Synchronous Bone Metastases Research Articles

A clinical model to predict the risk of synchronous bone metastasis in newly diagnosed colorectal cancer: a population-based study

BackgroundThe early detection of synchronous bone metastasis (BM) in newly diagnosed colorectal cancer (CRC) affects its initial management and prognosis. A clinical model to individually predict the risk of developing BM would be attractive in current clinical practice.MethodsA total of 55,869 CRC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, of whom 317 patients were diagnosed with synchronous BM. Risk factors for BM in CRC patients was identified using multivariable logistic regression. A weighted scoring system was built with beta-coefficients (P < 0.05). A random sample of 75% of the CRC patients was used to establish the risk model, and the remaining 25% was used to validate its accuracy of this model. The performance of risk model was estimated by receiver operating curve (ROC) analysis.ResultsThe risk model consisted of 8 risk factors including rectal cancer, poorly-undifferentiation, signet-ring cell carcinoma, CEA positive, lymph node metastasis, brain metastasis, liver metastasis and lung metastasis. The areas under the receiver operating curve (AUROC) were 0.903 and 0.889 in the development and validation cohort. Patients with scores from 0 to 4 points had about 0.1% risk of developing BM, and the risk increased to about 30% in patients with scores ≥15 points.ConclusionsThis clinical risk model is accurate enough to identify the CRC patients with high risk of synchronous BM and to further provide more individualized clinical decision.

Bone metastases from head and neck malignancies: Prognostic factors and skeletal-related events.

BackgroundWe conducted a multicenter retrospective analysis to describe the characteristics, frequency of skeletal-related events (SREs), and prognosis of head and neck cancer (HNC) in patients with bone metastases (BM).Patients and methodsThe data of 192 HNC patients with BMs were collected. Analyses were conducted separately in 64 nasopharyngeal cancer (NPC) patients and in 128 non-NPC patients.ResultsSREs occurred in 34 (27%) non-NPC and in 6 (9%) NPC patients, respectively. Median overall survival (OS) was 25 and 6 months in NPC and non-NPC patients, respectively. Locoregional recurrence (hazard ratio [HR] 2.33, 95% confidence interval (CI) 1.1–4.93), synchronous BM (HR 0.25, 95% CI 0.59–0.71) and bone-directed therapies (BDT) (HR 0.26, 95% CI 0.10–0.68) were independent prognostic factors for OS in NPC patients. Combined bone radiotherapy (RT) and BDT in NPC patients obtained longer survival (38 months) than either therapy alone (25 months) or neither of these therapies (8 months).ConclusionsPatients with BMs from non-NPC have a poor prognosis and are at high risk of SREs. NPC patients with BMs are at relatively low risk of SREs. BDT may potentially improve survival, particularly when combined with bone RT. This last finding deserves prospective confirmation.

The clinical feature of bone metastases in lung cancer patients with different pathological types

