Bone metastases(BM)are a common complication in advanced cancer patients,significantly contributing to morbidity and mortality due to their ability to cause pain,fractures,and spinal cord compression.Radiation therapy...Bone metastases(BM)are a common complication in advanced cancer patients,significantly contributing to morbidity and mortality due to their ability to cause pain,fractures,and spinal cord compression.Radiation therapy(RT)is vital in managing these complications by targeting metastatic lesions to ease pain,improve mobility,and reduce the risk of skeletal-related events such as fractures.Evidence supports the effectiveness of RT in pain relief,showing its ability to provide significant palliation and lessen the need for opioid painkillers,thereby enhancing the overall quality of life(QoL)for patients with BM.However,optimizing RT outcomes involves considerations such as the choice of radiation technique,dose fractionation schedules,and the integration of supportive care measures to mitigate treatment-related side effects like fatigue and skin reactions.These factors highlight the importance of personalized treatment planning tailored to individual patient needs and tumor characteristics.This mini-review aims to provide comprehensive insights into the multifaceted impacts of RT on pain management and QoL enhancement in BM patients,with implications for refining clinical practices and advancing patient care through the synthesis of findings from various studies.展开更多
BACKGROUND Evaluating the psychological resilience of lung cancer(LC)patients helps understand their mental state and guides future treatment.However,there is limited research on the psychological resilience of LC pat...BACKGROUND Evaluating the psychological resilience of lung cancer(LC)patients helps understand their mental state and guides future treatment.However,there is limited research on the psychological resilience of LC patients with bone me-tastases.AIM To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience.METHODS LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University.The psychological scores of the enrolled patients were collected.They were then grouped based on the mean psychological score:Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group.The baseline data(age,gender,education level,marital status,residence,monthly income,and religious beliefs),along with self-efficacy and medical coping mode scores,were compared.RESULTS This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023,with an average psychological resilience score of 63.24±9.96 points.After grouping,the low-score group consisted of 69 patients,including 42 males and 27 females,with an average age of 67.38±9.55 years.The high-score group consisted of 73 patients,including 49 males and 24 females,with a mean age of 61.97±5.00 years.χ2 analysis revealed significant differences between the two groups in education level(χ2=6.604,P=0.037),residence(χ2=12.950,P=0.002),monthly income(χ2=9.375,P=0.009),and medical coping modes(χ2=19.150,P=0.000).Independent sample t-test showed that the high-score group had significantly higher self-efficacy scores(t=3.383,P=0.001)and lower age than the low-score group(t=4.256,P<0.001).Furthermore,multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience[odds ratio(OR)=0.926,P=0.035,95%confidence interval(CI):0.862-0.995],while age(OR=1.099,P=0.003,95%CI:1.034-1.169)and medical coping modes(avoidance vs confrontation:OR=3.767,P=0.012,95%CI:1.342-10.570;resignation vs confrontation:OR=5.687,P=0.001,95%CI:1.974-16.385)were identified as independent risk factors.A predictive model based on self-efficacy,age,and medical coping modes was developed.The receiver operating characteristic analysis showed an area under the curve value of 0.778(95%CI:0.701-0.856,P<0.001),indicating that the model has good predictive performance.CONCLUSION LC patients with bone metastases are less psychologically resilient than the general population.Factors such as self-efficacy,age,and medical coping modes influence their psychological resilience.Patients with low self-efficacy,old age,and avoidance/resignation coping modes should be closely observed.展开更多
To identify the clinical features and independent predictors of survival in patients with bone metastases from prostate cancer （PCa）. We retrospectively analysed 115 PCa patients with bone metastases between 1997 an...To identify the clinical features and independent predictors of survival in patients with bone metastases from prostate cancer （PCa）. We retrospectively analysed 115 PCa patients with bone metastases between 1997 and 2009. The overall survival rate after bone metastases was calculated using the Kaplan-Meier method. The prognostic factors were identified by univariate analysis using a log-rank test and by multivariate analysis using Cox proportional hazards regression models. The follow-up rate was 100%, the follow-up cases during 1, 3 and 5 years were 103, 79 and 55, respectively. The 1-, 3- and 5-year survival rates were 89.1%, 60.9% and 49.8%, respectively, with a median survival time of 48.5 months for patients with bone metastases from PCa. In univariate analysis, age, Gleason score, clinical stage, the number of bone lesions, alkaline phosphatase （ALP） level, invasion of neighbouring organs and non-regional lymph node metastases were correlated with prognosis. By multivariate analysis using Cox regression, ALP level, Gleason score and non-regional lymph node metastases were independent prognostic factors. These prognostic factors will help us to determine the appropriate dose and fraction of radiotherapy for these patients.展开更多
BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among ...BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.展开更多
Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected H...Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected HCC with symptoms due to bone lesions as initial presentation. Morphological characteristics and immunohistochemistry from the examined bone were the key data for diagnosis. None of the patients had an already known chronic liver disease. Differential diagnoses with HCC upon ectopic liver disease or hepatoid adenocarcinoma were shown. Therapy with the orally active multikinase inhibitor sorafenib plus symptomatic treatment was indicated.展开更多
Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytolo...Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate. The primary efficacy parameters were pain scores（NRS）, Corrected serum calcium（CSC） and CSC effective rate The vital signs, biochemical and hematological parameters were determined. Results： Twenty patients were enrolled in this study, twelve patients in zoledronic acid group and eight in pamidronate group. Zoledronic acid and pamidronate significantly palliated pain. Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion（5.92 vs 3.25, P〈0.01; 6.13 vs 4.38, P〈0.01, respectively）. The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively. The CSC effective rate was about 90% at 14 days after infusion in two groups. There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group. An adverse reaction was mild fever after pamidronate infusion and then completely reversible. Conclusion： Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.展开更多
Objective： The aim of our study was to evaluate the efficacy of 89Sr combined with Technetium [^99Tc] Methylene- diphosphonate Injection （^99Tc-MDP） in the treatment of cancer pain in the advanced breast cancers wi...Objective： The aim of our study was to evaluate the efficacy of 89Sr combined with Technetium [^99Tc] Methylene- diphosphonate Injection （^99Tc-MDP） in the treatment of cancer pain in the advanced breast cancers with bone metastases. Methods： A total of 80 patients with various degrees of bone pain due to multiple metastases of breast cancer were treated with ^89Sr combined with ^99Tc-MDP. ^89Sr was given intravenously at 4mCi on day 1 during the 3-month schedule. After 7 days, ^99Tc-MDP was given at 22 rag/day on days 1-10 during the 1-month schedule, for 3 to 6 months. Results： The effective rate of relieving pain was 83.75%. The effective rate of curing bone metastases was 81.25%. So there was a significant improvement in the quality of life of the patients. Conclusion： ^89Sr combined with ^99Tc-MDP are effective in the treatment of cancer pain in the breast cancers with bone metastasis, and can obviously repair the bone destruction caused by metastases, thereby improving the quality of life in advanced breast cancer patients with bone metastases.展开更多
Objective： To evaluate the long-term efficacy and safety of pamidronate disodium in patients with bone lesions secondary to advanced breast carcinoma. Methods： A retrospective chart review was conducted of 62 patie...Objective： To evaluate the long-term efficacy and safety of pamidronate disodium in patients with bone lesions secondary to advanced breast carcinoma. Methods： A retrospective chart review was conducted of 62 patients receiving intravenous pamidronate disodium for metastatic breast cancer. The proportion of patients experiencing at least one skeletal related event （SRE） after 12 months of therapy was determined. Results： The proportion of patients who had an SRE was 29.00% （18 individuals） and the median time to first event was greater than 350 days. Radiotherapy（ll individuals）and pathologic fracture（6 individuals）were the most frequent type of SRE, while cord compression（1 individuals） and hypercalcaemia（0 individuals） were rare. A total of 37 individuals had transient hypocalcaemia without any clinical symptom. No significant creatinine abnormalities were encountered. There were no clinically relevant changes of calcium ,phosphate and creatinine before and after therapy. Conclusion： Long-term treatment with pamidronate disodium significantly reduces and delays skeletal morbidity from osteolytic metastases . Prolonged therapy was well tolerated. This study suggests that the rate of clinically relevant SREs is substantially lower than the event rate observed in phase llI clinical trials.展开更多
