1
|
Expert Panel on Thoracic Imaging, Madan R, El Alam RH, Walker CM, Bang TJ, Bartel TB, Batra K, Brixey AG, Christensen JD, Cox CW, Gonzalez AV, Little BP, Lui NS, Maxfield H, Moore WH, Qin A, Shroff GS, Yasufuku K, Chung JH. ACR Appropriateness Criteria® Lung Cancer-Surveillance After Therapy. J Am Coll Radiol 2025; 22:S319-S342. [PMID: 40409885 DOI: 10.1016/j.jacr.2025.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 02/24/2025] [Indexed: 05/25/2025]
Abstract
This document reviews the evidence supporting different imaging modalities and techniques used to evaluate patients with a history of lung cancer. It focuses on the imaging evaluation of patients treated for stage I-III non-small-cell lung cancer and small-cell lung cancer, whether using individual modalities or combinations. Guidelines for both routine surveillance of stage I-III lung cancer and for the evaluation of suspected recurrence or disease progression are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | - Rachna Madan
- Brigham and Women's Hospital, Boston, Massachusetts.
| | | | | | | | - Twyla B Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas; Commission on Nuclear Medicine and Molecular Imaging
| | - Kiran Batra
- UT Southwestern Medical Center, Dallas, Texas
| | - Anupama G Brixey
- Portland VA Healthcare System and Oregon Health & Science University, Portland, Oregon
| | | | | | - Anne V Gonzalez
- McGill University, Montreal, Quebec, Canada; American College of Chest Physicians
| | | | - Natalie S Lui
- Stanford University School of Medicine, Stanford, California; The Society of Thoracic Surgeons
| | - Hannah Maxfield
- University of Kansas Medical Center, Kansas City, Kansas, Family practice physician
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Angel Qin
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan; American Society of Clinical Oncology
| | - Girish S Shroff
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kazuhiro Yasufuku
- University of Toronto, Toronto, Ontario, Canada; American Thoracic Society
| | | |
Collapse
|
2
|
Tao H, Hui X, Zhang Z, Zhu R, Wang P, Zhou S, Yang K. Accuracy of artificial intelligence in detecting tumor bone metastases: a systematic review and meta-analysis. BMC Cancer 2025; 25:286. [PMID: 39966724 PMCID: PMC11837447 DOI: 10.1186/s12885-025-13631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 02/03/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Bone metastases (BM) represent a prevalent complication of tumors. Early and accurate diagnosis, however, is a significant hurdle for radiologists. Recently, artificial intelligence (AI) has emerged as a valuable tool to assist radiologists in the detection of BM. This meta-analysis was undertaken to evaluate the AI diagnostic accuracy for BM. METHODS Two reviewers performed an exhaustive search of several databases, including Wei Pu (VIP) database, China National Knowledge Infrastructure (CNKI), Web of Science, Cochrane Library, Ovid-Embase, Ovid-Medline, Wan Fang database, and China Biology Medicine (CBM), from their inception to December 2024. This search focused on studies that developed and/or validated AI techniques for detecting BM in magnetic resonance imaging (MRI) or computed tomography (CT). A hierarchical model was used in the meta-analysis to calculate diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), area under the curve (AUC), specificity (SP), and pooled sensitivity (SE). The risk of bias and applicability were assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST), while the Transparent Reporting of a multivariable prediction model for individual prognosis or diagnosis-artificial intelligence (TRIPOD-AI) was employed for evaluating the quality of evidence. RESULT This review covered 20 articles, among them, 16 studies were included in the meta-analysis. The results revealed a pooled SE of 0.88 (0.82-0.92), a pooled SP of 0.89 (0.84-0.93), a pooled AUC of 0.95 (0.92-0.96), PLR of 8.1 (5.57-11.80), NLR of 0.14 (0.09-0.21) and DOR of 58 (31-109). When focusing on imaging algorithms. Based on ML, a pooled SE of 0.88 (0.77-0.92), SP 0.88 (0.82-0.92), and AUC 0.93 (0.91-0.95). Based on DL, a pooled SE of 0.89 (0.81-0.95), SP 0.89 (0.81-0.94), and AUC 0.95 (0.93-0.97). CONCLUSION This meta-analysis underscores the substantial diagnostic value of AI in identifying BM. Nevertheless, in-depth large-scale prospective research should be carried out for confirming AI's clinical utility in BM management.
Collapse
Affiliation(s)
- Huimin Tao
- The First Clinical Medical College of Gansu, University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
| | - Xu Hui
- Evidence-Based Medicine Centre, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China
- Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Zhihong Zhang
- The First Clinical Medical College of Gansu, University of Chinese Medicine, Lanzhou, Gansu, 730000, China
| | - Rongrong Zhu
- The First Clinical Medical College of Gansu, University of Chinese Medicine, Lanzhou, Gansu, 730000, China
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
| | - Ping Wang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
| | - Sheng Zhou
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China.
| | - Kehu Yang
- Evidence-Based Medicine Centre, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China.
- Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| |
Collapse
|
3
|
Sánchez JF, Ramtani S, Boucetta A, Velasco MA, Vaca-González JJ, Duque-Daza CA, Garzón-Alvarado DA. Is Tumor Growth Influenced by the Bone Remodeling Process? J Comput Biol 2025; 32:104-124. [PMID: 39723973 DOI: 10.1089/cmb.2023.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024] Open
Abstract
In this study, we develop a comprehensive model to investigate the intricate relationship between the bone remodeling process, tumor growth, and bone diseases such as multiple myeloma. By analyzing different scenarios within the Basic Multicellular Unit, we uncover the dynamic interplay between remodeling and tumor progression. The model developed developed in the paper are based on the well accepted Komarova's and Ayati's models for the bone remodeling process, then these models were modified to include the effects of the tumor growth. Our in silico experiments yield results consistent with existing literature, providing valuable insights into the complex dynamics at play. This research aims to improve the clinical management of bone diseases and metastasis, paving the way for targeted interventions and personalized treatment strategies to enhance the quality of life for affected individuals.