Objective Based on lung cancer center database, we analyzed the clinical characteristics of lung patients with bone metastases. The relationship between bone metastases, skeletal-related events, survival time and different pathological subtypes of lung cancer were also evaluated in this study. Methods A total of 861 patients with lung cancer were studied from May 2010 to April 2012 at Tianjin Medical University Cancer Institute and Hospital. As to follow-up situation, patients' survival status and treatment information were collected by telephone follow-up and (or) examinationsin outpatient. The clinical characteristics, skeletal-related events and survival of bone metastaticpatients with different pathological types of lung cancer were analyzed. Logistic regression analysis was used to identify risk factors for bone metastases. The relationship between histological subtypes and the incidence of bone metastases was evaluated using Odds Ratios (ORs). The chi-square test was used to compare the proportion of bone metastases, synchronous bone metastases and SREs among different histological subtypes patients. The overall survivals was evaluated using the Kaplan Meier. Results A total of861 patients with lung cancerwere enrolled in this study, including 293 cases with bone metastases.The average follow-up of our population was 14.2 months and the last follow-up time was September 2017. Among different pathological types of lung cancer, adenocarcinoma (39.14%, 173/442) has the highest incidence of bone metastases, followed by other types (29.91%, 35/117), squamous cell carcinoma (29.47%, 56/190) and SCLC (25.89%, 29/112). Spine (59.73%, 175/293) was the most common location site of the bone metastases, followed by the ribs (49.15%, 144/293), pelvis (20.48%, 60/293), femur (16.38%, 48/293) and sternal (16.38%, 48/293). Lung adenocarcinoma was a risk factor for bonemetastases (P=0.002). In ORs analyze, adenocarcinoma patients were more likely to develop bone metastases [OR=1.60, 95%CI (1.21~2.13)]. In our cohort, 58.36% of patients with lung cancer had skeletal related events. Among various types of skeletal related events of patients with bone metastases, the most common one was radiotherapy for bone metastases (51.88%, 152/293), followed by pathological fractures (15.02%, 44/293), spinal cord compression (6.48%, 19/293), bone instability requiring surgery (4.78%, 14/293) and hypercalcemia (1.71%, 5/293). There was no significant difference between different types of skeletal related events. The median survival time of the patients with bone metastases was 11.5 months. There was no significant difference in survival between adenocarcinoma patients and non-adenocarcinoma patients (P=0.111). Conclusion This study suggested that the incidence of bone metastasis in lung adenocarcinoma was 39.14% and lung adenocarcinoma was a risk factor for bone metastases, which supported early screening and monitoring of bone metastasis in the patients. Key words: Lung neoplasms; Pathology; Neoplasm metastasis; Prognosis

Clear cell renal cell carcinoma bone metastasis: What should be considered in prognostic evaluation

IntroductionKnowledge of clear cell renal cell carcinoma bone metastasis (ccRCC-BM) remains scarce. This study depicts clinical, pathological and outcome features of the disease and provides suggestions to establish prognosis prediction system more appropriate for ccRCC-BM. Materials and methodsPatients with ccRCC-BM had clinical, pathological data collected. Kaplan-Meier survival analysis was used for outcome profiles. Prognostic risks were evaluated using MSKCC/Motzer score. Univariate and multivariate logistic regression were performed to investigate association between clinical, pathological features and prognosis. ResultsIn the series containing 106 ccRCC-BM patients with 4:1 male predominance, 44.3% of them had synchronous bone metastasis and 28.3% had multi-organ metastasis. Axial bone was prone to bone metastasis and the incidence of severe skeletal-related events was 54.7%. Curative bone lesion resection was performed in 70.7% patients. The median overall survival (mOS) time was 45 months for all and 32 months for those in unfavorable risk stratification. Shorter time to bone metastasis (TTBM) [OR 1.019, 95% CI (1.007, 1.031)], elderly age [OR 1.040, 95% CI (1.001, 1.080)], concomitant multi-organ metastasis [OR 3.883, 95% CI (1.375, 10.967)] and carbonic anhydrase (CA)-IX expression loss [OR 58.824, 95% CI (2.653, 1000)] were associated with poor prognosis. ConclusionThe outcome of ccRCC-BM remained poor in unfavorable risk stratification. Bone lesion resection accompanied by systematic therapy for selected patient could improve prognosis. Shorter TTBM, elderly age, concomitant multi-organ metastasis and the expression loss of CA-IX along with gender-bias, feasibility for surgical treatment are suggested to be incorporated in modified ccRCC-BM-specific prognosis prediction system.

Bone, muscle, and metabolic parameters predict survival in patients with synchronous bone metastases from lung cancers.

Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.

PATHOLOGICAL FRACTURES DUE TO BONE METASTASES FROM LUNG CANCER: RISK FACTORS AND SURVIVAL.

