scholarly journals Scrambler therapy for incident pain in bone metastases

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Lauren E. Berninger ◽  
Thomas J. Smith
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Scrambler Therapy ◽  
High Doses ◽  
Electrical Neuromodulation ◽  
Incident Pain

Abstract Incident pain, described as pain induced by bone metastasis and produced by movement, can be devastating. The high doses of opioids needed to control such pain may sedate the patient and cause additional complications. Treatment of incident pain with pharmaceuticals has rarely been studied; only eight patients have been reported in the literature who did not receive additional opioids. We present the case of a 69 year old man with shoulder destruction due to bone metastases who was able to use his arm for normal activities without pain after three sessions of scrambler therapy, a noninvasive form of electrical neuromodulation that requires further study.

scholarly journals National survey of radiation oncologists’ practice patterns regarding hormone-naïve prostate cancer with bone metastases

2020 ◽  
Vol 50 (10) ◽  
pp. 1188-1194
Author(s):  
Katsumasa Nakamura ◽  
Hitoshi Ishikawa ◽  
Tetsuo Akimoto ◽  
Manabu Aoki ◽  
Shinji Kariya ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Practice Patterns ◽  
Primary Treatment ◽  
Dose Fractionation ◽  
Radiation Oncologists ◽  
Multiple Bone Metastases ◽  
Single Bone ◽  
Radiotherapy Dose

Abstract Objective To explore radiation oncologists’ attitudes and practice patterns of radiotherapy for hormone-naïve prostate cancer with bone metastases in Japan. Methods An internet-based survey was distributed to board-certified radiation oncologists of the Japanese Society of Radiation Oncology. Three hypothetical cases were assumed: hormone-naïve prostate cancer with single, three or multiple non-symptomatic bone metastases. The respondents described their attitude regarding such cases, treatment methods and the radiotherapy dose fractionation that they would recommend. Results Among the 1013 board-certified radiation oncologists in Japan, 373 (36.8%) responded to the questionnaire. Most of the respondents (85.0%) believed that radiotherapy may be applicable as a primary treatment for hormone-naïve prostate cancer with bone metastases in some circumstances. For Case 1 (single bone metastasis), 55.0% of the respondents recommended radiotherapy for the prostate and bone metastasis. For Case 2 (three bone metastases), only 24.4% recommended radiotherapy for all lesions, and 31.4% recommended radiotherapy for the prostate only. For Case 3 (multiple bone metastases), 49.1% of the respondents stated that there was no indication for radiotherapy. However, 34% of the respondents still preferred to administer radiotherapy for the prostate. The radiotherapy techniques and dose fractionations varied widely among the respondents. Conclusion Most of the respondent radiation oncologists believed that radiotherapy may be beneficial for hormone-naïve prostate cancer with bone metastases.

scholarly journals Bone Metastasis Prognostic Factors in Breast Cancer

2019 ◽  
Vol 13 ◽  
pp. 117822341983097 ◽  
Author(s):  
Akram Yazdani ◽  
Sara Dorri ◽  
Alireza Atashi ◽  
Hoda Shirafkan ◽  
Hedieh Zabolinezhad
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Bone Metastasis ◽  
Lymph Nodes ◽  
Bone Metastases ◽  
Tumor Size ◽  
Menopausal Status ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Factors Associated

Objective: Bone is the most common site of metastasis in breast cancer. Prognostic factors for predicting bone metastases in breast cancer are controversial yet. In this study, we investigated clinical factors associated with secondary bone metastasis of breast cancer. Methods: In total, 1690 patients with breast cancer recorded between 2002 and 2012 in Motamed Cancer Institute, Tehran, Iran entered in the retrospective study. We studied age, menopausal status, histologic type, tumor size, number of cancerous axillary lymph nodes, serum concentrations of alkaline phosphatase (ALP), carcinogenicity antigen (CEA), cancer antigen (CA)-153, and hemoglobin (HB) in 2 groups with bone metastases (n = 123) and without it, respectively. We applied logistic regression to identify bone metastasis prognostic factors in breast cancer patients and calculated the cut-off value, sensitivity, and characteristics of independent prognostic factors using receiver operating characteristic (ROC) curve analysis. Results: Menopause, larger tumor size, and the greater number of cancerous axillary lymph nodes increased the chance of bone metastases significantly ( P < .05). There was no significant difference between mean groups with and without bone metastases regarding serum concentration of CEA, CA-153, HB, and histopathologic type ( P > .05). Logistic regression showed that age (odds ratio (OR) = 1.021), menopausal status (OR = 1.854), number of cancerous axillary lymph nodes (OR = 1.065), a tumor size between 2 and 5 cm diameter (OR = 2.002) and more than 5 cm diameter (OR = 4.009), and ALP (OR = 1.005) are independent prognostic factors associated with bone metastases. The ROC curve showed that the abovementioned factors have comparable predictive accuracy for bone metastases. Conclusions: Age, menopausal status, number of axillary lymph node metastases, tumor size, and ALP were identified as prognostic factors for bone metastasis in patients with breast cancer. So patients with these characteristics should be monitored more precisely with regular follow-ups.