Collapse
Affiliation(s)
| | - Salah Ramtani
- Laboratoire CSPBAT, equipe LBPS, CNRS (UMR 7244), Universit e Sorbonne Paris Nord, Villetaneuse, France
| | - Abdelkader Boucetta
- Laboratoire CSPBAT, equipe LBPS, CNRS (UMR 7244), Universit e Sorbonne Paris Nord, Villetaneuse, France
| | | | | | | | | |
Collapse
|
4
|
Suna PA, Cengız O, Ceyhan A, Atay E, Ertekin T, Nısarı M, Yay A. The protective role of curcumin against toxic effect of nonylphenol on bone development. Hum Exp Toxicol 2021; 40:S63-S76. [PMID: 34219512 DOI: 10.1177/09603271211030548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In the study, it was aimed to investigate the possible protective effects of curcumin, a potent antioxidant, against the toxic effect of nonylphenol on bone development. METHODS Thirty pregnant female Wistar albino rats were used. The rats were randomly divided into the following five groups; the control group, corn oil group (150 µl/kg/day), nonylphenol group (50 µl/kg/day), curcumin group (100 mg/kg/day) and curcumin + nonylphenol group (100 mg/kg/day + 50 µl/kg/day). The doses were given by gavage from the 5th day to the 20th day of gestation. The fetuses were removed out on the 20th day of pregnancy by cesarean at the end of the study. After the sacrifice of the animals, double skeletal staining in front extremity (clavicula, scapula, humerus, radius, ulna) and hind extremity (femur, tibia, fibula), additionally histological and immunohistochemical examinations in femur bone were performed. RESULTS The nonylphenol group offspring have the lowest weights of fetuses and placenta, head-to-hip lengths, biparietal and occipitofrontal length, and also, bone length percentage and percentage of the ossification area in all measurements of the front extremity and hind extremity Interestingly, the groups treated with curcumin showed close to the control group in terms of double skeletal staining, histological, and immunohistochemical examinations. CONCLUSIONS Our findings demonstrated an association between bone development and exposure to nonylphenol. The findings suggest that curcumin treatments may be effective in accelerating bone formation.
Collapse
Affiliation(s)
- P Alısan Suna
- Department of Histology and Embryology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - O Cengız
- Department of Histology and Embryology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - A Ceyhan
- Department of Histology and Embryology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.,Tokat Health Services Vocational School/Medical Services and Techniques Department, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - E Atay
- Department of Anatomy, Medicine Faculty, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - T Ertekin
- Department of Anatomy, Medicine Faculty, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - M Nısarı
- Department of Anatomy, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - A Yay
- Department of Histology and Embryology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.,Genome and Stem Cell Center (GENKOK), Erciyes University, Kayseri, Turkey
| |
Collapse
|
5
|
Kreps LM, Addison CL. Targeting Intercellular Communication in the Bone Microenvironment to Prevent Disseminated Tumor Cell Escape from Dormancy and Bone Metastatic Tumor Growth. Int J Mol Sci 2021; 22:ijms22062911. [PMID: 33805598 PMCID: PMC7998601 DOI: 10.3390/ijms22062911] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Metastasis to the bone is a common feature of many cancers including those of the breast, prostate, lung, thyroid and kidney. Once tumors metastasize to the bone, they are essentially incurable. Bone metastasis is a complex process involving not only intravasation of tumor cells from the primary tumor into circulation, but extravasation from circulation into the bone where they meet an environment that is generally suppressive of their growth. The bone microenvironment can inhibit the growth of disseminated tumor cells (DTC) by inducing dormancy of the DTC directly and later on following formation of a micrometastatic tumour mass by inhibiting metastatic processes including angiogenesis, bone remodeling and immunosuppressive cell functions. In this review we will highlight some of the mechanisms mediating DTC dormancy and the complex relationships which occur between tumor cells and bone resident cells in the bone metastatic microenvironment. These inter-cellular interactions may be important targets to consider for development of novel effective therapies for the prevention or treatment of bone metastases.
Collapse
Affiliation(s)
- Lauren M. Kreps
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christina L. Addison
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700
| |
Collapse
|
6
|
Damron TA, Mann KA. Fracture risk assessment and clinical decision making for patients with metastatic bone disease. J Orthop Res 2020; 38:1175-1190. [PMID: 32162711 PMCID: PMC7225068 DOI: 10.1002/jor.24660] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/17/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
Metastatic breast, prostate, lung, and other cancers often affect bone, causing pain, increasing fracture risk, and decreasing function. Management of metastatic bone disease (MBD) is clinically challenging when there is potential but uncertain risk of pathological fracture. Management of MBD has become a major focus within orthopedic oncology with respect to fracture and impending fracture care. If impending skeletal-related events (SREs), particularly pathologic fracture, could be predicted, increasing evidence suggests that prophylactic surgical treatment improves patient outcomes. However, current fracture risk assessment and radiographic metrics do not have high accuracy and have not been combined with relevant patient survival tools. This review first explores the prevalence, incidence, and morbidity of MBD and associated SREs for different cancer types. Strengths and limitations of current fracture risk scoring systems for spinal stability and long bone fracture are highlighted. More recent computed tomography (CT)-based structural rigidity analysis (CTRA) and finite element (FE) analysis methods offer advantages of increased specificity (true negative rate), but are limited in availability. Other fracture prediction approaches including parametric response mapping and positron emission tomography/computed tomography measures show early promise. Substantial new information to inform clinical decision-making includes measures of survival, clinical benefits, and economic analysis of prophylactic treatment compared to after-fracture stabilization. Areas of future research include use of big data and machine learning to predict SREs, greater access and refinement of CTRA/FE approaches, combination of clinical survival prediction tools with radiographically based fracture risk assessment, and net benefit analysis for fracture risk assessment and prophylactic treatment.
