Palliative Re-Irradiation of Bone Metastases - Case Report

Bone metastasis is a severe complication of malignant tumors. Management of multiple bone metastases remains difficult and prognosis is generally unfavorable, radiotherapy being often the therapeutic option. The main goals of the palliative irradiation of bone metastases are the reduction of pain intensity and the decreasing the analgesic dose used. Overall survival of patients with oligometastatic disease for hormone dependent cancers like breast and prostate may exceed three years and for these groups of patients the reduction of the associated tardive toxicity after irradiation is essential for preserving the quality of life. We present the case of a patient diagnosed in March 2011 with prostate cancer, multiple bone metastases in November 2012. In December 2012, palliative radiotherapy was administrated in a total dose of 21Gy/ fractions, weekly in the lumbosacral region. Seven years after the first presented an increase in pain intensity in the left ischio-pubian branch and pubic symphysis and the bone scintigraphy reveal the progression of the metastatic disease. Palliative re-irradiation was administrated in total dose of 20Gy/5fractions in painful region. Re-irradiation for bone metastasis remains a therapeutic option with the potential to reduce the pain. Image guided radiotherapy can reduce the risk of late toxicity, especially for long-term survivors.

Download Full-text

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

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa111 ◽

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.

Download Full-text

Contributing Factors for Bone Metastasis in Uterine Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829da127 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1311-1317 ◽

Cited By ~ 14

Author(s):

Aera Yoon ◽

Chel Hun Choi ◽

Ha-Jeong Kim ◽

Jin-Young Park ◽

Yoo-Young Lee ◽

...

Keyword(s):

Cervical Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Medical Center ◽

Stage Iv ◽

Metastatic Lesion ◽

Uterine Cervical Cancer ◽

Contributing Factors ◽

Stage Iv Disease ◽

Multiple Bone Metastases

ObjectiveThe purpose of this study was to describe the clinical characteristics and to assess the contributing factors in patients developing bone metastasis in uterine cervical cancer.MethodsTwo thousand thirteen patients had a diagnosis of uterine cervical cancer at Samsung Medical Center between June 1994 and December 2011. During the study period, 105 patients with bone metastasis were identified, and their clinicopathologic data were investigated retrospectively.ResultsAmong 105 patients with bone metastasis, 14 patients were excluded and 91 patients were evaluable. The median bone metastasis–free survival was 27 months (range, 0–279 months).The time to bone metastasis was significantly shorter in patients with adenocarcinoma than in patients with squamous cell carcinoma (median duration, 12 vs 29 months;P= 0.016). In addition, it was shorter in patients with stage IIB to stage IV disease than in those with stage I to stage IIA disease (15 vs 22 months;P= 0.02). The median survival after bone metastasis was 10 months, longer in the patients who received radiotherapy (± chemotherapy) than in the patients who received chemotherapy alone as a salvage therapy (12 vs 7 months;P= 0.01). Initial stage, number of bone metastases, location of involved bone, and coexisting metastatic lesion were not associated with the overall survival of the patients.ConclusionsOur study demonstrates that adenocarcinoma, advanced stage (IIB-IV) and initial multiple bone metastases contribute to earlier bone metastasis. Once bone metastasis was recognized, the survival of these patients was poor and no factors were identified to predict survival of those patients.

Download Full-text

Development of a Quantitative Method Based on the Hill-Shading Technique for Assessing Morphological Changes in the Bone During Image-Guided Radiotherapy for Bone Metastasis

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3818 ◽

2021 ◽

Vol 11 (8) ◽

pp. 2109-2113

Author(s):

Yoshinori Tanabe ◽

Takayuki Ishida

Keyword(s):

Bone Metastasis ◽

Bone Metastases ◽

High Frequency ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Normal Bone ◽

Metastatic Lesions ◽

Irradiation Field ◽

Frequency Components ◽

The Hill

We hypothesized that positioning corrections matching the image in image-guided radiotherapy (IGRT) for bone metastasis contain information on temporal structural changes in irradiated bone metastatic lesions during the treatment period. To extract and quantify these changes, a hill-shading technique was used to emphasize the characteristics of the structure. Spatial frequency components of the bone lesions were described based on hill-shading transformations of the images, and a quantification method was suggested. The matching images of 11 patients who received IGRT for lytic bone metastases were evaluated retrospectively. The hill-shading technique was applied to images of both metastatic lesions and normal bone outside the irradiation field. Outlined bone microstructures were analyzed by a two-dimensional power spectrum using fast Fourier transformation, and the frequency components were quantified. Correlations between the frequency components and cumulative radiation doses were analyzed between the irradiated metastatic bone and normal bone outside the irradiation field. The high-frequency components of the metastatic bone lesion images decreased by a mean of 7% (minimum: -0.2%, maximum: -13.2%) following cumulative irradiation doses of 20-30 Gy versus 0-10 Gy. In the normal bone outside the irradiation field, high-frequency components increased by a mean of 0.07% (minimum: -2.0%, maximum: +4.4%) following irradiation doses of 20-30 Gy versus 0-10 Gy. High-frequency components were significantly different between the normal bone and bone metastases following radiotherapy (p < 0.0001). Hill-shading transformation of matching images obtained during the treatment period enabled adaptation and evaluation of irradiation-induced changes in the microstructure of bone metastatic lesions.

