of osteolytic spinal metastases from gynecologic cancer by facilitating re-ossification in survivors. KPS may be a predictor for response. Pts who received ChT prior to RT may require additional bone supportive treatment to overcome bone remodeling imbalance. Survival in women with bone metastases from gynecologic cancer remains poor.

P07.01 * NEUROSURGICAL TREATMENT OF SPINAL TUMORS IN THE ELDERLY

INTRODUCTION: Thanks to the increasing life expectancy and to the improvements made in the treatment of systemic diseases and cancer, combined with advancements in imaging technology, the incidence of spinal tumors has greatly increased in the elderly population. Metastases constitute the majority of lesions, while benign tumors accounts for 25-30% of all spinal neoplasms. The hesitation in performing spinal surgery in aged people is related to the greater likelihood of intra and post-operative complications. Despite this concrete risk, the need for histological diagnosis, root and/or spinal cord decompression, pain relief and improvement of quality of life make surgery quite often a necessary option for this cohort. The primary goal of surgery depends on Histology and tumor extension, but the best surgical result should be faced with the minimal invasiveness, in order to decrease the possible spinal instability and postoperative morbidity and mortality. MATERIALS AND METHODS: We report a series of 70 patients, aged 70 years or more, treated by minimally invasive approach from 2008 to 2013. Forty patients harboured spinal bone metastases, 30 patients benign extramedullary lesions, mainly meningiomas. Surgery was performed to achieve diagnosis and/or decompression of neurological structures; the additional aim for benign lesions was total resection and the further surgical indication for spinal metastases was pain relief. RESULTS: Mono or multisegmental hemilaminectomy in order to preserve the spinal stability was performed in all cases of meningiomas, with gross total removal in 28 patients and subtotal resection in 2 patients. Laminectomy and/or vertebroplasty were performed in the 30% of metastatic cases, followed by internal fixation with screws and rods in the majority of cases in order to reduce back pain primary due to spinal instability. Although this last procedure is not intrinsically minimal invasive, it was performed considering the minimally invasive attitude. Improvement of neurological deficits was achieved in 90% of patients with benign lesions and in the 38 % of spinal metastatic group. In this last group pain relief was also reached in 55% of patients. The rate of mortality, major morbidity and postoperative quality of life was comparable to that of the younger patients. CONCLUSIONS: Until the previous decade, age itself represented quite often a contraindication for surgery, particularly because of the presumed high risk of postoperative morbidity and mortality. Nowadays, planning a tailored anesthetic protocol, surgical strategy and meticulous postoperative assistance, surgical treatment can be offered to this cohort of patients, because their quality of life, referring to neurological deficits and pain, can be greatly improved in the vast majority of cases.

The effect of resistance training during radiotherapy on spinal bone metastases in cancer patients – A randomized trial

PurposeTo compare the effects of resistance training versus passive physical therapy on bone density in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to quantify pathological fractures after combined treatment. Material and methodsIn this randomized trial, 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. Bone density in metastatic and non-metastatic vertebral bone was assessed at baseline, 3 and 6months after RT. ResultsBone density in all metastases increased significantly by 28.3% (IQR 11.4–139.0) and 80.3% (IQR 32.6–250.6) after 3 and 6months in group A (both p<0.01). The bone density in group A was significantly increased compared to control group after 3 and 6months (both p<0.01, median 59.7; IQR 21.1–98.3 and median 62.9; IQR −9.7 to 161.7). The bone density data in group B showed no significant increase over the course of time (p=0.289, median 5.5, IQR 0.0–62.2 and p=0.057, median 52.1, IQR 0.0–162.7). 23.3% of the patients in group A and 30.0% of the patients in group B had pathological fractures, no fracture was assigned to intervention, and no difference between groups after 3 and 6months was observed (p=0.592 and p=0.604). ConclusionsOur trial demonstrated that resistance training concomitant to RT can improve bone density in spinal bone metastases. This combined treatment is effective, practicable, and without side effects for patients. Importantly, the pathological fracture rate in the intervention group was not increased. The results offer a rationale for future large controlled investigations to confirm these findings.Trial registration: Clinical trial identifier NCT01409720.