Collapse
|
7
|
Atay E, Ertekin T, Yılmaz H, Güler HS, Al Ö, Nisari M, Yay A, Unur E, Özdamar S, Yalçın B. Impact of prenatal exposure to bisphenol A on pregnant rats: Fetal bone development and immunohistochemistry implications. Toxicol Ind Health 2019; 35:119-135. [PMID: 30803398 DOI: 10.1177/0748233718823146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND: Bisphenol A (BPA) is one of the most commonly produced chemicals in the world. BPA is used in products such as food packaging, personal care products, detergents, and plastic bottles. This study was conducted to determine the effect of BPA on fetal bone development. MATERIAL AND METHODS: In this study, 16 pregnant female Sprague-Dawley rats were used. The rats were divided into four groups: the control group and 0.5 mg/kg/day, 5 mg/kg/day, and 50 mg/kg/day dose BPA groups. The skeletal system development of fetuses was examined with double skeletal and immunohistochemistry (IHC) staining (tartrate resistant acid phosphatase (TRAP) and the alkaline phosphatase (AP) expressions) methods. RESULTS: The highest ossification rates in the humerus, radius, and ulna were detected as 41.05%, 39.25%, and 37.26% in the control group, respectively. The highest ossification rates in the femur, tibia, and fibula were detected as 23.04%, 30.73%, and 32.78% in the control group, respectively. Statistically significant differences were found between control and experimental groups in the TRAP and AP expression of the femur by IHC staining ( p < 0.001). CONCLUSION: Exposure to BPA during pregnancy adversely affected ossification and bone growth. A dose-dependent decrease was observed in the rate of ossification.
Collapse
Affiliation(s)
- Emre Atay
- 1 Department of Anatomy, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Tolga Ertekin
- 1 Department of Anatomy, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Halil Yılmaz
- 2 Department of Therapy and Rehabilitation, Kozakli Vocational School, Nevsehir Haci Bektas Veli University, Nevsehir, Turkey
| | - Hatice Susar Güler
- 3 Department of Anatomy, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Özge Al
- 4 Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehtap Nisari
- 4 Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Arzu Yay
- 5 Department of Histology Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Erdoğan Unur
- 4 Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Saim Özdamar
- 5 Department of Histology Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Betül Yalçın
- 5 Department of Histology Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
8
|
Ma Y, Wallace AN, Waqar SN, Morgensztern D, Madaelil TP, Tomasian A, Jennings JW. Percutaneous Image-Guided Ablation in the Treatment of Osseous Metastases from Non-small Cell Lung Cancer. Cardiovasc Intervent Radiol 2017; 41:726-733. [PMID: 29204695 DOI: 10.1007/s00270-017-1843-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/13/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Percutaneous image-guided ablation is an emerging minimally invasive therapy for patients with metastatic bone disease for whom radiation therapy is ineffective or contraindicated. The purpose of this study was to examine the safety and efficacy of percutaneous ablation in achieving pain palliation and local tumor control of osseous metastases from non-small cell lung cancer (NSCLC). METHODS A retrospective review was performed of 76 musculoskeletal metastases in 45 patients treated with percutaneous ablation. 63% (48/76) were treated with radiofrequency ablation (RFA), 35% (27/76) with cryoablation, and 1.3% (1/76) with microwave ablation (MWA). In 70% (53/76) of cases, associated cementoplasty was performed. Primary outcomes measured were pre- and post-procedure pain scores 4 weeks after treatment and local tumor control at 3-, 6-, and 12-month follow-up. RESULTS Mean age of the cohort was 63.6 ± 9.5 years. Median tumor diameter was 3.60 cm (range 1.0-10.0 cm). Mean and median pain scores before treatment were 7.5 ± 2.3 and 8.0, respectively. Post-procedure, patients reported significantly decreased pain scores at 4 weeks (mean, 3.7 ± 3.5; median, 3.0; p < 0.00001). Radiographic local tumor control rates were 83% (35/42) at 3 months, 77% (23/30) at 6 months, and 68% (17/25) at 12 months after treatment. The overall complication rate was 2.6% (2/76). CONCLUSION Percutaneous tumor ablation is a well-tolerated, minimally invasive procedure associated with improving pain palliation and achieving local tumor control of osseous metastases from NSCLC. LEVEL OF EVIDENCE Level 4, case series.
Collapse
Affiliation(s)
- Yuntong Ma
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
| | - Adam N Wallace
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Saiama N Waqar
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Morgensztern
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas P Madaelil
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anderanik Tomasian
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
9
|
Wang Z, Wen X, Lu Y, Yao Y, Zhao H. Exploiting machine learning for predicting skeletal-related events in cancer patients with bone metastases. Oncotarget 2017; 7:12612-22. [PMID: 26871471 PMCID: PMC4914308 DOI: 10.18632/oncotarget.7278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/24/2016] [Indexed: 12/03/2022] Open
Abstract
The aim of the bone metastases (BM) treatment is to prevent the occurrence of skeletal-related events (SREs). In clinical, physicians could only predict the occurrence of SREs by subjective experience. Machine learning (ML) could be used as predictive models in the medical field. But there is no published research using ML to predict SREs in cancer patients with BM. The purpose of this study was to assess the associations of clinical variables with the occurrence of SREs and to subsequently develop prediction models to help identify SREs risk groups. We analyzed 1143 cancer patients with BM. We used the statistical package of SPSS and SPSS Modeler for data analysis and the development of the prediction model. We compared the performance of logistic regression (LR), decision tree (DT) and support vector machine(SVM). The results suggested that Visual Analog Scale (VAS) scale was a key factor to SREs in LR, DT and SVM model. Modifiable factors such as Frankel classification, Mirels score, Ca, aminoterminal propeptide of type I collagen (PINP) and bone-specific alkaline phosphatase (BALP) were identified. We found that the result of applying LR, DT and SVM classification accuracy was 79.2%, 85.8% and 88.2%, with 9, 4 and 8 variables, respectively. In conclusion, DT and SVM achieved higher accuracies with smaller number of variables than the number of variables used in LR. ML techniques can be used to build model to predict SREs in cancer patients with BM.