A 65-year-old man presented with bone pains and anemia. Skull X-ray revealed multiple osteolytic lesions. The pa- tient was evaluated for multiple myeloma but detailed workup revealed the diagnosis of primary hepatoce...A 65-year-old man presented with bone pains and anemia. Skull X-ray revealed multiple osteolytic lesions. The pa- tient was evaluated for multiple myeloma but detailed workup revealed the diagnosis of primary hepatocellular carcinoma (HCC) with osteolytic bone metastases. Thus, bone metastases due to HCC, although rare, should be considered in patients presenting with bone pains due to os- teolytic lesions.展开更多
Objective:To summarize the experience of diagnosis and treatment outcomes for bone metastatic prostate cancer.Methods:A retrospective study with a total of 128 prostate cancer(Pca) was performed from 2000 to 2005,in o...Objective:To summarize the experience of diagnosis and treatment outcomes for bone metastatic prostate cancer.Methods:A retrospective study with a total of 128 prostate cancer(Pca) was performed from 2000 to 2005,in our institute.We analyzed the clinical features and outcomes of patients with bone metastases and the data and follow-up of 63 bone metastases was collected by one registrar.Cochran Armitage trend test was used for statistic analysis and a P-value of < 0.05 was taken as statistically significant.Results:The mean age was 73(range 55 to 87) years.The PSA level was from 0.083 ng/mL to 6462 ng/mL.Bone metastases morbidity had good relationship with PSA level.With the mean follow up of 30(range 6 to 72) months for 52/63(82.5%) patients,15(28.8%) died from Pca with a mean survival of 21 months and 1 patient with PSA less than 4 ng/mL at the time died from cerebrovascular suddenness 6 months post-treatment.Conclusion:The early effect of endocrine treatment for bone metastases is obvious,and palliative prostatectomy is satisfactory and able to improve the quality of life rapidly for patients with obstructive symptoms.展开更多
Objective: To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8 Gy in single...Objective: To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8 Gy in single fraction, 31 given 20 Gy in 5 fractions, 43 given 40 Gy in 20 fractions. Results and Conclusion: The method of 40 Gy in 20 fractions had a higher pain relief rate and a lower pain relapse rate, suggesting that large-dose fractioned treatment regimen is more appropriate for patients with bone metastasis.展开更多
Introduction: Breast cancer is the most common cancer in women worldwide, accounting for an estimated 22% of all female cancers. It is the leading cause of cancer mortality in women, almost all of which is due to meta...Introduction: Breast cancer is the most common cancer in women worldwide, accounting for an estimated 22% of all female cancers. It is the leading cause of cancer mortality in women, almost all of which is due to metastases, with 73% of metastases occurring in the bone. In oncology, metastable technetium 99-labelled methylene bisphosphonate bone scintigraphy (BS) remains the standard examination for detecting and assessing the extent of bone metastases. The aim of this study was to assess the role of BS in the evaluation and follow-up of breast cancer in Senegal. Methodology: This was a retrospective study of breast cancer patients who underwent bone scintigraphy with <sup>99m</sup>Tc-HMDP in the nuclear medicine department of Idrissa Pouye General Hospital (IPGHO), from July 2009 to June 2022. Results: We enrolled 165 patients, mean age 46.79 years (27 - 87 years). BS was performed in 94.37% of cases for post-therapeutic monitoring and in 5.63% for pre-therapeutic assessment. Results were contributory in 131 patients (92.25%), of whom 72 cases (50.70%) were normal and 59 cases (41.55%) positive or presenting bone metastases;and non-contributory or doubtful in 11 cases (7.75%). Secondary bone locations were multiple in 57 cases (96.61%) and single or solitary in 2 cases (3.39%). The scintigraphic appearance of bone metastases was hyper-fixative in 58 cases (98.31%) and mixed in 1 case (1.69%). Bone lesions were quantified using the Soloway’s grading classification. Conclusion: BS with <sup>99m</sup>Tc-labelled bisphosphonates remains the examination of choice for skeletal exploration, in the detection and extension of bone metastases in breast cancer. Performance has been enhanced by the development of SPECT coupled with CT (SPECT-CT).展开更多
Metastatic renal cell carcinoma(mRCC)presents with bone metastases in around 20%-30%of patients enrolled in the most recent first-line clinical trials.Emergence of several new agents in first line,in both monotherapy ...Metastatic renal cell carcinoma(mRCC)presents with bone metastases in around 20%-30%of patients enrolled in the most recent first-line clinical trials.Emergence of several new agents in first line,in both monotherapy and combination,has significantly improved patient outcomes.However,the activity of such agents on bone metastases is unclear and management of these patients is complex,due to potential complications that can significantly impair quality of life.This review addresses mRCC diagnosis and monitoring and summarizes the current evidence on systemic therapy,ablative therapies such as stereotactic ablative radiotherapy and surgery,and supportive therapy with bone-targeting agents for these patients,with the goal of improving their outcomes.展开更多
Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the inc...Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in different malignancies (P<0.02). The metastatic rates of nasopharyn-geal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P<0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single 'hot spot' in skeletal imaging, particularly in the rib.展开更多
Musculoskeletal alterations in hepatocellular carcinoma(HCC)are less common than liver-related complications.However,they can significantly impact the quality of life and overall prognosis of patients with HCC.The mai...Musculoskeletal alterations in hepatocellular carcinoma(HCC)are less common than liver-related complications.However,they can significantly impact the quality of life and overall prognosis of patients with HCC.The main obstacle in the clinical assessment of HCC-induced musculoskeletal alterations is related to effective and timely diagnosis because these complications are often asym-ptomatic and unapparent during routine clinical evaluations.This narrative literature review aimed to provide a comprehensive overview of the contem-porary literature related to the changes in the musculoskeletal system in patients with HCC,focusing on its clinical implications and underlying etiopathogenetic mechanisms.Osteolytic bone metastases are the most common skeletal alterations associated with HCC,which could be associated with an increased risk of low-trauma bone fracture.Moreover,previous studies reported that osteopenia,sarcopenia,and myosteatosis are associated with poor clinical outcomes in patients with HCC.Even though low bone mineral density and sarcopenia are consistently reported as reliable predictors of pretransplantation and post-transplantation mortality in HCC patients,these complications are frequently overlooked in the clinical management of patients with HCC.Taken together,contemporary literature suggests that a multidisciplinary approach is essential for early recognition and clinical management of HCC-associated musculoskeletal alterations to improve patient prognosis.Further research into the mechanisms and treatment options for musculoskeletal complications is warranted to enhance our understanding and clinical management of this aspect of HCC.展开更多
Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.Methods: We performed a systematic literatur...Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.Methods: We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.Results: In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.Conclusion: CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.展开更多
Some of the most common human cancers, including breast cancer, prostate cancer, and lung cancer, metastasize with avidity to bone. What is the basis for their preferential growth within the bone microenvironment? Bid...Some of the most common human cancers, including breast cancer, prostate cancer, and lung cancer, metastasize with avidity to bone. What is the basis for their preferential growth within the bone microenvironment? Bidirectional interactions between tumor cells and cells that make up bone result in a selective advantage for tumor growth and can lead to bone destruction or new bone matrix deposition. This review discusses our current understanding of the molecu- lar components and mechanisms that are responsible for those interactions.展开更多
To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2...To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.RESULTSA total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSIONPancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.展开更多
Objective:The aim of the study was to observe the efficacies of 89Sr and combination treatments with regional extra-beam radiotherapy for cancer patients with multiple bone metastasis.Methods:A total of 106 patients w...Objective:The aim of the study was to observe the efficacies of 89Sr and combination treatments with regional extra-beam radiotherapy for cancer patients with multiple bone metastasis.Methods:A total of 106 patients were divided into two groups, and each group were 53 patients:the simple 89Sr treatment group (simple group), and local radiotherapy and 89Sr treatment group (combination group).The dose of 4 mci of 89Sr was made in every patient by intravenous injection, 6 MV linear accelerator external irradiation dose was given 30-60 Gy/2-4 weeks.Results:The effective rates of simple and combination groups were respectively 83.01% and 90.56%; the effective improvement rates of the bone focus of two groups were 75.48% and 86.8%, respectively.There was homologous improvement in general conditions.Conclusion:89Sr treatment has a certain effect to the cancers of whole-body multiple bone metastases.And the combined treatment with regional radiotherapy can improve the efficacy and life quality of cancer patients with bone metastasis.展开更多