ABSTRACTIntroduction:Pathological fractures are frequent skeletal-related events among lung cancer patients, which result in high morbidity and decreased overall survival and make operative treatment decisions challenging.Objectives:To identify risk factors associated with the occurrence of pathological fractures in patients with lung cancer and to determine survival.Methods:We conducted a retrospective cohort study with 407 lung carcinoma patients diagnosed between 2006 and 2015. The prevalence of bone metastases and pathological fractures was calculated. Statistical analysis was conducted using a chi-squared test, and the odds ratio and 95% confidence interval were calculated. Overall survival was determined using the Kaplan-Meier method and differences were compared using the log-rank test.Results:The prevalence of bone metastases and pathological fractures was 28.2% (n = 115) and 19.1% (n = 22), respectively. Pathological fractures were more frequent among patients with bone metastases at the time of diagnosis of lung cancer (24.7% [n = 20] vs. 5.9% [n = 2]; p < 0.05). The median overall survival following the diagnosis of lung cancer, bone metastases, and pathological fracture was 6, 4, and 2 months, respectively.Conclusions:Pathological fracture was associated with synchronous bone metastases and overall survival times were considerably reduced. Level of Evidence IV, Case Series.

Prognostic Factors and Treatment Outcome of Nasopharyngeal Carcinoma with Bone Metastases

This study was aimed to investigate prognostic factors of nasopharyngeal carcinoma (NPC) patients with bone metastases. A total of 72 NPC patients with bone metastases were treated in Salah Azaiz Cancer Institute between 2000 and 2012. Of the 72 patients, 33 patients had synchronous bone metastasis and 39 had metachronous bone metastasis. The survival rate was calculated by Kaplan-Meier method and compared by log-rank test. The 2- and 5- year survival rates of the 72 patients were 45.4 % and 21.7 %, respectively. The median survival was 23 months (range 2–144 months). Univariate analysis showed that the patients with synchronous bone metastasis had significantly poorer overall survival (OS) than that of the patients with metachronous bone metastasis (14 vs. 28 months, P=0.004). The use of biphosphonate therapy was a prognostic factor of NPC with bone metastasis. Patients with only single bone metastases had better survival. Our study revealed that the time of metastases and the use of biphosphonates were prognostic factors associated with better OS. Curative treatment should be considered for patients with single bone metastasis.

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.

The relationship between lung cancer histology and the clinicopathological characteristics of bone metastases

ObjectivesLung cancer is the leading cause of death due to cancer, and bone is one of the most frequent sites of metastasis. However, there is no published evidence regarding an association between lung cancer histology and skeletal complications. Therefore, we evaluated the influence of lung cancer histology on the frequency of bone metastases (BMs), skeletal-related events (SREs), and survival after BM. Material and methodsThis retrospective study evaluated medical records from 413 patients who were diagnosed with lung cancer between 2003 and 2012. The prevalences of BMs and SREs were calculated, and their associations with the histological subtypes were evaluated using the chi-square test, odds ratios (OR), and 95% confidence intervals (CI). Overall survivals and associations with the histological subtypes were evaluated using the Kaplan-Meier method and the log-rank test. ResultsThe prevalences of BM, synchronous BM, and SREs were 28.2%, 70.4%, and 68.7%, respectively. Adenocarcinoma was the most common histological subtype (46.7%), and was significantly more frequent among patients with BM (58.3% vs. 42.1%; p=0.003; OR: 1.92; 95% CI: 1.29–2.97). Squamous cell was significantly less frequent among patients with BM (13.0% vs. 29.8%; p=0.0004; OR: 0.35; 95% CI: 0.19–0.64). The median survival time after the first BM diagnosis was 4 months, and there was no significant difference in the survival periods for the various histological subtypes. ConclusionAdenocarcinoma and squamous cell were significantly associated with higher and lower risks of developing BM, respectively.

Does the onset of bone metastasis in sunitinib-treated renal cell carcinoma patients impact the overall survival?