Collapse
Affiliation(s)
- Zhiyu Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaoting Wen
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaohong Lu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hui Zhao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
10
|
Chen YM, Fang YT, Lai CH, Rau KM, Huang CH, Chang HC, Chao TY, Tseng CC, Fang WF, Wang CC, Chen YC, Chung YH, Wang YH, Su MC, Liu SF, Huang KT, Chen HC, Chang YC, Chang YP, Lin MC. A Survival Scoring System for Non-Small Cell Lung Cancer Patients with De Novo Bone Metastases. PLoS One 2016; 11:e0167923. [PMID: 27930702 PMCID: PMC5145216 DOI: 10.1371/journal.pone.0167923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/22/2016] [Indexed: 01/18/2023] Open
Abstract
In the pre-tyrosine kinase inhibitors (TKIs) era, non-small cell lung cancer (NSCLC) patients with de novo bone metastases had a worse prognosis than those without. However, whether epidermal growth factor receptor (EGFR)-TKIs affect the outcomes of EGFR mutant NSCLC patients with de novo bone metastases has not been well studied thus far. We retrospectively studied the effect of EGFR mutation status and first-line EGFR-TKIs on patient outcomes and created a survival scoring system for NSCLC patients with de novo bone metastases. This retrospective study evaluated 1510 NSCLC patients diagnosed between November 2010 and March 2014. Among these patients, 234 patients had de novo bone metastases. We found that 121 of these 234 patients (51.7%) had positive EGFR mutation tests, and a positive EGFR mutation test significantly affected overall survival (OS) (EGFR mutant: 15.2 months, EGFR wild type: 6.5 months; p < 0.001). Other prognostic factors significant in the multivariable analysis for NSCLC with de novo bone metastases included Eastern Cooperative Oncology Group performance status (PS) (OS; PS 0–2: 11.2 months, PS 3–4: 4.9 months; p = 0.002), presence of extraosseous metastases (OS; with extraosseous metastases: 8.8 months, without extraosseous metastases: 14.0 months; p = 0.008), blood lymphocyte-to-monocyte ratio (LMR) (OS; LMR > 3.1: 17.1months, LMR ≤ 3.1: 6.9months; p < 0.001). A positive EGFR mutation status reversed the poor outcomes of NSCLC patients with de novo bone metastases. A simple and useful survival scoring system including the above clinical parameters was thus created for NSCLC patients with de novo bone metastases.
Collapse
Affiliation(s)
- Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Tang Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hao Lai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ming Rau
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hua Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chih Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tung-Ying Chao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Cheng Tseng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Hsiu Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hsi Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Feng Liu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Chun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ping Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
| |
Collapse
|
11
|
Conen K, Hagmann R, Hess V, Zippelius A, Rothschild SI. Incidence and predictors of Bone Metastases (BM) and Skeletal-Related Events (SREs) in Small Cell Lung Cancer (SCLC): A Swiss patient cohort. J Cancer 2016; 7:2110-2116. [PMID: 27877227 PMCID: PMC5118675 DOI: 10.7150/jca.16211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/14/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives: Bone metastases (BM) and skeletal-related events (SREs) are frequent complications in patients with lung cancer. Whereas in non-small-cell lung cancer (NSCLC) incidence, prognostic impact, and risk factors are well established, there is only little knowledge in patients with small cell lung cancer (SCLC). We retrospectively evaluated the incidence of BM, SRE and their treatment in a SCLC patient cohort treated at our hospital. We further assessed the role of Lactate Dehydrogenase (LDH), a possible predictor of BM development in SCLC patients. Materials and Methods: We retrospectively analyzed patients with the diagnosis of SCLC for BM, SRE, overall treatment patterns, outcome and established prognostic parameters by record review. The prognostic role of LDH was tested using univariate longitudinal regression analysis. Results: We identified 92 consecutive patients with SCLC diagnosed between 2000 and 2010 at our institution. Overall, 36.9% presented with BM at first diagnosis. Median time to BM from first diagnosis was 14.8 months (range) in limited disease (LD) and 0.9 months (range) in extensive disease (ED). The overall incidence of SRE was 18.4%. Only 19.6% of patients with BM were initially treated with bisphosphonates. Conclusions: Elevated LDH, as well as age ≥75 years were independent predictors for BM development in SCLC patients. Although SREs are relevant complications in SCLC, early antiresorptive treatment of BM to reduce the risk of SREs was rare. LDH served as a predictive factor for BM development in our SCLC cohort and therefore should be taken into account in future randomized controlled trials.