종양응급 상황에서의 방사선치료의 역할

Purpose. Radiation therapy for oncologic emergencies is an important modality in the management of cancer patients. The aim of the present study was to review the roles of RT in oncologic emergencies based on literature review. Methods. The oncologic emergencies requiring rapid treatment include superior vena cava syndrome, spinal cord compression, brain metastasis, and bone metastasis. We reviewed the literatures on the pathophysiology, diagnosis, and treatment of oncologic emergencies. Results. In this literature review, radiation therapy among treatment modalities for oncologic emergencies has been shown to be fast and very effective treatment modality for oncologic emergencies. Conclusions. Based on this review, we conclude that the literature provides support for the role of radiation therapy in the situation of oncologic emergencies. As the number of cancer patients increase, the prevalence of oncologic emergencies will increase. In the future, the development of RT techniques will provide the improvement of not only patient's quality of life but also the survival.

Distinguishing imaging features between spinal hyperplastic hematopoietic bone marrow and bone metastasis.

Systematic investigations of the distinguishing imaging features between spinal hyperplastic hematopoietic bone marrow and bone metastasis have not been reported, to our knowledge. The purpose of this study was to determine the distinguishing imaging features of the 2 entities. We retrospectively reviewed the radiologic images of 8 consecutive male patients (age range, 52-78 years; mean, 64 years) with suspected spinal metastasis on MR imaging and FDG-PET, which was later confirmed as hyperplastic hematopoietic bone marrow. MR imaging, FDG-PET, CT, and bone scintigraphy images were qualitatively and/or quantitatively evaluated. Imaging findings in 24 patients with spinal metastasis were compared, and differences were statistically analyzed. All 8 vertebral hyperplastic hematopoietic bone marrow lesions were hypointense on T1- and T2-weighted images; lesions contiguous with the adjacent vertebra were significantly more often seen in hyperplastic hematopoietic bone marrow than in metastasis (P = .035). T2 signal intensity of the lesion was significantly different between the 2 entities (P = .033). FDG-PET showed slightly higher uptake in all hyperplastic hematopoietic bone marrow lesions; their maximum standard uptake value was significantly lower than that of metastatic lesions (P = .037). CT attenuation of hyperplastic hematopoietic bone marrow was equal to or slightly higher than that of adjacent normal-appearing vertebra; the CT appearances of hyperplastic hematopoietic bone marrow and metastasis were significantly different (P < .01). Bone scintigraphy showed normal uptake for all vertebrae with hyperplastic hematopoietic bone marrow; the uptake was significantly different from that of metastasis (P < .01). If a lesion was isointense to hyperintense to normal-appearing marrow on MR imaging or had a maximum standard uptake value of >3.6, the lesion was considered metastatic. A normal appearance on CT or bone scintigraphy excluded metastasis.

Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial

BackgroundSpinal bone metastases are commonly diagnosed in cancer patients. The consequences are pain both at rest and under exercise, impairment of activities of daily life (ADL), reduced clinical performance, the risk of pathological fractures, and neurological deficits. The aim of this randomized, controlled pilot trial was to investigate the feasibility of muscle-training exercises in patients with spinal bone metastases under radiotherapy. Secondary endpoints were local control, pain response and survival.MethodsThis study was a prospective, randomized, monocentre, controlled explorative intervention trial to determine the multidimensional effects of exercises for strengthening the paravertebral muscles. On the days of radiation treatment, patients in the control group were physically treated in form of respiratory therapy. Sixty patients were randomized between September 2011 and March 2013 into one of the two groups: differentiated resistance training or physical measure with thirty patients in each group.ResultsThe resistance training of the paravertebral muscles was feasible in 83.3% of patients (n = 25). Five patients died during the first three months. The exercise group experienced no measurable side effects. “Chair stand test” in the intervention group was significant enhanced with additionally improved analgesic efficiency. Patients in intervention group improved in pain score (VAS, 0–10) over the course (p < .001), and was significant better between groups (p = .003) after 3 months. The overall pain response showed no significant difference between groups (p = .158) There was no significant difference in overall and bone survival (survival from first diagnosed bone metastases to death).ConclusionsOur trial demonstrated safety and feasibility of an isometric resistance training in patients with spinal bone metastases. The results offer a rationale for future large controlled investigations to confirm these findings.Trial registrationClinical trial identifier NCT01409720.

