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Ito I, Ito K, Takahashi S, Horibe M, Karita R, Nishizaka C, Nagai T, Hamada K, Sato H, Shindo N. Association between bone scan index and activities of daily living in patients with advanced non-small cell lung cancer. Support Care Cancer 2017; 25:1779-1785. [PMID: 28108818 DOI: 10.1007/s00520-016-3557-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/27/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this retrospective cross-sectional study was to investigate the association between the bone scan index (BSI) and activities of daily living (ADL) in patients with advanced non-small cell lung cancer (NSCLC). METHODS Among patients with advanced NSCLC, subjects who underwent bone scintigraphy were recruited from this study. Clinical information about patients, including the Barthel Index of ADL, was extracted from their medical charts. Variables including the age, sex, BSI, presence/absence skeletal-related events (SREs), diagnostic state (initial vs. relapse), and history of use of certain medications (e.g. opiates) were evaluated as factors possibly associated with the Barthel Index. In Addition, associations between these factors, including the Barthel Index, with the overall survival were also assessed. RESULTS A total of 111 patients with bone metastases were selected. The BSI and Barthel Index of the patients were 1.59 ± 2.25 and 69.7 ± 19.6, respectively. Multivariable analysis identified age (≥70 years), a high BSI (≥1.0), and presence of SREs were as factors statistically significantly associated with lower values of the Barthel Index (<75). On the other hand, Cox proportional hazards analysis identified low values of the Barthel Index (<75), use of opiates, and male sex as significant factors associated with a shorter overall survival; the BSI was not associated with the overall survival in the patients with advanced NSCLC in this study. CONCLUSION The results suggest that a high BSI (≥1.0) is an independent predictor of poor ADL in patients with NSCLC, while showing no correlation with the overall survival.
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Affiliation(s)
- Ikuno Ito
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan.
| | - Kimiteru Ito
- Department of Diagnostic Radiology, Tokyo Mertopolitan Geniatric and Institute of Gerontology, Tokyo, Japan
| | - Shinichi Takahashi
- Department of Radiology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Mitsuko Horibe
- Department of Radiology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Rui Karita
- Department of Radiology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Chika Nishizaka
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Takako Nagai
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Kohei Hamada
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Hiroyuki Sato
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Naoko Shindo
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
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Shi Y, Sun Y, Yu J, Ding C, Wang Z, Wang C, Wang D, Wang C, Wang Z, Wang M, Zhi X, Lu Y, Feng J, Liu Y, Liu X, Liu W, Wu G, Li X, Li K, Li E, Li W, Chen G, Chen Z, Yu P, Wu N, Wu M, Xiao W, Zhang L, Zhang Y, Zhang S, Yang S, Song X, Lin D, Luo R, Shan L, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Guo Q, Chang J, Huang C, Zeng X, Han B, Han X, Jia B, Han Y, Huang Y. China experts consensus on the diagnosis and treatment of advanced stage primary lung cancer (2016 version). Asia Pac J Clin Oncol 2016; 13:87-103. [PMID: 28134505 DOI: 10.1111/ajco.12608] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Yan Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, Ji'nan, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Changli Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Dong Wang
- Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Cunde Wang
- Yunnan Province Cancer Hospital, Kunming, China
| | | | | | - Xiuyi Zhi
- Beijing Xuanwu Hospital, Capital Medical University, China
| | - You Lu
- West China Hospital of Sichuan University, Chengdu, China
| | | | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, China
| | - Wei Liu
- Beijing Cancer Hospital, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, Wuhan, China
| | - Xiaomei Li
- Chinese People's Liberation Army General Hospital, China
| | - Kai Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Li
- The First Hospital of Jilin University, Changchun, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhengtang Chen
- Xinqiao Hospital of The Third Military Medical University, Chongqing, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu, China
| | - Ning Wu
- Department of Imaging Diagnostic, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Milu Wu
- Qinghai University Affiliated Hospital, Xining, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, China
| | - Li Zhang
- Peking Union Medical College Hospital, China
| | | | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shujun Yang
- Henan Province Cancer Hospital, Zhengzhou, China
| | - Xia Song
- Shanxi Province Cancer Hospital, Taiyuan, China
| | | | - Rongcheng Luo
- Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Li Shan
- Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, China
| | - Zongmei Zhou
- Department of Imaging Diagnostic, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsha, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, China
| | - Qisen Guo
- Shandong Province Cancer Hospital, Ji'nan, China
| | | | | | - Xuan Zeng
- Peking Union Medical College Hospital, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, China
| | - Xiaohong Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Bo Jia
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Ying Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Yu Huang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
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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: 2.1] [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.