Collapse
Affiliation(s)
- Katrin Conen
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Raphael Hagmann
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Viviane Hess
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alfred Zippelius
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Lung Tumor Center, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sacha I Rothschild
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Lung Tumor Center, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| |
Collapse
|
12
|
Lipton A, Smith MR, Fizazi K, Stopeck AT, Henry D, Brown JE, Shore ND, Saad F, Spencer A, Zhu L, Warner DJ. Changes in Bone Turnover Marker Levels and Clinical Outcomes in Patients with Advanced Cancer and Bone Metastases Treated with Bone Antiresorptive Agents. Clin Cancer Res 2016; 22:5713-5721. [DOI: 10.1158/1078-0432.ccr-15-3086] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022]
|
13
|
Ayan A, Erdemci B, Orsal E, Bayraktutan Z, Akpinar E, Topcu A, Turkeli M, Seven B. Is there any correlation between levels of serum ostepontin, CEA, and FDG uptake in lung cancer patients with bone metastasis? Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Vicent S, Perurena N, Govindan R, Lecanda F. Bone metastases in lung cancer. Potential novel approaches to therapy. Am J Respir Crit Care Med 2016; 192:799-809. [PMID: 26131844 DOI: 10.1164/rccm.201503-0440so] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The skeleton is a common site of metastases in lung cancer, an event associated with significant morbidities and poor outcomes. Current antiresorptive therapies provide limited benefit, and novel strategies of prevention and treatment are urgently needed. This review summarizes the latest advances and new perspectives on emerging experimental and clinical approaches to block this deleterious process. Progress propelled by preclinical models has led to a deeper understanding on the complex interplay of tumor cells in the osseous milieu, unveiling potential new targets for drug development. Improvements in early diagnosis through the use of sophisticated imaging techniques with bone serum biomarkers are also discussed in the context of identifying patients at risk and monitoring disease progression during the course of treatment.
Collapse
Affiliation(s)
- Silvestre Vicent
- 1 Division of Oncology, Center for Applied Medical Research, and.,2 Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Spain.,3 IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; and
| | - Naiara Perurena
- 1 Division of Oncology, Center for Applied Medical Research, and
| | - Ramaswamy Govindan
- 4 Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Fernando Lecanda
- 1 Division of Oncology, Center for Applied Medical Research, and.,2 Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Spain.,3 IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; and
| |
Collapse
|
15
|
Ayan AK, Erdemci B, Orsal E, Bayraktutan Z, Akpinar E, Topcu A, Turkeli M, Seven B. Is there any correlation between levels of serum ostepontin, CEA, and FDG uptake in lung cancer patients with bone metastasis? Rev Esp Med Nucl Imagen Mol 2015; 35:102-6. [PMID: 26521996 DOI: 10.1016/j.remn.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, an evaluation was made of the relationship between the serum levels of carcinoembryonic antigen (CEA), osteopontin (OPN), and the semi-quantitative parameters of 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in lung cancer patients with bone metastasis. MATERIAL AND METHODS The evaluation included 42 non-small cell lung cancer (NSCLC) and 31 small cell lung cancer (SCLC) patients who were referred to our institution for staging by (18)F-FDG PET/CT. The biochemical parameters measured included CEA and OPN serum levels. RESULTS Serum levels of OPN in NSCLC patients with and without bone metastasis were 21.20±4.97 ng/ml and 13.33±4.53 ng/ml, respectively (p<0.05). In SCLC patients with and without bone metastasis serum OPN levels were 23.95±4.78 ng/ml and 17.30±3.09 ng/ml, respectively (p<0.05). Serum levels of CEA in NSCLC patients with and without bone metastasis were 33.79±6.49 ng/ml and 11.74±2.96 ng/ml, respectively (p<0.05). In SCLC patients with and without bone metastasis serum levels of CEA were 28.93±4.59 ng/ml and 13.88±4.47 ng/ml, respectively (p<0.05). There were no correlations between primary tumor SUVmax, and serum levels of CEA and OPN. CONCLUSIONS Bone metastasis can be detected in patients with lung cancer by measuring CEA and OPN levels. Increased levels of CEA and OPN levels may be considered an early warning sign in patients needing accurate imaging, as they are at higher risk of bone metastasis.
Collapse
Affiliation(s)
- A K Ayan
- Department of Nuclear Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey.
| | - B Erdemci
- Department of Radiation Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - E Orsal
- Department of Nuclear Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Z Bayraktutan
- Department of Biochemistry, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - E Akpinar
- Department of Pharmacology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - A Topcu
- Department of Pharmacology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - M Turkeli
- Department of Internal Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - B Seven
- Department of Nuclear Medicine, Mevlana University Faculty of Medicine, Konya, Turkey
| |
Collapse
|
16
|
D'Antonio C, Passaro A, Gori B, Del Signore E, Migliorino MR, Ricciardi S, Fulvi A, de Marinis F. Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies. Ther Adv Med Oncol 2014; 6:101-14. [PMID: 24790650 DOI: 10.1177/1758834014521110] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bone and brain metastases are a very common secondary localization of disease in patients with lung cancer. The prognosis of these patients is still poor with a median survival of less than 1 year. Current therapeutic approaches include palliative radiotherapy and systemic therapy with chemotherapy and targeted agents. For bone metastasis, zoledronic acid is the most commonly used bisphosphonate to prevent, reduce the incidence and delay the onset of skeletal-related events (SREs). Recently, denosumab, a fully human monoclonal antibody directed against the receptor activator of nuclear factor κB (RANK) ligand inhibiting the maturation of pre-osteoclasts into osteoclasts, showed increased time to SREs and overall survival compared with zoledronic acid. The treatment of brain metastasis is still controversial. Available standard therapeutic options, such as whole brain radiation therapy and systemic chemotherapy, provide a slight improvement in local control, overall survival and symptom relief. More recently, novel target agents such as the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) erlotinib, gefitinib and afatinib have shown activity in patients with brain metastasis. Inter alia, in patients harboring EGFR mutations, the administration of EGFR TKIs is followed by a response rate of 70-80%, and a longer progression-free and overall survival than those obtained with standard chemotherapeutic regimens. This review is focused on the evidence for therapeutic strategies in bone and brain metastases due to lung cancer.