Introduction: Bone is the most common site of hematogenous metastasis of malignant tumors. Patients with bone metastasis can have a series of bone related adverse events, which seriously affect the quality of life and...Introduction: Bone is the most common site of hematogenous metastasis of malignant tumors. Patients with bone metastasis can have a series of bone related adverse events, which seriously affect the quality of life and survival time of patients. Imaging examination is the main means of clinical diagnosis and evaluation of bone metastasis. Aim of the Work: To evaluate the value of single-photon emission computerized tomography (SPECT) combined with CT and MRI in the diagnosis of bone metastasis of malignant tumors. Subjects and Methods: Eighty patients with bone metastasis from malignant tumors who were admitted to Affiliated Hospital of Chengde Medical College were selected from March 2019 to June 2021. They underwent bone scan with SPECT imaging, CT and MRI separately. The distribution of bone metastasis from primary tumors as well as efficacy of the above three detection methods for bone metastasis was analyzed. Results: A total of 464 lesions were detected by SPECT and CT in the same scanning field, with SPECT detection rate of 92.5% (429/464) and CT detection rate of 77.8% (361/464) (P P P P Conclusion: SPECT may be the preferred screening modality for uspected bone metastases, and when combined with CT and MRI, it can clarify the regional distribution of bone metastasis from malignant tumors and improve the sensitivity, specificity and accuracy of diagnosis with high clinical significance.展开更多
文摘Bone metastases(BM)are a common complication in advanced cancer patients,significantly contributing to morbidity and mortality due to their ability to cause pain,fractures,and spinal cord compression.Radiation therapy(RT)is vital in managing these complications by targeting metastatic lesions to ease pain,improve mobility,and reduce the risk of skeletal-related events such as fractures.Evidence supports the effectiveness of RT in pain relief,showing its ability to provide significant palliation and lessen the need for opioid painkillers,thereby enhancing the overall quality of life(QoL)for patients with BM.However,optimizing RT outcomes involves considerations such as the choice of radiation technique,dose fractionation schedules,and the integration of supportive care measures to mitigate treatment-related side effects like fatigue and skin reactions.These factors highlight the importance of personalized treatment planning tailored to individual patient needs and tumor characteristics.This mini-review aims to provide comprehensive insights into the multifaceted impacts of RT on pain management and QoL enhancement in BM patients,with implications for refining clinical practices and advancing patient care through the synthesis of findings from various studies.
基金Zhejiang Provincial Medical and Health Science and Technology Plan Project,No.2024KY401Zhejiang Provincial Traditional Chinese Medicine Science and Technology Plan Project,No.2024ZF136Zhejiang Province Traditional Chinese Medicine Science and Technology Project,No.2023ZL170.
文摘BACKGROUND Evaluating the psychological resilience of lung cancer(LC)patients helps understand their mental state and guides future treatment.However,there is limited research on the psychological resilience of LC patients with bone me-tastases.AIM To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience.METHODS LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University.The psychological scores of the enrolled patients were collected.They were then grouped based on the mean psychological score:Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group.The baseline data(age,gender,education level,marital status,residence,monthly income,and religious beliefs),along with self-efficacy and medical coping mode scores,were compared.RESULTS This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023,with an average psychological resilience score of 63.24±9.96 points.After grouping,the low-score group consisted of 69 patients,including 42 males and 27 females,with an average age of 67.38±9.55 years.The high-score group consisted of 73 patients,including 49 males and 24 females,with a mean age of 61.97±5.00 years.χ2 analysis revealed significant differences between the two groups in education level(χ2=6.604,P=0.037),residence(χ2=12.950,P=0.002),monthly income(χ2=9.375,P=0.009),and medical coping modes(χ2=19.150,P=0.000).Independent sample t-test showed that the high-score group had significantly higher self-efficacy scores(t=3.383,P=0.001)and lower age than the low-score group(t=4.256,P<0.001).Furthermore,multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience[odds ratio(OR)=0.926,P=0.035,95%confidence interval(CI):0.862-0.995],while age(OR=1.099,P=0.003,95%CI:1.034-1.169)and medical coping modes(avoidance vs confrontation:OR=3.767,P=0.012,95%CI:1.342-10.570;resignation vs confrontation:OR=5.687,P=0.001,95%CI:1.974-16.385)were identified as independent risk factors.A predictive model based on self-efficacy,age,and medical coping modes was developed.The receiver operating characteristic analysis showed an area under the curve value of 0.778(95%CI:0.701-0.856,P<0.001),indicating that the model has good predictive performance.CONCLUSION LC patients with bone metastases are less psychologically resilient than the general population.Factors such as self-efficacy,age,and medical coping modes influence their psychological resilience.Patients with low self-efficacy,old age,and avoidance/resignation coping modes should be closely observed.
