Diagnosis, Management and Clinical Outcome of Bone Metastases in Breast Cancer Patients: Results from a Prospective, Multicenter Study

Abstract

Background: Little information is available about the management and clinical outcome of bone metastases (BM) in breast cancer patients. Methods: We prospectively studied 459 breast cancer patients with first diagnosis of BM for at least 2 years to collect information about diagnosis, management and clinical outcome. Results: Two hundred and forty-eight patients (54%) had only BM, 86 (18.7%) had concomitant nonskeletal BM and 125 (27.2%) had previous nonskeletal BM. At enrolment, skeletal-related events were present in 132 patients (28.8%). Cancer treatments consisted of hormones (227/459, 49.5%) or chemotherapy (192/459, 41.8%). Age (≤70) and nonskeletal BM are inversely correlated with the use of chemotherapy or endocrine treatment (p < 0.0001). Bisphosphonates were used in 67.5% of the cases, alone (62.3%) or combined with other drugs. After a median follow-up of 28 months (range 2–43), 272 patients developed new metastases (59.2%), progression occurred mainly in nonskeletal sites (107/459, 23.3%), except for BM patients, who progressed prevalently at bone (69/248, 27.8%). New skeletal-related events were observed in 122 patients (26.6%). The 2-year probability for disease progression control and survival was 0.19 (95% CI 0.15–0.24) and 0.64 (95% CI 0.58–0.69), respectively. The 2-year probability for death according to the presence of nonskeletal metastases and the time of appearance (previous or concomitant to BM) was 0.74 (95% CI 0.67–0.79) for BM, 0.38 (95% CI 0.25–0.51) for previous nonskeletal BM and 0.56 (95% CI 0.46–0.66) for concomitant nonskeletal BM (p < 0.0001). Conclusions: Clinical outcome is significantly different according to the metastatic sites.

Potential for Early Fracture Risk Assessment in Patients with Metastatic Bone Disease Using Parametric Response Mapping of CT Images

“…Interestingly, near the end of the imaging time points the lesion appeared to shift in activity from lytic resorption, as evidenced by elevated PRM HU− , toward predominantly sclerotic remodeling, as evidenced by a large PRM HU+ in the final time point. This sclerotic progression falls in line with the clinical evaluation, with evidence of disease progression in the lumbar spine as evidenced by (1) worsening lower back pain, (2) a rise in tumor blood markers, (3) MRI results showing further lumbar vertebral collapse and increased associated soft tissue, and (4) increased uptake of the L3 and skull lesion via bone scan.…”

“…Longitudinal analysis of this lesion by PRM HU revealed no focal progression, however a diffuse loss of bone density throughout the bone was apparent starting at about 19 months (5 th time point) as evidenced by increased number of disseminated blue voxels. This loss in bone mass may be due to any combination of (1) osteoporosis, (2) tumor infiltration, (3) fatty infiltration, or (4) hemangioma.…”

“…The spine is involved in approximately 20% of patients who have only a solitary metastatic bone lesion and in approximately 50% of patients with multiple bone lesions (2). Without bone-directed therapies, the estimated yearly incidence of skeletal related events (SRE) is 3.5 (3) with a median incidence of 1.3 for pathologic vertebral compression fractures (PVCF) (4).…”

The evolution of tumor metastases during clonal expansion

“…Pancreatic cancer is a notoriously invasive cancer type in that approximately 80% of patients present with unresectable disease due to the presence of metastases or local extension (El Kamar et al, 2003). As a comparison, only 21% of breast cancer patients present with metastases at diagnosis (Cazzaniga et al, 2006). As shown in Fig.…”

Effects of Sangu Decoction on Osteoclast Activity in a Rat Model of Breast Cancer Bone Metastasis

“…Bone is one of the organs liable to get remote metastasis of malignancy, with the incidence only secondary to lung and liver [1]. Bone metastases (BMs) can cause a wide range of symptoms and signs that influence the quality of life or even shorten survival [2].…”