To evaluate the impact of bone metastasis (BM) onset toward prognosis in metastatic renal cell carcinoma (mRCC) patients treated with sunitinib. mRCC patients with BM and sunitinib as first targeted therapy between May 2005 and December 2012 were retrospectively analyzed. Patients with synchronous (s) BM or metachronous (m) BM were compared with regard to treatment and outcome [time to clinical progression (TTcP), overall survival (OS), skeletal-related events (SRE)]. Descriptive statistics, Kaplan-Meier estimation of TTcP and OS, Cox regression analyses, and a landmark analysis were administered. BM was identified in 127 mRCC patients; thereof, 82 sunitinib-treated patients were analyzed [sBM n=57 (69.5%), mBM n=25 (30.5%)]. Higher tumor grading (p=0.029), male predominance (p=0.02), and less second-line therapy (p=0.001) were detected in sBM compared to mBM. SRE remained similar between subgroups (p=0.462). TTcP during sunitinib was similar [median sBM 8.1 (95% CI 3.9-12.3) vs. mBM 8.7 (95% CI 2.7-14.8) months, p=0.903]. OS remained significantly inferior in sBM patients compared to mBM [median sBM 21.1 (95% CI 16-26.2) months vs. mBM 38.5 (95% CI 15-62) months, p=0.001], which was confirmed by landmark analyses at 1.5, 3, 6, 9, and 12months. However, OS after occurrence of BM was similar in both groups [median sBM 24.2 (95% CI 17.3-31.1) months vs. mBM 17.2 (95% CI 8.4-26) months, p=0.519]. mBM is associated with an improved OS compared to sBM in mRCC with sunitinib treatment, despite similar efficacy of sunitinib treatment in both groups of patients.

Late onset of bone metastases as a prognostic parameter in metastatic renal cell cancer (mRCC): A single-center experience in 82 mRCC patients treated with sunitinib.

523 Background: Bone metastasis (BM) is considered a negative prognostic marker in metastatic renal cell carcinoma (mRCC). Here, we address the impact of BM onset on overall survival (OS) in mRCC patients during targeted therapy. Methods: Patients with BM who received sunitinib (SU) as 1st targeted treatment at our center between May 2005 and December 2012 were included in this retrospective analyzes. Treatment was performed according to local standard and patients were followed for survival. Spine surgery, fracture or irradiation were considered skeletal related events (SRE). Results: Out of 128 mRCC patients with BM, 82 patients had SU as 1st line targeted agent. 57 (69.5%) patients suffered from BM at initial diagnosis of mRCC (=synchronous BM [sBM]), while 25 (30.5%) patients developed BM during treatment course (=metachronous BM [mBM]). Baseline characteristics showed different histological gradings for sBM compared to mBM patients (p=0.029) and higher frequency of ≥3 metastatic organ sites prior to SU for sBM patients (sBM: n=40 [70.2%] vs. mBM: n=10 [40%], p=0.016). In Kaplan-Meier analysis, sBM patients showed a reduced mean OS from SU start (sBM 23.5 [95%CI:18.6-28.3] vs. mBM 41.3 [95%CI:31.7-50.9] month, p=0.001), whereas PFS during SU treatment was similar (sBM: 8.1 [95%CI:3.9-12.3] vs. mBM: 8.7 [95CI:2.7-14.8] months, p=0.93). Bisphosphonate treatment and SRE revealed no differences between subgroups (p=0.62), while spinal compression occurred in 6 patients with sBM, but none with mBM (p=0.153). 2nd-line targeted agents were less frequently administered in sBM patients (sBM n=17 vs. mBM: n=10). Multivariate Cox-regression confirmed MSKCC score (OR: 2.6 [95%CI:0.99-7.28], p=0.052), liver metastases (OR: 2.66 [95%CI:1.28-5.51], p=0.009], and sBM [OR: 2.45 [95%CI:1.19-5.08], p=0.016) as independent prognostic parameters for reduced OS after SU start. Conclusions: In our cohort, OS in patients with sBM was significantly reduced compared to mBM patients, despite similar PFS with SU and SRE rate. Despite the lower incidence of subsequent therapies in sBM, a more aggressive biology is likely to be the cause of these findings.