scholarly journals The Mode-of-Action of Targeted Alpha Therapy Radium-223 as an Enabler for Novel Combinations to Treat Patients with Bone Metastasis

2019 ◽  
Vol 20 (16) ◽  
pp. 3899 ◽  
Author(s):  
Mari I. Suominen ◽  
Timothy Wilson ◽  
Sanna-Maria Käkönen ◽  
Arne Scholz
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Cancer Cells ◽  
Bone Cells ◽  
Metastatic Cancer ◽  
Signal Molecules ◽  
Targeted Alpha Therapy ◽  
Radium 223 ◽  
Alpha Therapy

Bone metastasis is a common clinical complication in several cancer types, and it causes a severe reduction in quality of life as well as lowering survival time. Bone metastases proceed through a vicious self-reinforcing cycle that can be osteolytic or osteoblastic in nature. The vicious cycle is characterized by cancer cells residing in bone releasing signal molecules that promote the differentiation of osteoclasts and osteoblasts either directly or indirectly. The increased activity of osteoclasts and osteoblasts then increases bone turnover, which releases growth factors that benefit metastatic cancer cells. In order to improve the prognosis of patients with bone metastases this cycle must be broken. Radium-223 dichloride (radium-223), the first targeted alpha therapy (TAT) approved, is an osteomimetic radionuclide that is incorporated into bone metastases where its high-linear energy transfer alpha radiation disrupts both the activity of bone cells and cancer cells. Therefore, radium-223 treatment has been shown preclinically to directly affect cancer cells in both osteolytic breast cancer and osteoblastic prostate cancer bone metastases as well as to inhibit the differentiation of osteoblasts and osteoclasts. Clinical studies have demonstrated an increase in survival in patients with metastatic castration-resistant prostate cancer. Due to the effectiveness and low toxicity of radium-223, several novel combination treatment strategies are currently eliciting considerable research interest.

scholarly journals Radiation-induced occult insufficiency fracture or bone metastasis after radiotherapy for cervical cancer? The nomogram based on quantitative apparent diffusion coefficients for discrimination

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xi Zhong ◽  
Huali Jiang ◽  
Hui Mai ◽  
Jialin Xiang ◽  
Jiansheng Li ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Predictive Value ◽  
Bone Lesions ◽  
Potential Value ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Radiation Induced

Abstract Background Radiation-induced insufficiency fractures (IF) is frequently occult without fracture line, which may be mistaken as metastasis. Quantitative apparent diffusion coefficient (ADC) shows potential value for characterization of benign and malignant bone marrow diseases. The purpose of this study was to develop a nomogram based on multi-parametric ADCs in the differntiation of occult IF from bone metastasis after radiotherapy (RT) for cervical cancer. Methods This study included forty-seven patients with cervical cancer that showed emerging new bone lesions in RT field during the follow-up. Multi-parametric quantitative ADC values were measured for each lesion by manually setting region of interests (ROIs) on ADC maps, and the ROIs were copied to adjacent normal muscle and bone marrow. Six parameters were calculated, including ADCmean, ADCmin, ADCmax, ADCstd, ADCmean ratio (lesion/normal bone) and ADCmean ratio (lesion/muscle). For univariate analysis, receiver operating characteristic curve (ROC) analysis was performed to assess the performance. For combined diagnosis, a nomogram model was developed by using a multivariate logistic regression analysis. Results A total of 75 bone lesions were identified, including 48 occult IFs and 27 bone metastases. There were significant differences in the six ADC parameters between occult IFs and bone metastases (p < 0.05), the ADC ratio (lesion/ muscle) showed an optimal diagnostic efficacy, with an area under ROC (AUC) of 0.887, the sensitivity of 95.8%, the specificity of 81.5%, respectively. Regarding combined diagnosis, ADCstd and ADCmean ratio (lesion/muscle) were identified as independent factors and were selected to generate a nomogram model. The nomogram model showed a better performance, yielded an AUC of 0.92, the sensitivity of 91.7%, the specificity of 96.3%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 86.7%, respectively. Conclusions Multi-parametric ADC values demonstrate potential value for differentiating occult IFs from bone metastasis, a nomogram based on the combination of ADCstd and ADCmean ratio (lesion/muscle) may provide an improved classification performance.