文摘To identify the clinical features and independent predictors of survival in patients with bone metastases from prostate cancer （PCa）. We retrospectively analysed 115 PCa patients with bone metastases between 1997 and 2009. The overall survival rate after bone metastases was calculated using the Kaplan-Meier method. The prognostic factors were identified by univariate analysis using a log-rank test and by multivariate analysis using Cox proportional hazards regression models. The follow-up rate was 100%, the follow-up cases during 1, 3 and 5 years were 103, 79 and 55, respectively. The 1-, 3- and 5-year survival rates were 89.1%, 60.9% and 49.8%, respectively, with a median survival time of 48.5 months for patients with bone metastases from PCa. In univariate analysis, age, Gleason score, clinical stage, the number of bone lesions, alkaline phosphatase （ALP） level, invasion of neighbouring organs and non-regional lymph node metastases were correlated with prognosis. By multivariate analysis using Cox regression, ALP level, Gleason score and non-regional lymph node metastases were independent prognostic factors. These prognostic factors will help us to determine the appropriate dose and fraction of radiotherapy for these patients.
基金supported by grants from Zhejiang Provincial Clinical Scientific Research Foundation of China(2013ZYC-A17)Ministry of Health of China(WKJ-ZJ-12)Health Bureau of Zhejiang Province(2013KYB098)
文摘BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.
基金Supported by Department of Gastroenterology and Hepatology of the Hospital Universitario Central de Asturias
文摘Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected HCC with symptoms due to bone lesions as initial presentation. Morphological characteristics and immunohistochemistry from the examined bone were the key data for diagnosis. None of the patients had an already known chronic liver disease. Differential diagnoses with HCC upon ectopic liver disease or hepatoid adenocarcinoma were shown. Therapy with the orally active multikinase inhibitor sorafenib plus symptomatic treatment was indicated.
文摘Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate. The primary efficacy parameters were pain scores（NRS）, Corrected serum calcium（CSC） and CSC effective rate The vital signs, biochemical and hematological parameters were determined. Results： Twenty patients were enrolled in this study, twelve patients in zoledronic acid group and eight in pamidronate group. Zoledronic acid and pamidronate significantly palliated pain. Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion（5.92 vs 3.25, P〈0.01; 6.13 vs 4.38, P〈0.01, respectively）. The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively. The CSC effective rate was about 90% at 14 days after infusion in two groups. There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group. An adverse reaction was mild fever after pamidronate infusion and then completely reversible. Conclusion： Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.
文摘Objective： The aim of our study was to evaluate the efficacy of 89Sr combined with Technetium [^99Tc] Methylene- diphosphonate Injection （^99Tc-MDP） in the treatment of cancer pain in the advanced breast cancers with bone metastases. Methods： A total of 80 patients with various degrees of bone pain due to multiple metastases of breast cancer were treated with ^89Sr combined with ^99Tc-MDP. ^89Sr was given intravenously at 4mCi on day 1 during the 3-month schedule. After 7 days, ^99Tc-MDP was given at 22 rag/day on days 1-10 during the 1-month schedule, for 3 to 6 months. Results： The effective rate of relieving pain was 83.75%. The effective rate of curing bone metastases was 81.25%. So there was a significant improvement in the quality of life of the patients. Conclusion： ^89Sr combined with ^99Tc-MDP are effective in the treatment of cancer pain in the breast cancers with bone metastasis, and can obviously repair the bone destruction caused by metastases, thereby improving the quality of life in advanced breast cancer patients with bone metastases.
文摘Objective： To evaluate the long-term efficacy and safety of pamidronate disodium in patients with bone lesions secondary to advanced breast carcinoma. Methods： A retrospective chart review was conducted of 62 patients receiving intravenous pamidronate disodium for metastatic breast cancer. The proportion of patients experiencing at least one skeletal related event （SRE） after 12 months of therapy was determined. Results： The proportion of patients who had an SRE was 29.00% （18 individuals） and the median time to first event was greater than 350 days. Radiotherapy（ll individuals）and pathologic fracture（6 individuals）were the most frequent type of SRE, while cord compression（1 individuals） and hypercalcaemia（0 individuals） were rare. A total of 37 individuals had transient hypocalcaemia without any clinical symptom. No significant creatinine abnormalities were encountered. There were no clinically relevant changes of calcium ,phosphate and creatinine before and after therapy. Conclusion： Long-term treatment with pamidronate disodium significantly reduces and delays skeletal morbidity from osteolytic metastases . Prolonged therapy was well tolerated. This study suggests that the rate of clinically relevant SREs is substantially lower than the event rate observed in phase llI clinical trials.