Aspects anatomocliniques des métastases cérébrales des carcinomes nasopharyngés

Metastasis to the central nervous system, either through a hematogenous route or through the cerebrospinal fluid, is extremely rare in nasopharynx cancer. We aim to expose clinical aspects, therapeutic features and prognosis of nasopharyngeal carcinoma with brain metastases. We retrospectively reviewed the medical history of about 420 patients with nasopharyngeal carcinoma treated during 17 years at the university hospital of Sfax (Tunisia). Among them, three patients had brain metastasis. We excluded patients with direct extension to the brain. Tumours of the nasopharynx were locally advanced. The first patient had brain metastases at the initial diagnosis. The two other patients had brain metastases at 10 and 16 months during the follow-up. Ocular signs were the symptoms. Lesions were unique in two patients. Synchronous bone metastases were recorded in the three cases. All patients had whole brain radiation therapy and palliative chemotherapy. All patients had a progression of the disease and died. Brain metastases in nasopharynx cancer represent a rare event. Prognosis is poor, depending on age, surgical excision and synchronous metastases. Survival does not exceed 6 months.

Fifteen-year Survivor of Renal Cell Carcinoma After Metastasectomies for Multiple Bone Metastases

This article describes a patient with multiple metastases from renal cell carcinoma who survived and maintained an ambulatory status for 15 years with no recurrence in the spine after en bloc resection of solitary spinal metastasis. Skeletal metastasis from renal cell carcinoma is common, second only to lung metastasis. Surgery plays an important role in the treatment of the metastasis because of its resistance to chemotherapy and radiotherapy. A 60-year-old man had T1N2M1 renal cell carcinoma in the right kidney and synchronous bone metastases at T12 vertebral body and the right humerus. The patient underwent right nephrectomy and en bloc resection of T12 metastasis at the same time using a retroperitoneal approach. He also underwent curetted total excision of metastasis in the right humerus. He underwent radiotherapy and an additional 7 tumor excision surgeries in the right humerus due to repeated tumor recurrences and a pulmonary metastasectomy in the right lung. Thirteen years after initial surgery, he underwent right forequarter amputation due to tumor recurrence and surgical site infection. Fifteen years after initial surgery, he is still alive with no evidence of disease. He has been ambulatory with no tumor recurrence in the spine for 15 years. En bloc resection of solitary spinal metastasis allowed the patient to be ambulatory without recurrence. This contrasts with curetted total excision of bone metastasis in the humerus that resulted in repeated recurrences and surgeries and loss of the arm.

18F-fluorodeoxyglucose positron emission tomography–computed tomography for the evaluation of bone metastasis in patients with gastric cancer

The roles of positron emission tomography and bone scanning in identifying bone metastasis in gastric cancer are unclear. We compared the usefulness of positron emission tomography-computed tomography and scanning in detecting bone metastasis in gastric cancer. Data from 1485 patients diagnosed with gastric cancer who had undergone positron emission tomography-computed tomography and scanning were reviewed. Of 170 enrolled patients who were suspected of bone metastasis in either positron emission tomography or scanning, 81.2% were confirmed to have bone metastasis. The sensitivity, specificity, and accuracy were 93.5%, 25.0%, and 80.6%, respectively, for positron emission tomography and 93.5%, 37.5%, and 82.9%, respectively, for scanning. 87.7% of patients with bone metastasis showed positive findings on two modalities. 15.0% of solitary bone metastases were positive on positron emission tomography only. Positron emission tomography was superior to scanning for the detection of synchronous bone metastasis, but the two modalities were similar for the detection of metachronous bone metastasis. The concordance rate of response assessment after treatment between two modalities was moderate. Positron emission tomography-computed tomography may be more effective for the diagnosis of bone metastasis in the initial staging workup. Conversely, bone scanning and positron emission tomography-computed tomography may be similarly effective for the detection of metachronous bone metastasis.