scholarly journals Microenvironmental IL1β promotes breast cancer metastatic colonisation in the bone via activation of Wnt signalling

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Rachel Eyre ◽  
Denis G. Alférez ◽  
Angélica Santiago-Gómez ◽  
Kath Spence ◽  
James C. McConnell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Colony Formation ◽  
Breast Cancer Cells ◽  
Wnt Signalling ◽  
Early Event ◽  
Metastatic Lesions ◽  
Breast Cancer Bone Metastasis

Abstract Dissemination of tumour cells to the bone marrow is an early event in breast cancer, however cells may lie dormant for many years before bone metastases develop. Treatment for bone metastases is not curative, therefore new adjuvant therapies which prevent the colonisation of disseminated cells into metastatic lesions are required. There is evidence that cancer stem cells (CSCs) within breast tumours are capable of metastasis, but the mechanism by which these colonise bone is unknown. Here, we establish that bone marrow-derived IL1β stimulates breast cancer cell colonisation in the bone by inducing intracellular NFkB and CREB signalling in breast cancer cells, leading to autocrine Wnt signalling and CSC colony formation. Importantly, we show that inhibition of this pathway prevents both CSC colony formation in the bone environment, and bone metastasis. These findings establish that targeting IL1β-NFKB/CREB-Wnt signalling should be considered for adjuvant therapy to prevent breast cancer bone metastasis.

Pain Control with Morphine for Vertebral Metastases and Sciatica in Advanced Cancer Patients

1994 ◽  
Vol 10 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Hideo Yoshioka ◽  
Satoru Tsuneto ◽  
Tetsuo Kashiwagi
Keyword(s):  
Bone Metastases ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Bone Pain ◽  
Malignant Tumors ◽  
Spinal Metastases ◽  
Pelvic Bone ◽  
Advanced Cancer Patients ◽  
Direct Invasion ◽  
High Doses

Morphine was administered to 56 advanced cancer patients; of that number spinal metastases had induced bone pain in 28 and malignant tumors had induced sciatica in 28. The sciatica was caused in 16 patients by direct invasion of the sacral plexus, in four by lumbar bone metastases, and in eight by pelvic bone metastases. Spinal bone pain was controlled adequately with morphine. However, sciatica required larger dosages of morphine than did bone pain. Among the group with sciatica, rectal cancer patients needed larger dosages of morphine than the other cancer patients. Even with high doses of morphine, it was occasionally difficult to control neuropathic pain of the sciatic nerve caused by intrapelvic cancer.

CA 15.3 with Urinary Calcium Excretion is Useful in the Diagnosis and Monitoring of Bone Metastases from Breast Cancer

1993 ◽  
Vol 8 (4) ◽  
pp. 208-214
Author(s):  
G.C. Yadav ◽  
A. Rao ◽  
M.M. Motawy ◽  
N. Safadi ◽  
M. Jameel Ahmed
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Serum Levels ◽  
Urinary Calcium ◽  
Response To Therapy ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Diagnostic Efficacy ◽  
Ca 15.3

Serum levels of breast carcinoma antigen (CA 15.3) and urinary calcium excretion (UCa) were determined in 73 patients with breast cancer: 36 without bone metastases (stage I-IV) and 37 with bone metastases. The patients in the latter group were further investigated at 2,4 and 6 months from the start of treatment. Both markers showed significant elevations in the group with bone metastases (CA 15.3: P = 1.0×10–6, UCa: P = 8.6×10–9). The bone metastasis index (BMI), which represents the combination of the markers, had better diagnostic efficacy (90%) than CA 15.3 alone (84%) or UCa alone (82%). During treatment of bone metastasis, the longitudinal levels of the markers showed a highly significant association with the therapeutic response assessed by the UICC criteria. For identifying progression of disease, the diagnostic efficacy of CA 15.3, UCa and a combination of both, the so-called Biochemical Index of Response (BIR), was 65%, 70% and 79%, respectively, at two months and 89%, 84% and 92% at four months. Application of the tandem, CA 15.3 with UCa, was very useful for the detection of bone metastases and the prediction of response to therapy.

scholarly journals Bone metastases: an overview

2017 ◽  
Author(s):  
Filipa Macedo ◽  
Katia Ladeira ◽  
Filipa Pinho ◽  
Nadine Saraiva ◽  
Nuno Bonito ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Multidisciplinary Approach ◽  
Skeletal Metastases ◽  
Clinical Approach ◽  
Short Term ◽  
Frequent Site ◽  
Primary Bone ◽  
Breast And Prostate Cancer

Bone is a frequent site of metastases and typically indicates a short-term prognosis in cancer patients. Once cancer has spread to the bones it can rarely be cured, but often it can still be treated to slow its growth. The majority of skeletal metastases are due to breast and prostate cancer. Bone metastasis is actually much more common than primary bone cancers, especially in adults. The diagnosis is based on signs, symptoms and imaging. New classes of drugs and new interventions are given a better quality of life to these patients and improved the expectancy of life. It is necessary a multidisciplinary approach to treat patients with bone metastasis. In this paper we review the types, clinical approach and treatment of bone metastases.