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma.

The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.

PO-0878: MRI-based adaptive treatment planning for stereotactic radiotherapy of spinal bone metastases

PO-0878: MRI-based adaptive treatment planning for stereotactic radiotherapy of spinal bone metastases

Measurement of Blood Perfusion in Spinal Metastases With Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Study Design.This was a retrospective study focusing on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess treatment response in patients with spinal metastases.Objective.To demonstrate DCE-MRI changes before and after radiation treatment and correlating with other imaging and clinical findings.Summary of Background Data.Currently, conventional imaging is limited in evaluating early treatment success or failure, which impacts patient care.Methods.Consecutive patients with known spinal metastases underwent DCE-MRI before and after radiotherapy. Perfusion data on 19 lesions were analyzed. Radiotherapy was classified as success (n = 17) or failure (n = 2) on the basis of evidence of tumor contraction (n = 4), negative positron emission tomography (n = 2), or stability for more than 11 months (n = 11). Perfusion parameters blood plasma volume (Vp), time-dependent leakage (Ktrans), area under the curve, and peak enhancement were derived from the signal intensity-time curves and changes in parameter values from pre- to post-treatment were calculated. Curve morphologies were also qualitatively assessed in 13 pre- and 13 post-treatment scans.Results.Vp was the strongest predictor of treatment response (false-positive rate = 9.38 × 10−9 and false-negative rate = 0.055). All successfully treated lesions showed decreases in Vp, and the 2 treatment failures showed drastic increases in Vp. Changes in area under the curve and peak enhancement demonstrated similar relationships to the observed treatment response, whereas changes in Ktrans showed no significant relationship. Signal intensity curve morphologies also demonstrated specificity for active disease (11 of 13) and treated disease (8 of 13).Conclusion.Changes in perfusion, particularly Vp, reflect tumor responses to radiotherapy in spinal bone metastases. These changes were able to predict positive outcomes earlier than 6 months after treatment in 16 of 17 tumors. The ability of DCE-MRI to detect early treatment response has the potential to improve patient care and outcome.

Stereotactic radiosurgery for spinal metastases: a literature review

ABSTRACTObjective:The spine is the most common location for bone metastases. Since cure is not possible, local control and relief of symptoms is the basis for treatment, which is grounded on the use of conventional radiotherapy. Recently, spinal radiosurgery has been proposed for the local control of spinal metastases, whether as primary or salvage treatment. Consequently, we carried out a literature review in order to analyze the indications, efficacy, and safety of radiosurgery in the treatment of spinal metastases.Methods:We have reviewed the literature using the PubMed gateway with data from the MEDLINE library on studies related to the use of radiosurgery in treatment of bone metastases in spine. The studies were reviewed by all the authors and classified as to level of evidence, using the criterion defined by Wright.Results:The indications found for radiosurgery were primary control of epidural metastases (evidence level II), myeloma (level III), and metastases known to be poor responders to conventional radiotherapy – melanoma and renal cell carcinoma (level III). Spinal radiosurgery was also proposed for salvage treatment after conventional radiotherapy (level II). There is also some evidence as to the safety and efficacy of radiosurgery in cases of extramedullar and intramedullar intradural metastatic tumors (level III) and after spinal decompression and stabilization surgery.Conclusion:Radiosurgery can be used in primary or salvage treatment of spinal metastases, improving local disease control and patient symptoms. It should also be considered as initial treatment for radioresistant tumors, such as melanoma and renal cell carcinoma.

Metástasis sacra simulando quiste óseo aneurismático

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with initial suspicion of ABC and confirmed diagnosis of metastasis. The case presented is, to our knowledge, the second case published of spinal cystic bone metastasis with H-FFL pattern with unknown primary tumour at the time of diagnosis and the only one that received resective surgical treatment, achieving pulmonary and metastatic disease control with good quality of life after 1 year of follow up.