Role of breast surgery in T1-3 breast cancer patients with synchronous bone metastases

The impact of breast surgery on survival of metastatic breast cancer (MBC) patients is controversial. We addressed the question in a mono-institutional series of MBC patients with synchronous bone metastases. We identified 187 consecutive women diagnosed between 2000 and 2008 with locally operable (T1-T3) MBC, synchronous bone metastases, with no other distant sites being involved. Progression-free survival (PFS) and overall survival (OS) were compared between operated and non-operated patients. Median age was 51 years; 92 % of the women had a hormone-positive tumor. At the time of diagnosis, 131 patients out of 187 (70 %) underwent surgery. Operated and non-operated patients differed in terms of number of bone metastatic sites: a single metastasis was detected in 35 (28 %) operated, and 6 (11 %) non-operated cases (P = 0.01). No other significant differences were observed. The multi-adjusted hazard ratio was 0.63 (95 % CI 0.43-0.92) for PFS and 0.64 (95 % CI 0.41-0.99) for OS in favor of surgery. The 5-year cumulative incidence of ipsilateral breast skin progressions among non-operated patients was 18 %. In this large and homogeneous series of MBC patients with synchronous bone metastases, the role of breast surgery had a favorable impact on both disease progression and mortality.

Role of breast surgery in T1-T3 breast cancer patients with synchronous bone metastases.

1115 Background: The role of breast surgery in advanced breast cancer (ABC) is controversial. The main potential advantage of removing the primary tumor is to eliminate the source of further metastatic spread. While previous studies addressed the question in very heterogeneous populations (e.g. patients with any local and distant extension), we have focused on a homogeneous series of ABC patients. Methods: From our institutional Tumor Registry we selected 191 consecutive women diagnosed between 2000 and 2008 with locally operable (T1-T3) ABC, synchronous bone metastases and no other distant sites involved. The progression free survival (PFS) was calculated from diagnosis to the date of progression, defined as either a new site of metastatic disease or clinical/radiographic evidence of increasing tumor burden at a previously known bone metastatic site. Results: Median age was 51 years and 92% of the women had an endocrine-responsive tumor. One-hundred and thirty patients out of 191 (68%) underwent surgery at the time of diagnosis, while 61 (32%) did not. Twenty-six of the operated patients (20%) had previously undergone neoadjuvant chemotherapy; 15 (12%) had positive or undetermined surgical margins. Operated and non-operated patients were similar with respect to age, tumor size, nodal involvement, estrogen and progesterone receptor status, HER2 overexpression and Ki-67, but differed in terms of number of bone metastatic sites: a single metastasis was detected in 34 (26%) operated and 7 (11%) non-operated cases (P=0.02). First-line treatment strategies with endocrine therapy, chemotherapy and Trastuzumab were similarly distributed between the two groups. The 5-year PFS was 22.0% and 10.4% in operated and non-operated patients, respectively. The multi-adjusted hazard ratio was 0.62 (95% confidence interval 0.39-0.98) in favor of surgery. The exclusion of the patients who had received neoadjuvant chemotherapy and patients with positive or undetermined surgical margins did not alter the results. Conclusions: In this large and homogeneous series of ABC patients with synchronous bone metastases, the role of breast surgery had a favorable impact on the progression of the disease, indicating a potential survival benefit.

Mo1564 The Efficacy of 18F-FDG PET-CT and Wbbs in Detecting Bone Metastasis of Gastric Cancer: A Single-Center, Large-Volume Study in Korea