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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
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104
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Huang CY, Wang L, Feng CJ, Yu P, Cai XH, Yao WX, Xu Y, Liu XK, Zhu WJ, Wang Y, Zhou J, Lu Y, Wang YS. Bisphosphonates enhance EGFR-TKIs efficacy in advanced NSCLC patients with EGFR activating mutation: A retrospective study. Oncotarget 2016; 7:66480-66490. [PMID: 26624882 PMCID: PMC5341815 DOI: 10.18632/oncotarget.5515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/05/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bisphosphonates have exhibited anti-tumor activity in non-small cell lung cancer (NSCLC). We aimed to evaluate whether the combination of bisphosphonates with tyrosine kinase inhibitors of EGFR (EGFR-TKIs) could obtain a synergistic effect on advanced NSCLC patients with EGFR mutations. METHODS Between January 2008 and October 2013, 114 advanced EGFR mutations NSCLC patients who received EGFR-TKIs as first-line therapy were recruited from two cancer centers. Patients were separated into EGFR-TKIs alone or EGFR-TKIs plus bisphosphonates (combination) group. Median progression free survival (mPFS), median overall survival (mOS) distributions and survival curves were analyzed. RESULTS Among the 114 patients, 62 had bone metastases (19 patients treated with EGFR-TKIs, 43 patients treated with EGFR-TKIs + bisphosphonates). Median PFS and OS were significantly improved in combination group compared with EGFR-TKIs group (mPFS: 15.0 vs 7.3 months, P = 0.0017; mOS: 25.2 vs 10.4 months, P = 0.0015) in patients with bone metastases. Among the 71 patients (19 patients with bone metastases) treated with EGFR-TKIs alone, patients with bone metastases had poor survival prognosis (mPFS:7.3 vs 12.1 months, P = 0.0434; mOS:10.4 vs 22.0 months, P = 0.0036). The survival of patients with bone metastases who received EGFR-TKIs plus bisphosphonates therapy was non-inferior to patients without bone metastases treated with EGFR-TKIs alone (mPFS: 15.0 vs 12.1 months, p = 0.1871; mOS: 25.2 vs 22.0 months, p = 0.9798). CONCLUSIONS Concomitant use of bisphosphonates and EGFR-TKIs improves therapeutic efficacy and brings survival benefits to NSCLC patients with EGFR mutation and bone metastases.
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Affiliation(s)
- Chu-Ying Huang
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Medical Oncology, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Hubei Province, China
| | - Li Wang
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Dermatology, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Hubei Province, China
| | - Cheng-Jun Feng
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Yu
- Department of Oncology, The Second People's Hospital of Sichuan, Chengdu, China
| | - Xiao-Hong Cai
- Department of Oncology, The Second People's Hospital of Sichuan, Chengdu, China
| | - Wen-Xiu Yao
- Department of Oncology, The Second People's Hospital of Sichuan, Chengdu, China
| | - Yong Xu
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Ke Liu
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jiang Zhu
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Oncology, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Jin Zhou
- Department of Oncology, The Second People's Hospital of Sichuan, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Sheng Wang
- Department of Thoracic Oncology, Cancer Center, and State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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105
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Shi Y, Sun Y, Yu J, Ding C, Wang Z, Wang C, Wang D, Wang C, Wang Z, Wang M, Zhi X, Lu Y, Feng J, Liu Y, Liu X, Liu W, Wu G, Li X, Li K, Li E, Li W, Chen G, Chen Z, Yu P, Wu N, Wu M, Xiao W, Zhang L, Zhang Y, Zhang S, Yang S, Song X, Lin D, Luo R, Shan L, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Guo Q, Chang J, Huang C, Zeng X, Han B, Han X, Jia B, Han Y, Huang Y. [China Experts Consensus on the Diagnosis and Treatment of Advanced Stage Primary Lung Cancer (2016 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:1-15. [PMID: 26805732 PMCID: PMC5999802 DOI: 10.3779/j.issn.1009-3419.2016.01.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yan Sun
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, Ji'nan 250117, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ziping Wang
- Beijing Cancer Hospital, Beijing 100142, China
| | - Changli Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin 300070, China
| | - Dong Wang
- Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Cunde Wang
- Yunnan Province Cancer Hospital, Kunming 650118, China
| | | | - Mengzhao Wang
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiuyi Zhi
- Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - You Lu
- West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, Beijing 100071, China
| | - Wei Liu
- Beijing Cancer Hospital, Beijing 100142, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, Wuhan 430022, China
| | - Xiaomei Li
- Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Kai Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin 300070, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Wei Li
- The First Hospital of Jilin University, Changchun 130021, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Zhengtang Chen