PTHrP(12-48) for the diagnosis of breast cancer bone metastasis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21039-e21039
Author(s):  
Charity L. Washam ◽  
Stephanie D. Byrum ◽  
Kim Leitzel ◽  
Ali M. Suhail ◽  
Allan Lipton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Breast Cancer Patients ◽  
Parathyroid Hormone Related Protein ◽  
Increased Risk ◽  
Breast Cancer Bone Metastasis

e21039 Background: Bone metastasis of breast cancer significantly compromises patient morbidity and mortality. Currently, no reliable methods detect or predict patients at increased risk for developing bone metastasis. We utilized 3 independent cohorts of breast cancer patients to validate a highly discriminatory plasma-based proteomic profile that identifies breast cancer bone metastasis. The identity of the most discriminatory protein component identified was a parathyroid hormone-related protein fragment, PTHrP(12-48). Methods: Plasma samples collected from 21 breast cancer patients with clinical evidence of a bone metastasis and 21 patients with no evidence of bone metastasis from time of diagnosis to clinical outcome were evaluated. A novel mass spectrometry-based assay using human serum spiked with synthetic PTHrP(12-48) was used to measure PTHrP(12-48) concentrations (pg/μl). Statistical significance was assessed by one-way ANOVA. ROC curves evaluated the diagnostic potential of PTHrP(12-48) and a simple logistic regression derived from the combined measurement of PTHrP(12-48) and NTx. Results: PTHrP(12-48) concentrations ranged between 11.6 and 92.1 pg/μl in bone metastasis patients and between 4.5 and 34.2 pg/μl in patients without bone metastases. PTHrP(12-48) was significantly increased in bone metastasis plasma (p < 0.05). No significant correlation was identified between PTHrP(12-48) and NTx. ROC analysis of PTHrP(12-48), threshold 18 pg/μl, classified the two groups with high accuracy. Class prediction by the PTHrP(12-48)/NTx logistic regression model increased diagnostic specificity. Conclusions: The measurement of PTHrP(12-48) in patient plasma has potential as a viable clinical measure of bone metastasis. In combination with serum NTx, PTHrP(12-48) may assist in identifying bone metastases in patients presenting with low to normal bone turnover markers.

Palliative treatment directives for bone metastases: A quality-directed approach to guiding institutional practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Lindsay Puckett ◽  
Lucille Lee ◽  
Petrina Zuvic ◽  
Isabella Bingchan Zhang ◽  
Louis Potters ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Radiation Treatment ◽  
Standard Of Care ◽  
Evidence Based ◽  
Chi Square ◽  
Evidence Based Treatment ◽  
Improve Compliance ◽  
Chi Square Test ◽  
New Treatment

188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population. Methods: Institutionally, palliative bone metastasis treatments are routinely tracked by a Quality Assurance committee. In 2/2016, two consensus-driven and evidence-based clinical directives were created within our electronic health system for use with either simple or complicated bone metastasis, irrespective of primary histology. The simple and complex directives had default prescriptions of 8 Gy/1fx or 20 Gy/5fx, respectively. The directives were reviewed with physician staff to improve compliance; directives were allowed to be edited at the physician’s discretion if an alternative fx was indicated. The chi-square test was used for analysis. Results: From 1/2009-5/2016, there were 1,781 treatment courses of palliative external beam RT. Following implementation in 2/2016, the new clinical directives were used for 96% of cases and were modified in 12 cases (n = 72). Single fx use increased from 17% to 36% among palliative bone metastasis treatments (p ≤ 0.001) and HFX (1 or 5 fx) utilization increased from 71% to 92% compared to other fractionation schemes (10 fx or other) (p = 0.001). Conclusions: The institution-wide adoption of evidence-based, treatment directives proved to be a straightforward and successful intervention which allowed for rapid adoption and increased utilization of the standard of care. Our early data suggests that this may be a useful approach in the setting of reticence to new treatment paradigms. Further examination of evidence based directives is warranted to address issues of overtreatment in palliation and in standardizing oncologic care.

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