Background/Aims: The role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-computed tomography (CT) and whole body bone scan (WBBS) in identifying bone metastasis in gastric cancer is not clear. We compared the usefulness of PET-CT and WBBS in detecting bone metastasis in patient with gastric cancer. Methods: 1,485 patients who were diagnosed as gastric cancer and taken PET-CT or WBBS were retrospectively reviewed from January 2003 to August 2011. 114 patients were enrolled and 73.2% of the patients were confirmed as bone metastasis. Positive indicators of bone metastasis were based on following criteria: presence of multiple asymmetric foci of increased radionuclide uptake over the skeleton on either PET-CT or WBBS without reasonable explanation other than metastasis; histologic examination; compatible findings on CT or MRI; and one or more equivocal lesions on PET-CT or WBBS with obvious progression on follow up examinations. Bone metastasis was confirmed when one or more criteria were met. Results: The mean duration from the diagnosis of gastric cancer to skeletal metastasis was 23.2 months. 78.6% of patients with skeletal metastasis had undifferentiated histology by Japanese classification and 69.0% had metachronous bone metastasis. Most of the patients (84.5%) had multiple bone metastasis and common sites were in order from the vertebra, pelvis, and ribs. The sensitivity, specificity, and accuracy of PET-CT were 88.1%, 10.0%, and 67.5% respectively. WBBS showed higher sensitivity, specificity, and accuracy than PET-CT such as 97.6%, 46.7%, and 84.2% respectively. When analyzed according to image modality, 85.7% of the patients with bone metastasis showed positive findings at both PET-CT and WBBS. Most of synchronous bone metastasis showed positive findings at both studies, however 15.5% of metachronous bone metastasis were positive at WBBS only. Based on the sites of bone metastasis, WBBS was more sensitive in detection of axial bones such as the vertebrae than PET-CT. Serologic markers such as alkaline phosphatase, CEA, and CA199 didn't show a significant difference between two studies. The concordance rate of response after treatment between PET-CT and WBBS was low (k=0.116). Conclusions: WBBS is more sensitive and specific than PET-CT for detecting bone metastasis in gastric cancer. Especially, WBBSmay bemore effective to detect metachronous bonemetastasis than PET-CT. For tumor assessment after treatment, both studies may be complementary due to low concordance rate between two studies.

Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case report

Early gastric cancer (EGC) is defined as an adenocarcinoma confined to the gastric mucosa or submucosa, regardless of the presence of lymph node metastases. Early gastric cancer carries an excellent prognosis, with a 5-year survival rate at least 85% in most series. However, there are rare cases where distant metastases exist. Bone metastases are rare in gastric cancer; osteoblastic bone metastases are even rarer. We report a patient with EGC (mucosal) and synchronous osteosclerotic bone metastasis. To our knowledge, this is the first reported case of submucosal EGC with synchronous bone metastases. The patient was operated and he received adjuvant chemotherapy and radiotherapy. He died 18 months after gastric surgery from generalized disease.

Hypofractionated High-Dose Intensity-Modulated Radiotherapy (60 Gy at 2.5 Gy per Fraction) for Recurrent Renal Cell Carcinoma: A Case Report

A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensity-modulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy.

A case of synchronous relapse of breast cancer and uterine mullerian adenosarcoma after adjuvant tamoxifen in a pre-menopausal woman

20533 Background: Uterine müllerian adenosarcoma is a rare tumor of postmenopausal women. An increase in its incidence with the use of tamoxifen therapy for breast carcinoma is reported in several studies. Methods: We report a case of 42 years multigravida, premenopaused woman with breast carcinoma, who presented - after four years of use of adjuvant tamoxifen - a synchronous liver, bone, and lung metastasis of breast cancer with müllerian adenosarcoma. Results: Immunohistochemical stains on uterine tumor for estrogen and progesterone receptors showed positivity for both epithelial and stromal cells, actin, desmin and proliferative index (MIB-1) showed positivity for stromal cells only. The patient underwent a hysterectomy followed by palliative chemotherapy. The patient deceased at 14 months after her relapse because of progressive disease (cerebral, bone, liver and lung metastasis). Conclusion: Our case is the only one reported in the literature with synchronous relapse of the breast adenocarcinoma and a Müllerian adenosarcoma. Also it's of the rare cases occurring in a pre-menopaused woman since all except two cases were postmenopausal. [Table: see text] No significant financial relationships to disclose.