Collapse
Affiliation(s)
- Chiara D'Antonio
- 1st Oncological Pulmonary Unit/Department of Medical and Surgical Sciences and Translational Medicine, 'Sapienza' University of Rome, Sant'Andrea Hospital San Camillo, High Specialization Hospital/University of Rome, Sant'Andrea Hospital, Cir. ne Gianicolense 87, 00151, Rome, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Bruno Gori
- 1st Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Maria Rita Migliorino
- 1st Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy
| | - Serena Ricciardi
- 1st Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy
| | - Alberto Fulvi
- 1st Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| |
Collapse
|
17
|
Is there any significance of lung cancer histology to compare the diagnostic accuracies of (18)F-FDG-PET/CT and (99m)Tc-MDP BS for the detection of bone metastases in advanced NSCLC? Contemp Oncol (Pozn) 2014; 18:106-10. [PMID: 24966793 PMCID: PMC4068819 DOI: 10.5114/wo.2014.42725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/06/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Bone scintigraphy (BS) and fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in histological subgroups of non-small cell lung cancer (NSCLC) remains ambiguous. The aim of this study was to compare the efficacy of 18F-FDG-PET/C and 99mTc-methylene diphosphonate (99mTc-MDP) BS in the detection of bone metastases of patients in NSCLC. Specifically, we compared the diagnostic accuracies of these imaging techniques evaluating bone metastasis in histological subgroups of NSCLC. Material and methods Fifty-three patients with advanced NSCLC, who had undergone both 18F-FDG-PET/CT and BS and were eventually diagnosed as having bone metastasis, were enrolled in this retrospective study. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT and BS were 90.4%, 99.4%, 98.1%, 96.6%, 97.0% and 84.6%, 93.1%, 82.5%, 93.2, 90.8%, respectively. The κ statistics were calculated for 18F-FDG-PET/CT and BS. The κ-value was 0.67 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the κ-value was 0.65 in adenocarcinoma, and 0.61 in squamous cell carcinoma between 18F-FDG-PET/CT and BS. The κ-values suggested excellent agreement between all patients and histological subgroups of NSCLC. Conclusions 18F-FDG-PET/CT was more favorable than BS in the screening of metastatic bone lesions, but the trend did not reach statistical significance in all patients and histological subgroups of NSCLC. Our results need to be validated in prospective and larger study clinical trials to further clarify this topic.
Collapse
|
18
|
Dai H, Qiang M, Chen Y, Zhai W, Zhang K. Lung cancer presenting as heel pain: A case report. Oncol Lett 2014; 8:736-738. [PMID: 25009652 PMCID: PMC4081435 DOI: 10.3892/ol.2014.2164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 04/03/2014] [Indexed: 11/06/2022] Open
Abstract
Bone metastasis as the first symptom of lung cancer is common, particularly in the axial skeleton. The calcaneus is an unusual site of metastatic involvement. Chronic plantar heel pain (CPHP) is one of the most common complaints of the foot requiring medical treatment. The most typical symptom of CPHP is pain under the medial heel during weight-bearing, and this symptom is therefore generally initially diagnosed as CPHP by clinicians. The current case study reports a female patient never-smoker with non-small cell lung cancer accompanied by calcaneal metastasis presenting as heel pain. The patient was initially diagnosed with CPHP without any imaging examinations. As there was no relief from the heel pain six months later, a foot X-ray was performed, which revealed a lesion of the calcaneus. The analysis of a biopsy obtained from the lesion resulted in a diagnosis of adenocarcinoma. The present case indicates that patients suspected to have CPHP should be conventionally examined with radiography of the foot during the initial diagnosis. Similarly, if a patient with lung cancer has symptoms such as CPHP, distant metastasis should be accounted for; despite their rarity, clinicians should maintain a high level of suspicion, since accurate diagnosis and timely treatment is important in management and outcome.
Collapse
Affiliation(s)
- Hao Dai
- Department of Orthopedics, Guanghua Integrative Medicine Hospital, Shanghai 200052, P.R. China
| | - Minfei Qiang
- Department of Orthopedics and Traumatology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Yanxi Chen
- Department of Orthopedics and Traumatology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Weitao Zhai
- Department of Orthopedics, Guanghua Integrative Medicine Hospital, Shanghai 200052, P.R. China
| | - Kun Zhang
- Department of Orthopedics and Traumatology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| |
Collapse
|
19
|
Katakami N, Kunikane H, Takeda K, Takayama K, Sawa T, Saito H, Harada M, Yokota S, Ando K, Saito Y, Yokota I, Ohashi Y, Eguchi K. Prospective study on the incidence of bone metastasis (BM) and skeletal-related events (SREs) in patients (pts) with stage IIIB and IV lung cancer-CSP-HOR 13. J Thorac Oncol 2014; 9:231-8. [PMID: 24419421 PMCID: PMC4132043 DOI: 10.1097/jto.0000000000000051] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone metastasis (BM) is a frequent complication in patients with advanced lung cancer and it causes skeletal-related events (SREs). Our study aim is to prospectively investigate the incidence of BM, incidence and types of SRE, and predictive factors of BM and SREs. METHODS Newly diagnosed, advanced non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) patients were enrolled into the study. Patients were followed up every 4 weeks to monitor the development of SREs. Treatment for lung cancer was performed at the discretion of the investigator. RESULTS Two hundred seventy-four patients were enrolled in this study between April 2007 and December 2009 from 12 institutions. Patients included 77 cases of SCLC and 197 of NSCLC (stage IIIB/IV = 73/124). Median follow-up time was 13.8 months. The incidence of BM at initial diagnosis was 48% in stage IV NSCLC and 40% in extensive stage (ED)-SCLC. Forty-five percent of patients who developed BM had SREs consisting of pathologic fracture (4.7%), radiation to bone (15.3%), spinal cord compression (1.1%), and hypercalcemia (2.2%). Multivariate analysis revealed that factors predicting BM are stage IV, performance status 1 or greater and higher bone alkaline phosphatase in NSCLC patients, higher lactate dehydrogenase, and lower parathyroid hormone-related peptide in SCLC patients. Factors predicting SREs were stage IV, age 64 or younger, and lower albumin in NSCLC patients. Multivariate analysis of SRE was not performed for SCLC because of the small number of events. CONCLUSION Predictive factors should be taken into consideration in future randomized studies evaluating BM and SREs.