文摘A 65-year-old man presented with bone pains and anemia. Skull X-ray revealed multiple osteolytic lesions. The pa- tient was evaluated for multiple myeloma but detailed workup revealed the diagnosis of primary hepatocellular carcinoma (HCC) with osteolytic bone metastases. Thus, bone metastases due to HCC, although rare, should be considered in patients presenting with bone pains due to os- teolytic lesions.
文摘Objective:To summarize the experience of diagnosis and treatment outcomes for bone metastatic prostate cancer.Methods:A retrospective study with a total of 128 prostate cancer(Pca) was performed from 2000 to 2005,in our institute.We analyzed the clinical features and outcomes of patients with bone metastases and the data and follow-up of 63 bone metastases was collected by one registrar.Cochran Armitage trend test was used for statistic analysis and a P-value of < 0.05 was taken as statistically significant.Results:The mean age was 73(range 55 to 87) years.The PSA level was from 0.083 ng/mL to 6462 ng/mL.Bone metastases morbidity had good relationship with PSA level.With the mean follow up of 30(range 6 to 72) months for 52/63(82.5%) patients,15(28.8%) died from Pca with a mean survival of 21 months and 1 patient with PSA less than 4 ng/mL at the time died from cerebrovascular suddenness 6 months post-treatment.Conclusion:The early effect of endocrine treatment for bone metastases is obvious,and palliative prostatectomy is satisfactory and able to improve the quality of life rapidly for patients with obstructive symptoms.
文摘Objective: To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8 Gy in single fraction, 31 given 20 Gy in 5 fractions, 43 given 40 Gy in 20 fractions. Results and Conclusion: The method of 40 Gy in 20 fractions had a higher pain relief rate and a lower pain relapse rate, suggesting that large-dose fractioned treatment regimen is more appropriate for patients with bone metastasis.
文摘Introduction: Breast cancer is the most common cancer in women worldwide, accounting for an estimated 22% of all female cancers. It is the leading cause of cancer mortality in women, almost all of which is due to metastases, with 73% of metastases occurring in the bone. In oncology, metastable technetium 99-labelled methylene bisphosphonate bone scintigraphy (BS) remains the standard examination for detecting and assessing the extent of bone metastases. The aim of this study was to assess the role of BS in the evaluation and follow-up of breast cancer in Senegal. Methodology: This was a retrospective study of breast cancer patients who underwent bone scintigraphy with <sup>99m</sup>Tc-HMDP in the nuclear medicine department of Idrissa Pouye General Hospital (IPGHO), from July 2009 to June 2022. Results: We enrolled 165 patients, mean age 46.79 years (27 - 87 years). BS was performed in 94.37% of cases for post-therapeutic monitoring and in 5.63% for pre-therapeutic assessment. Results were contributory in 131 patients (92.25%), of whom 72 cases (50.70%) were normal and 59 cases (41.55%) positive or presenting bone metastases;and non-contributory or doubtful in 11 cases (7.75%). Secondary bone locations were multiple in 57 cases (96.61%) and single or solitary in 2 cases (3.39%). The scintigraphic appearance of bone metastases was hyper-fixative in 58 cases (98.31%) and mixed in 1 case (1.69%). Bone lesions were quantified using the Soloway’s grading classification. Conclusion: BS with <sup>99m</sup>Tc-labelled bisphosphonates remains the examination of choice for skeletal exploration, in the detection and extension of bone metastases in breast cancer. Performance has been enhanced by the development of SPECT coupled with CT (SPECT-CT).
文摘Metastatic renal cell carcinoma(mRCC)presents with bone metastases in around 20%-30%of patients enrolled in the most recent first-line clinical trials.Emergence of several new agents in first line,in both monotherapy and combination,has significantly improved patient outcomes.However,the activity of such agents on bone metastases is unclear and management of these patients is complex,due to potential complications that can significantly impair quality of life.This review addresses mRCC diagnosis and monitoring and summarizes the current evidence on systemic therapy,ablative therapies such as stereotactic ablative radiotherapy and surgery,and supportive therapy with bone-targeting agents for these patients,with the goal of improving their outcomes.