Download Full-text

RANK, RANKL and OPG Expression in Breast Cancer – Influence on Osseous Metastasis

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0031-1298276 ◽

2012 ◽

Vol 72 (05) ◽

pp. 385-391 ◽

Cited By ~ 6

Author(s):

J. Ney ◽

T. Fehm ◽

I. Juhasz-Boess ◽

E. Solomayer

Keyword(s):

Breast Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Therapeutic Option ◽

Human Monoclonal Antibody ◽

Nuclear Factor Κb ◽

Bone Diseases ◽

Metastatic Tumour ◽

Nuclear Factor ◽

Receptor Activator

In women, malignant breast tumours are among the most common malignant diseases in Europe. In advanced breast cancer, the risk of bone metastasis increases to 65–75 %. The discovery of the physiological bone metabolism parameters RANK (receptor activator of nuclear factor-κB), RANKL (receptor activator of nuclear factor-κB ligand) and OPG (osteoprotegerin) as well as their pathophysiological involvement in bone-related diseases is the subject of new therapeutic strategies. The formation of osteolytic bone metastasis requires increased osteoclast activity. Activation of osteoclasts by excessive direct RANKL or reduced OPG expression of osseous metastatic tumour cells remains to be elucidated. More than 50 % of primary breast cancer cells express OPG and RANK, while RANKL could be detected only in 14–60 %. Increased OPG concentrations in the serum of patients with bone metastases have been shown in several studies, whereas the RANKL results are described in an opposite manner. The use of OPG as a biomarker for the detection of osteolytic bone metastases is not consistent and needs to be proved in further studies. Increased RANKL activity was found in diseases characterised by excessive bone loss and formed the basis of new therapeutic options. In several studies, a human monoclonal antibody to RANKL (denosumab) was investigated for the treatment of bone diseases. Denosumab is a promising therapeutic option due to its bone-protective effects.

Download Full-text

Scrambler therapy for incident pain in bone metastases

Journal of Osteopathic Medicine ◽

10.1515/jom-2021-0027 ◽

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.

Download Full-text

Efficacy of EMDR Therapy on the Pain Intensity and Subjective Distress of Cancer Patients

Journal of EMDR Practice and Research ◽

10.1891/emdr-d-20-00036 ◽

2021 ◽

Vol 15 (1) ◽

pp. 18-28

Author(s):

Naeem Abdi ◽

Mohammad Malekzadeh ◽

Zhila Fereidouni ◽

Mohammad Behnammoghadam ◽

Parisa Zaj ◽

...

Keyword(s):

Pain Intensity ◽

Rating Scale ◽

Therapeutic Option ◽

Controlled Trial ◽

Sampling Technique ◽

Control Group ◽

Subjective Distress ◽

Patients With Cancer ◽

Before And After ◽

Emdr Therapy

The present study was carried out to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) therapy in treating pain and subjective distress of patients with cancer. A randomized controlled trial was performed on patients with cancer suffering from moderate to severe cancer pain in Yasuj, Iran, in 2019 and 2020. Sixty patients aged 30–60 years who fulfilled the inclusion criteria were selected using a consensus sampling technique. Patients were randomly assigned to EMDR therapy or control groups based on random block allocation. EMDR therapy was administered in six to eight daily 1-hour sessions. The control group received the standard treatment provided by the hospital. A Numeric Pain-Rating Scale (NRS) and the Subjective Units of Disturbance Scale (SUDS) were used to assess pain and subjective distress before and after the intervention in each session. The collected data were analyzed by descriptive statistics, chi-square test, and independent t test using Statistical Package for the Social Sciences (SPSS) version 24. The mean pain intensity and subjective distress score in the experimental group before and after the EMDR intervention were significantly reduced (p < .001). In the control group, no decreases in NRS and SUDS scores occurred at any time (p > .05). Differences in pain scores between the groups were statistically significant (p < .001). EMDR can effectively and sustainably reduce the pain and subjective distress experienced by patients with cancer. Thus, EMDR is a recommended therapeutic option to mitigate pain and subjective distress among patients with cancer.

Download Full-text