Collapse
Affiliation(s)
- Nobuyuki Katakami
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Kunikane
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Koji Takeda
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Koichi Takayama
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Toshiyuki Sawa
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Saito
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Masao Harada
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Soichiro Yokota
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Kiyoshi Ando
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Yuko Saito
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Isao Yokota
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuo Ohashi
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| | - Kenji Eguchi
- Institute of Biomedical Research and Innovation, Kobe, Japan; Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Osaka City General Hospital, Osaka, Japan; Kyushu University Hospital, Fukuoka, Japan; Gifu Municipal Hospital, Gifu, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Japan; National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Toneyama National Hospital, Toyonaka, Japan; Tokai University School of Medicine, University Hospital, Isehara, Japan; Shizuoka Cancer Center, Shizuoka, Japan; The University of Tokyo, Tokyo, Japan; and Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Sathiakumar N, Delzell E, Morrisey MA, Falkson C, Yong M, Chia V, Blackburn J, Arora T, Kilgore ML. Mortality following bone metastasis and skeletal-related events among patients 65 years and above with lung cancer: A population-based analysis of U.S. Medicare beneficiaries, 1999-2006. Lung India 2013; 30:20-6. [PMID: 23661912 PMCID: PMC3644828 DOI: 10.4103/0970-2113.106127] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: To quantify the impact of bone metastasis and skeletal-related events (SREs) on mortality among older patients with lung cancer. Materials and Methods: Using the linked Surveillance, Epidemiology and End Results-Medicare database, we identified patients aged 65 years or older diagnosed with lung cancer between July 1, 1999 and December 31, 2005 and followed them to determine deaths through December 31, 2006. We classified patients as having possible bone metastasis and SREs using discharge diagnoses from inpatient claims and diagnoses paired with procedure codes from outpatient claims. We used Cox regression to estimate mortality hazards ratios (HR) among patients with bone metastasis with or without SRE, compared to patients without bone metastasis. Results: Among 126,123 patients with lung cancer having a median follow-up of 0.6 years, 24,820 (19.8%) had bone metastasis either at lung cancer diagnosis (9,523, 7.6%) or during follow-up (15,297, 12.1%). SREs occurred in 12,665 (51%) patients with bone metastasis. The HR for death was 2.4 (95% CI = 2.4-2.5) both for patients with bone metastasis but no SRE and for patients with bone metastasis plus SRE, compared to patients without bone metastasis. Conclusions: Having a bone metastasis, as indicated by Medicare claims, was associated with mortality among patients with lung cancer. We found no difference in mortality between patients with bone metastasis complicated by SRE and patients with bone metastasis but without SRE.
Collapse
Affiliation(s)
- Nalini Sathiakumar
- School of Public Health, University of Alabama at Birmingham. 1665 University Blvd, Birmingham, AL. 35294-0022, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Tokito T, Shukuya T, Akamatsu H, Taira T, Ono A, Kenmotsu H, Naito T, Murakami H, Takahashi T, Endo M, Yamamoto N. Efficacy of bevacizumab-containing chemotherapy for non-squamous non-small cell lung cancer with bone metastases. Cancer Chemother Pharmacol 2013; 71:1493-8. [PMID: 23532208 DOI: 10.1007/s00280-013-2148-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Skeletal-related events (SREs) negatively affect the quality of life of patients with cancer. Vascular endothelial growth factor receptor (VEGFR)-targeted therapy is effective against bone metastasis in animal models, but the clinical efficacy of anti-VEGFR inhibitors against bone metastases remains unclear. Therefore, we aimed to investigate the efficacy of chemotherapy with bevacizumab, an anti-VEGF antibody, against bone metastases. METHODS We retrospectively reviewed consecutive patients with non-squamous non-small cell lung cancer who received first-line platinum-based chemotherapy with zoledronic acid at Shizuoka Cancer Center between 2007 and 2011. RESULTS Of 25 patients, 13 received bevacizumab-based chemotherapy (BEV group) and 12 received chemotherapy without bevacizumab (non-BEV group). The overall response (54 vs. 8 %, p = 0.01) and disease control (100 vs. 50 %, p = 0.01) rates were higher in the BEV group than in the non-BEV group. The bone-specific response (23 vs. 0 %, p = 0.038) and disease control (100 vs. 67 %, p = 0.01) rates were also higher in the BEV group. The median time to progression (TTP) for bone metastases was higher in the BEV group (13.7 vs. 4.3 months, p = 0.06), whereas that for overall disease was similar between the groups (5.7 vs. 2.6 months, p = 0.17). The proportions of patients with SREs were 23 and 50 % in the BEV and non-BEV groups, respectively (p = 0.16). CONCLUSION Bevacizumab might potentiate the antitumor activity of chemotherapy against systemic disease and bone metastases, prolonging bone-specific TTP and reducing the incidence of SRE.
Collapse
Affiliation(s)
- Takaaki Tokito
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Abstract
In patients with lung cancer, bone is one of the most frequent sites of distant spread, with approximately 30% of patients developing skeletal metastases. About half of these patients will experience a skeletal-related event, the occurrence of which not only affects quality of life, but is also associated with poor prognosis. Bisphosphonates are currently the mainstay for treating bone metastases in patients with lung cancer, with proven beneficial effects on prevention and delay of skeletal complications. Their role in preventing the development of skeletal metastases, their anti-tumoral properties and their effect on survival remain to be elucidated. Other bone-targeted therapies are being investigated in phase II and III clinical trials and might expand the therapeutic arsenal in the near future.