文摘Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in different malignancies (P<0.02). The metastatic rates of nasopharyn-geal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P<0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single 'hot spot' in skeletal imaging, particularly in the rib.
基金Supported by the Ministry of Science of the Republic of Serbia,No.451-03-1524/2023-04/18the Science Fund of the Republic of Serbia(IDEAS Program),No.7749444,BoFraM Project.
文摘Musculoskeletal alterations in hepatocellular carcinoma(HCC)are less common than liver-related complications.However,they can significantly impact the quality of life and overall prognosis of patients with HCC.The main obstacle in the clinical assessment of HCC-induced musculoskeletal alterations is related to effective and timely diagnosis because these complications are often asym-ptomatic and unapparent during routine clinical evaluations.This narrative literature review aimed to provide a comprehensive overview of the contem-porary literature related to the changes in the musculoskeletal system in patients with HCC,focusing on its clinical implications and underlying etiopathogenetic mechanisms.Osteolytic bone metastases are the most common skeletal alterations associated with HCC,which could be associated with an increased risk of low-trauma bone fracture.Moreover,previous studies reported that osteopenia,sarcopenia,and myosteatosis are associated with poor clinical outcomes in patients with HCC.Even though low bone mineral density and sarcopenia are consistently reported as reliable predictors of pretransplantation and post-transplantation mortality in HCC patients,these complications are frequently overlooked in the clinical management of patients with HCC.Taken together,contemporary literature suggests that a multidisciplinary approach is essential for early recognition and clinical management of HCC-associated musculoskeletal alterations to improve patient prognosis.Further research into the mechanisms and treatment options for musculoskeletal complications is warranted to enhance our understanding and clinical management of this aspect of HCC.
文摘Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.Methods: We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.Results: In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.Conclusion: CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.
文摘Some of the most common human cancers, including breast cancer, prostate cancer, and lung cancer, metastasize with avidity to bone. What is the basis for their preferential growth within the bone microenvironment? Bidirectional interactions between tumor cells and cells that make up bone result in a selective advantage for tumor growth and can lead to bone destruction or new bone matrix deposition. This review discusses our current understanding of the molecu- lar components and mechanisms that are responsible for those interactions.
文摘To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.RESULTSA total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSIONPancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.
文摘Objective:The aim of the study was to observe the efficacies of 89Sr and combination treatments with regional extra-beam radiotherapy for cancer patients with multiple bone metastasis.Methods:A total of 106 patients were divided into two groups, and each group were 53 patients:the simple 89Sr treatment group (simple group), and local radiotherapy and 89Sr treatment group (combination group).The dose of 4 mci of 89Sr was made in every patient by intravenous injection, 6 MV linear accelerator external irradiation dose was given 30-60 Gy/2-4 weeks.Results:The effective rates of simple and combination groups were respectively 83.01% and 90.56%; the effective improvement rates of the bone focus of two groups were 75.48% and 86.8%, respectively.There was homologous improvement in general conditions.Conclusion:89Sr treatment has a certain effect to the cancers of whole-body multiple bone metastases.And the combined treatment with regional radiotherapy can improve the efficacy and life quality of cancer patients with bone metastasis.
文摘Introduction: Bone is the most common site of hematogenous metastasis of malignant tumors. Patients with bone metastasis can have a series of bone related adverse events, which seriously affect the quality of life and survival time of patients. Imaging examination is the main means of clinical diagnosis and evaluation of bone metastasis. Aim of the Work: To evaluate the value of single-photon emission computerized tomography (SPECT) combined with CT and MRI in the diagnosis of bone metastasis of malignant tumors. Subjects and Methods: Eighty patients with bone metastasis from malignant tumors who were admitted to Affiliated Hospital of Chengde Medical College were selected from March 2019 to June 2021. They underwent bone scan with SPECT imaging, CT and MRI separately. The distribution of bone metastasis from primary tumors as well as efficacy of the above three detection methods for bone metastasis was analyzed. Results: A total of 464 lesions were detected by SPECT and CT in the same scanning field, with SPECT detection rate of 92.5% (429/464) and CT detection rate of 77.8% (361/464) (P P P P Conclusion: SPECT may be the preferred screening modality for uspected bone metastases, and when combined with CT and MRI, it can clarify the regional distribution of bone metastasis from malignant tumors and improve the sensitivity, specificity and accuracy of diagnosis with high clinical significance.
