A Retrospective Analysis of Prognostic Factors Influencing Overall Survival and Choice of Radiotherapy Fractionation in Patients with Bone Metastases Who Received Conventional 2D or 3D Palliative Radiotherapy

Background. Bone metastases are among the most frequent complications of advanced cancers. Palliative radiotherapy regimens vary from single fraction (SFRT) to multiple fraction (MFRT). Objective: to identify prognostic factors for overall survival (OS) and factors that influence the choice of radiotherapy regimen for bone metastases. Methods. 582 patients with bone metastases irradiated between 1 January 2014–31 December 2017 were analyzed. OS was calculated by Kaplan–Meier method. Cox proportional hazard model was used to identify factors that influenced OS, and the logistic regression model was used to identify potential predictors of radiotherapy regimen. Results. 1-, 2- and 3- year OS were 36%, 23%, and 15%, respectively. Negative prognostic factors associated with OS were multiple bone metastases (HR = 5.4), poor performance status (PS) (HR = 1.5), and brain metastases (HR = 1.37) (p < 0.01). Spinal metastases were associated with the choice of a MFRT (OR = 2.09). A poor PS (OR = 0.55), lung (OR = 0.49), and urologic primaries (OR = 0.33) were more likely to receive SFRT (p < 0.01). The re-irradiation rates were 0.5% after MFRT and 12% after SFRT (p < 0.01). Conclusions. Patients with longer OS (good PS, single bone metastasis, and no brain metastases) can benefit the most from MFRT, which is less likely to require re-irradiation. SFRT remains a valid choice for patients with a more reserved outcome (poor PS, lung or urologic primaries, multiple bone metastases).

Palliative radiation treatment used for multiple purposes in a single irradiation field

In this case report, radiation therapy was performed for bilateral hydronephrosis developed during multiple bone metastases of breast cancer and ileus due to peritoneal dissemination. The patient’s preirradiation creatinine level was 8.2 mg/dL, which decreased by the fourth day after starting irradiation therapy. Creatinine level ultimately decreased to 0.6 mg/dL. Pain due to lumbar spine metastasis alleviated and ileus was resolved, allowing the patient to live at home for approximately 5 weeks. The effect of radiotherapy for bilateral hydronephrosis and gastrointestinal obstruction was rapid and good. Palliative radiation treatment can be used for multiple purposes, and in the present patient, we were able to prolong the vital prognosis.

Skipped multilevel lesion as an atypical tuberculous spondylitis mimicking spinal metastasis: A case report

Tuberculosis (TB) is one of major global health threats and leads to morbidity and mortality. TB is prevalent in low and middle income countries especially in Sub-Saharan Africa and South East Asia. M. tuberculosis usually affects the lungs. Spine is the most common extrapulmonary sites for TB after lymph nodes, accounts for 1% of all TB cases, and 50 to 60% of osteoarticular TB. In the case of spinal TB, two or more adjacent vertebrae are usually involved due to hematogenous spread of bacteria in which the vertebral arteries feed the two adjacent vertebrae. The incidence of multiplelevel non-contiguous spinal TB is 1.1 to 16% of all skeletal TB. Multiple-level non-contiguous, an atypical form of spinal TB is rare. It has insidious symptoms, often with diagnostic delays and a higher risk of permanent neurological deficits. We report a case of atypical TB spondylitis with non-contiguous multiple level of lesions mimicking multiple bone metastases.

Morphological Verification Of Malignant Neoplasm Of The Urinary System With Multiple Bone Metastases

In metastatic renal cell carcinoma (mRCC), bone is the second most common site of metastases, occurring in one third of patients. Most bone metastases are found in the sacrum, pelvis, spine and proximal limbs. In addition, the majority of bone metastases are osteolytic with elements of destruction; mixed metastases also occur. This predisposes patients to skeletal events such as pathological fracture, spinal cord compression, which implies the prescription of radiation therapy or bone surgery.

Efficacy of 3 Monthly versus Monthly Zoledronic Acid on Bone Metastasis

Background: Bone metastatic disease affect a patient’s quality of life. Aim: Evaluating possible stratification factors affecting the efficacy of different schedules of zoledronic acid on SREs. Patients and Methods: A randomized, clinical trial at Zagazig university hospitals. 108 Patients were enrolled to receive zoledronic acid 4 mg (A and B groups=12 and 4 weeks, respectively) for 2 years. Results: Regarding age, tumour type, types of bone metastasis and number of bone metastasis, there was an insignificant difference between both groups. However, 3 monthly regimen of zoledronic acid gave better results in solitary than multiple bone metastases. Regarding pretreatment ECOG, there was an insignificant difference between between both groups. However, 3 monthly regimen of zoledronic acid gave better results in pre-treatment ECOG 1and ECOG 2 than ECOG 3. Conclusion: A 3-monthly regimen of zoledronic acid is more effective in management of solitary or few sites of bone metastasis, osteoblastic bony lesions and patients with good performance status. Recommendations: We recommend a larger sample size and the study should include a homogenous groups of patients so we can judge well on different stratifications factors that can affect efficacy of 3- monthly regimen of zoledronic acid.