Collapse
|
24
|
Bayrak SB, Ceylan E, Serter M, Karadağ F, Demir E, Çildağ O. The clinical importance of bone metabolic markers in detecting bone metastasis of lung cancer. Int J Clin Oncol 2011; 17:112-8. [DOI: 10.1007/s10147-011-0266-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
|
25
|
Epidemiology and treatment costs of bone metastases from lung cancer: a French prospective, observational, multicenter study (GFPC 0601). J Thorac Oncol 2011; 6:576-82. [PMID: 21270669 DOI: 10.1097/jto.0b013e318206a1e3] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this prospective, observational, multicenter study was to examine the epidemiology and management costs of bone metastatic disease (BMD) in patients with lung cancer. METHODS The analysis included all patients with BMD from lung cancer diagnosed between May 2006 and May 2007 in 40 centers. We analyzed their management and the direct costs of BMD from the health care provider's perspective, using a Markov model. Skeletal-related event (SRE) was defined as pathological fractures, spinal cord compression, or hypercalcemia (clinical SRE [cSRE]) for an initial analysis; a second analysis included palliative radiotherapy and surgery (therapeutic SRE [tSRE]). RESULTS Among the 554 patients enrolled (62 ± 11 years, 76.5% males, 69.3% performance status 0/1, 91% non-small cell lung cancer), 24.7% had a cSRE and 26.7% a tSRE at baseline and 9% and 39% during follow-up, respectively; 81.8% received at least one chemotherapy cycle. The median survival time was 5.8 months, and the 1- and 2-year survival rates were 22% and 7%, respectively; there was no significant difference in overall survival between the patients with and without SRE at enrollment. The main BMD treatments were opiate therapy (77.7%), biphosphonates (52.3%), radiotherapy (42.1%), and surgery (9.2%). The mean monthly BMD treatment costs in euros were €190, €374, and €4672 for asymptomatic patients, symptomatic patients, and patients with SRE, respectively. The average first-year BMD management cost in euros was €3999 ± 4135 (95% confidence interval: 374-15,886), and 49.5% of this cost was attributable to patients with SRE. CONCLUSIONS This analysis confirms the poor prognosis of BMD from lung cancer and underlines the burden of SRE in overall treatment costs.
Collapse
|
26
|
Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, von Moos R, Willenbacher W, Woll PJ, Wang J, Jiang Q, Jun S, Dansey R, Yeh H. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 2011; 29:1125-32. [PMID: 21343556 DOI: 10.1200/jco.2010.31.3304] [Citation(s) in RCA: 844] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study compared denosumab, a fully human monoclonal anti-receptor activator of nuclear factor kappa-B ligand antibody, with zoledronic acid (ZA) for delaying or preventing skeletal-related events (SRE) in patients with advanced cancer and bone metastases (excluding breast and prostate) or myeloma. PATIENTS AND METHODS Eligible patients were randomly assigned in a double-blind, double-dummy design to receive monthly subcutaneous denosumab 120 mg (n = 886) or intravenous ZA 4 mg (dose adjusted for renal impairment; n = 890). Daily supplemental calcium and vitamin D were strongly recommended. The primary end point was time to first on-study SRE (pathologic fracture, radiation or surgery to bone, or spinal cord compression). RESULTS Denosumab was noninferior to ZA in delaying time to first on-study SRE (hazard ratio, 0.84; 95% CI, 0.71 to 0.98; P = .0007). Although directionally favorable, denosumab was not statistically superior to ZA in delaying time to first on-study SRE (P = .03 unadjusted; P = .06 adjusted for multiplicity) or time to first-and-subsequent (multiple) SRE (rate ratio, 0.90; 95% CI, 0.77 to 1.04; P = .14). Overall survival and disease progression were similar between groups. Hypocalcemia occurred more frequently with denosumab. Osteonecrosis of the jaw occurred at similarly low rates in both groups. Acute-phase reactions after the first dose occurred more frequently with ZA, as did renal adverse events and elevations in serum creatinine based on National Cancer Institute Common Toxicity Criteria for Adverse Events grading. CONCLUSION Denosumab was noninferior (trending to superiority) to ZA in preventing or delaying first on-study SRE in patients with advanced cancer metastatic to bone or myeloma. Denosumab represents a potential novel treatment option with the convenience of subcutaneous administration and no requirement for renal monitoring or dose adjustment.
Collapse
Affiliation(s)
- David H Henry
- Joan Karnell Cancer Center, Philadelphia, PA 19106, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Xu R, Sciubba DM, Gokaslan ZL, Bydon A. Metastasis to the occipitocervical junction: A case report and review of the literature. Surg Neurol Int 2010; 1:16. [PMID: 20657697 PMCID: PMC2908354 DOI: 10.4103/2152-7806.63911] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 04/29/2010] [Indexed: 12/02/2022] Open
Abstract
Background The management of metastatic spinal disease is generally considered palliative, as the progression of systemic disease is likely to hinder survival. Although the occurrence of C1-C2 instability due to metastatic disease is not uncommon and thus treatment options have been well-defined, craniocervical instability due to lesions occurring at the junction of the occiput and atlas is more rare, and treatment for metastasis to this region is less well-defined. Case Description We present a patient with non-small-cell lung cancer metastatic to the atlanto-occipital facet joint complex. A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion. A literature review of published cases of metastases to the occipitocervical junction was conducted along with treatment options. Conclusions The atlanto-occipital facet joint is a rare site of metastatic disease. Destruction of this joint can lead to significant neck pain secondary to instability. Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients—even those with end-stage oncologic disease.
Collapse
Affiliation(s)
- Risheng Xu
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | |
Collapse
|
28
|
Bisphosphonate Use in Patients with Lung Cancer and Bone Metastases: Recommendations of a European Expert Panel. J Thorac Oncol 2009; 4:1280-8. [DOI: 10.1097/jto.0b013e3181b68e5a] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|