Metastatic breast carcinoma confined to bone

Abstract

BACKGROUND The current study was performed to study metastatic breast carcinoma that remains confined to bone. METHODS The medical notes of 2514 breast carcinoma patients who were treated in 2 academic units over a 20‐year period were screened and patients who fulfilled the following criteria were selected: 1) clinical manifestation and imaging confirmation of bone metastases, and 2) metastatic disease remaining confined to bone for a minimum of 24 months. Available clinical and pathologic data were recorded and analyzed. The objective of the current study was to describe this clinical entity and investigate possible correlations between clinicopathologic parameters and clinical outcome. RESULTS A total of 104 patients (4% of the total screened patient population) fulfilled the study criteria. The majority of patients were postmenopausal, with a median age of 58 years; 44 of the patients were found to have metastases at the time of presentation (M1) and 60 patients developed metastases at a median of 38 months (range, 8–160 months) after surgery for the primary tumor. Metastases remained confined to bone for a median of 50 months. Survival after the diagnosis of bony metastases was 72 months and was similar in the 2 groups (66 months vs. 78 months). Of the patients treated, 80% responded to hormonal therapy, and 76.5% responded to chemotherapy. There was no association noted between survival and tumor grade, anatomic distribution, or disease extension. CONCLUSIONS Bone‐confined metastatic breast carcinoma has an indolent clinical course that alleviates the need for vigorous follow‐up and calls into question aggressive therapeutic approaches in these patients. Translational studies are warranted to map the molecular profile, leading to the development of targeted therapies in this group of patients. Cancer 2004. © 2004 American Cancer Society.

Importance of the development time of isolated bone metastasis in breast cancer

“…The number of metastatic sites and the type of metastatic tumor load also affect survival [3][4][5][6][7]. Prior reports have shown that patients with metastatic spread limited to the skeleton have a relatively prolonged survival [7][8][9][10].…”

Diagnosis and surgical management of breast cancer metastatic to the spine

“…Consequences of bony metastases include pathologic fracture, spinal cord compression, anemia, and hypercalcemia [6] . Breast cancer has a particular affinity for the spine, accounting for approximately twothirds of the osseous metastases discovered [7] . Of these lesions to the spine about one-third become symptomatic, causing intractable pain, neurological deficits, mechanical instability, and ultimately disability and a severe deterioration in quality of life [8,9] .…”

Sobrevida de pacientes con cáncer de mama y metástasis ósea

“…Si bien la localización de la metástasis no define si existe un peor o mejor pronóstico, debemos mencionar que existe una predominancia por tórax seguido de columna vertebral, lo cual es diferente a lo que se ha reportado en la literatura 4,9 . Sin embargo, es relevante decir que es raro encontrar metástasis en extremidad superior y cráneo.…”

“…Según la literatura, estudios realizados en 1987 han reportado una sobrevida de 24 meses, con una supervivencia a los 5 años de un 40% en pacientes portadores de metástasis óseas 3,7 . Estudios posteriores en 2002, reportaron una sobrevida media de 18 a 24 meses, con una supervivencia a los 5 años del 20% 8 , y si la metástasis está confinada sólo a esqueleto, se estimó una sobrevida promedio de 6 años 9 . El sitio más común de metástasis es la columna vertebral (63%), seguido por pelvis, esternón, costillas, cráneo y huesos largos 4,9 .…”

“…Estudios posteriores en 2002, reportaron una sobrevida media de 18 a 24 meses, con una supervivencia a los 5 años del 20% 8 , y si la metástasis está confinada sólo a esqueleto, se estimó una sobrevida promedio de 6 años 9 . El sitio más común de metástasis es la columna vertebral (63%), seguido por pelvis, esternón, costillas, cráneo y huesos largos 4,9 . Al existir discrepancias al hablar de sobrevida, se definió como objetivo del siguiente estudio determinar la diferencia en la sobrevida de los pacientes diagnosticados con cáncer de mama y que presentaron aparición de metástasis óseas en comparación con los que no las presentaron, describiendo además las características del grupo estudiado, respecto a la realidad de nuestro país.…”