A 39-year-old male patient with non-functioning pituitary carcinoma with hepatic and spinal bone metastases

A 39-year-old male patient with non-functioning pituitary carcinoma with hepatic and spinal bone metastases

恶性肿瘤再程放疗18例的疗效和安全性观察

目的：观察恶性肿瘤再程放疗的疗效及安全性。方法：回顾性分析18例接受再程放疗的患者，其中食管癌8例，鼻咽癌5例，椎体转移癌2例，宫颈癌、直肠癌和脑胶质瘤各1例，肿瘤靶区剂量30~50 Gy/10~25 f。结果：全组患者的随访时间为3~42个月，中位时间10个月。对存在可评价病灶者，在放疗结束后3个月时取得完全缓解(CR)者为50%(8例/16例)，部分缓解(PR)为31.2%(5例/16例)，1例稳定(SD)，1人未评估，另1人治疗无效，截至末次随访时间，无进展生存期为5~34个月；另2例椎体转移癌者再程放疗后疼痛症状都明显缓解。毒副反应总体上可耐受。结论：对于放疗后局部病情进展的恶性肿瘤患者，再程放疗有效、可靠。 Objective: To observe the efficacy and safety of re-irradiation for recurrent malignant tumor. Methods: Eighteen patients with recurrent malignant tumor were enrolled, in whom eight patients with esophageal cancer, five with nasopharyngeal cancer, two with spinal bone metastases, one with rectal cancer, one with cervical cancer and one with cerebral glioma. The total dose of GTV was 30 - 50 Gy with 2 - 3 Gy per fraction. Results: Median follow-up time was ten months (range 3 - 42 months). For the sixteen evaluable patients, eight patients had a complete response, five patients had a partial response, one patient had a stable disease, one patient did not receive the evaluation, the symptoms persisted for the last one after radiotherapy, and the time to progression was 5 - 34 months. Radiotherapy also brought considerable relief of pain in both patients with spinal bone metastases. Toxicity was generally tolerable and manageable. Conclusions: For the patients with recurrent tumor, re-irradiation was effective and reliable.

A Case of Nonfunctioning Pituitary Carcinoma That Responded to Temozolomide Treatment

Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.

Stereotactic Radiotherapy with Intensity Modulation for Spinal Bone Metastases

Stereotactic Radiotherapy with Intensity Modulation for Spinal Bone Metastases

Prediction and Diagnosis of Bone Metastases in Well-Differentiated Gastro-Entero-Pancreatic Endocrine Cancer: A Prospective Comparison of Whole Body Magnetic Resonance Imaging and Somatostatin Receptor Scintigraphy

Our purpose was to compare the sensitivity of whole body (WB) magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS) for the diagnosis of bone metastases (BMs) in patients with well-differentiated gastro-entero-pancreatic endocrine cancer (WD-GEP-EC) and to determine predictive factors of BM. WB-MRI and SRS were prospectively performed in 79 patients with bronchial (11), thymic (five), gastric (two), duodeno-pancreatic (24), ileal (26), colic (one), or unknown primary (10) WD-GEP-EC. A total of 36 patients (46%) had 333 BMs involving 119 skeletal segments. WB-MRI and SRS were equally sensitive for detecting patients with BM (86 vs. 81%; P = 0.56), with 33% of the patients diagnosed with only one procedure. WB-MRI detected more BMs than SRS (80 vs. 57%; P = 0.017). Compared with SRS, WB-MRI detected more spine BMs (96 vs. 45%; P < 0.001) and tended to detect more pelvic and lower limb BMs (P = 0.054 and P = 0.06, respectively). Compared with WB-MRI, SRS detected more skull BMs (100 vs. 0%; P < 0.001) and tended to detect more rib BMs (P = 0.08). Sternal and upper-limb BMs were equally detected with WB-MRI and SRS (P = 0.32 and P = 0.46, respectively). Bone staging with SRS and spine MRI rather than WB-MRI would have detected 92% of the patients with BMs and 83% of all BMs. The extent of liver involvement and bronchial-thymic primary tumors were independent predictive factors for BM. We recommend bone staging with SRS and spine MRI in all patients with bronchial-thymic or unknown primary WD-GEP-EC. In case of duodeno-pancreatic or ileal primary, bone imaging may be restricted to patients with liver metastases.