Granulosa cell ovarian cancer with synchronous multiple bone metastases: case report of extreme rarity

Background: Adult granulosa cell tumor (AGCT) of the ovary generally has a good prognosis. Recurrences tend to be late and confined to the abdominopelvis. Bone metastases are extremely rare. We report an extremely rare case of AGCT with synchronous multiple bone metastases and discuss diagnostic procedures and management. Case description: A 35-year-old woman presented with abdominal bloating. On the day of surgery, acting on the complaint of right shoulder pain, an X-ray revealed a permeative lesion involving the neck of humerus, suggestive of a metastatic pathologic fracture. The patient underwent a full staging debulking surgery. Further imaging demonstrated multiple bone metastases. Histology confirmed an AGCT of the ovary. Diagnosis was established by a core bone biopsy from the left femur showing cells consistent with those seen with granulosa cell tumor. The patient received adjuvant chemotherapy with concurrent zoledronic acid as targeted therapy for her bone metastases. Endocrine systemic maintenance treatment was given. The patient rapidly deteriorated and died from her disease at 20 months from the initial diagnosis. Conclusion: Unpredictable biological behavior and clinical manifestations raise a high degree of suspicion for accurate AGCT diagnosis. Management of bone metastases often warrants input from the multidisciplinary team, and treatment may involve chemotherapy, palliative radiotherapy, or orthopaedic interventions.

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.

Reliability and validity test of VES-13 and analysis of influencing factors for the vulnerable condition of patients with advanced castration-resistant prostate cancer

Objectives: To study the relationship between the reliability and validity of VES-13 and the influencing factors of the vulnerable condition of patients with advanced castration-resistant prostate cancer, so as to provide a reference for the health management and nursing of elderly inpatients. Methods: By means of convenience sampling, 150 vulnerable patients with advanced castration-resistant prostate cancer who were admitted to the Department of Oncology of the Affiliated Hospital of Hebei University from April 2019 to March 2020 were selected. General data questionnaire, simple mental state checklist, anxiety self-assessment scale, and the vulnerable elders 13 survey (VES-13) were used in this study. The reliability and validity were tested by SPSS 20.0. Results: For this group of patients, VES-13 Cronbach’s α was 0.832, living function was 0.778, body function was 0.846, and the correlation coefficient between items was between 0.401 and 0.823 (P<0.01); the retest reliability was 0.831 (P<0.05), and the correlation coefficient was0.504 (P<0.05). The average time to fill in each scale was 4.53±1.32 Minutes, and general indicators such as economic status and education level were significantly correlated with vulnerability. The clinical indicators of prostate-specific antigen levels, multiple bone metastases, and bone pain were significantly correlated with vulnerability. Conclusion: VES-13 scale had high level of reliability and operability, and was straight forward to understand and use; it can be used as an effective tool for the assessment of vulnerability in patients with advanced prostate cancer. The vulnerability of patients with castration-resistant prostate cancer showed significant correlation with economic status, education level, prostate-specific antigen level, multiple bone metastases, bone pain and other indicators. Nursing staff should pay close attention to the relevant factors of inpatients and give targeted advance intervention measures to facilitate rapid recovery of elderly inpatients. doi: https://doi.org/10.12669/pjms.37.1.3095 How to cite this:Feng J, Sun Q, Li J, Li TT. Reliability and validity test of VES-13 and analysis of influencing factors for the vulnerable condition of patients with advanced castration-resistant prostate cancer. Pak J Med Sci. 2021;37(1):137-141. doi: https://doi.org/10.12669/pjms.37.1.3095 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bone metastases in an adult patient with diffuse midline glioma: a case report

A 36-year-old Chinese woman was diagnosed with diffuse midline glioma and received radiotherapy and chemotherapy. Ten months later, bone metastases were confirmed by pathological biopsy. This case is one of a handful of cases in which an adult patient with diffuse midline glioma had multiple bone metastases. Better diagnostic methods and more appropriate treatment strategies for diffuse midline glioma are urgently needed, requiring further investigations into the mechanisms underlying metastases.