Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese Orthopedic Association, Japanese Urological Association, and Japanese Society for Radiation Oncology

Abstract

Diagnosis and treatment of bone metastasis requires various types of measures, specialists and caregivers. To provide better diagnosis and treatment, a multidisciplinary team approach is required. The members of this multidisciplinary team include doctors of primary cancers, radiologists, pathologists, orthopaedists, radiotherapists, clinical oncologists, palliative caregivers, rehabilitation doctors, dentists, nurses, pharmacists, physical therapists, occupational therapists, medical social workers, etc. Medical evidence was extracted from published articles describing meta-analyses or randomised controlled trials concerning patients with bone metastases mainly from 2003 to 2013, and a guideline was developed according to the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Multidisciplinary team meetings are helpful in diagnosis and treatment. Clinical benefits such as physical or psychological palliation obtained using the multidisciplinary team approaches are apparent. We established a guideline describing each specialty field, to improve understanding of the different fields among the specialists, who can further provide appropriate treatment, and to improve patients’ outcomes.

Independent External Validation of a Score Predicting Survival After Radiotherapy for Bone Metastases and Expansion to Patients Treated With Single Fraction Radiotherapy

“…The purpose of the present study was independent external validation of the Rades et al score and, in addition, its application in patients who received single fraction irradiation, a convenient option currently endorsed in several guidelines [18][19][20][21]. The optimal utilization rate of single fraction radiotherapy is unknown and depends on institutional case mix.…”

“…Subsequent meta-analyses have confirmed the equal effectiveness of a single dose schedule compared to more protracted regimens [15][16][17]. Several guidelines and consensus reports recommend a single fraction of 8 Gy as preferred radiotherapy schedule for patients with uncomplicated bone pain, that is, for bone lesions not causing neurological complaints and without a high risk of pathological fracture [18][19][20][21]. Among the randomized trials comparing single versus multiple fractions for painful bone metastases, retreatment rates were consistently higher after the single dose schedules.…”

Current status and future directions in the treatment of bone metastases from breast cancer

“…1,11,13 These observations suggest that effective treatment options to eradicate bone metastasis should rely on the combination of bonetargeted agents in association with different local and/or systemic antitumour treatment. 6,12,13,[17][18][19][20] This would entail a multidisciplinary approach involving medical oncologists, radiotherapists, orthopaedic surgeons, intervention radiologists and others. 1,[11][12][13][17][18][19][20] Other pitfalls of current clinical treatment, in particular, treatment involving the systemic administration of antiresorptive drugs and/or antitumour agents and/or radiopharmaceuticals, include the negative effects exerted by these agents on the normal bone metabolism, which may result in detrimental consequences for cancer patients.…”

“…6,12,13,[17][18][19][20] This would entail a multidisciplinary approach involving medical oncologists, radiotherapists, orthopaedic surgeons, intervention radiologists and others. 1,[11][12][13][17][18][19][20] Other pitfalls of current clinical treatment, in particular, treatment involving the systemic administration of antiresorptive drugs and/or antitumour agents and/or radiopharmaceuticals, include the negative effects exerted by these agents on the normal bone metabolism, which may result in detrimental consequences for cancer patients. 1,6,13,19,20 These findings indicate the need to develop novel therapeutic options that, based on the hallmarks of bone metastasis, can effectively thwart tumour cell growth while, at the same time, overcoming antitumour drug-induced bone loss and preserving bone health.…”

“…1,6,13,19,20 These findings indicate the need to develop novel therapeutic options that, based on the hallmarks of bone metastasis, can effectively thwart tumour cell growth while, at the same time, overcoming antitumour drug-induced bone loss and preserving bone health. 1,11,13,17,19,20 In this setting, new emerging bone-targeting therapies are based on the use of molecules which specifically hinder bone resorption or stimulate osteoblastic activity F I G U R E 1 Emerging potential therapeutic targets in the treatment of bone metastases from breast cancer (see text for details)…”