- Xinqiao Hospital of The Third Military Medical University, Chongqing 400037, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu 610047, China
| | - Ning Wu
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Milu Wu
- Qinghai University Affiliated Hospital, Xining 810000, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing 100048, China
| | - Li Zhang
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Shujun Yang
- Henan Province Cancer Hospital, Zhengzhou 450008, China
| | - Xia Song
- Shanxi Province Cancer Hospital, Taiyuan 030013, China
| | - Dongmei Lin
- Beijing Cancer Hospital, Beijing 100142, China
| | - Rongcheng Luo
- Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China
| | - Li Shan
- Cancer Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Zongmei Zhou
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qisen Guo
- Shandong Province Cancer Hospital, Ji'nan 250117, China
| | - Jianhua Chang
- Cancer Hospital, Fudan Universitay, Shanghai 200032, China
| | - Cheng Huang
- Fujian Cancer Hospital, Fuzhou 350014, China
| | - Xuan Zeng
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Xiaohong Han
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Bo Jia
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Ying Han
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yu Huang
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
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LeVasseur N, Clemons M, Hutton B, Shorr R, Jacobs C. Bone-targeted therapy use in patients with bone metastases from lung cancer: A systematic review of randomized controlled trials. Cancer Treat Rev 2016; 50:183-193. [PMID: 27716496 DOI: 10.1016/j.ctrv.2016.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/11/2015] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with advanced lung cancer commonly have bone metastases. Compared with other malignancies, the use of bone-targeted agents (e.g. bisphosphonates and denosumab) is less common in lung cancer patients. This may be due to the perception that bone-targeted agents are less effective in this population. OBJECTIVE To perform a systematic review to evaluate data from randomized trials of bone-targeted agents in lung cancer patients with bone metastases. METHODS A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials through May 2015 was performed. Randomized trials of bone-targeted therapies in lung cancer patients with bone metastases were sought. Outcomes studied included skeletal related events (SREs), pain, quality of life, progression-free survival and overall survival. Random effects meta-analyses were planned if studies were judged homogeneous. RESULTS Of 632 abstracts, 17 publications describing 13 studies were included. Sample sizes ranged between 50 and 1776. Of 3379 patients, 1903 had lung cancer, with subgroup data available for 8 of 13 studies. Patient demographics were comparable, but enrollment criteria and endpoints were heterogeneous across studies, precluding meta-analysis. Study-specific results suggested that bone-modifying agents reduce the incidence of SREs and bone pain in lung cancer patients. Three studies suggested a survival benefit. CONCLUSION Data from included trials suggests benefit of bone-targeted agents in lung cancer for the prevention of SREs and bone pain. There is a trend toward improvement in overall survival and progression-free survival, although further research is needed. Impact on quality of life and key subgroups for benefit both require future research.
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Affiliation(s)
- Nathalie LeVasseur
- Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Mark Clemons
- Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | | | - Carmel Jacobs
- Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada
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107
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In vivo selection for spine-derived highly metastatic lung cancer cells is associated with increased migration, inflammation and decreased adhesion. Oncotarget 2016; 6:22905-17. [PMID: 26090868 PMCID: PMC4673208 DOI: 10.18632/oncotarget.4416] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/29/2015] [Indexed: 12/19/2022] Open
Abstract
We developed a murine spine metastasis model by screening five metastatic non-small cell lung cancer cell lines (PC-9, A549, NCI-H1299, NCI-H460, H2030). A549 cells displayed the highest tendency towards spine metastases. After three rounds of selection in vivo, we isolated a clone named A549L6, which induced spine metastasis in 80% of injected mice. The parameters of the A549L6 cell spinal metastatic mouse models were consistent with clinical spine metastasis features. All the spinal metastatic mice developed symptoms of nerve compression after 40 days. A549L6 cells had increased migration, invasiveness and decreased adhesion compared to the original A549L0 cells. In contrast, there was no significant differences in cell proliferation, apoptosis and sensitivity to chemotherapeutic agents such as cisplatin. Comparative transcriptomic analysis and Real-time PCR analysis showed that expression of signaling molecules regulating several tumor properties including migration (MYL9), metastasis (CEACAM6, VEGFC, CX3CL1, CST1, CCL5, S100A9, IGF1, NOTCH3), adhesion (FN1, CEACAM1) and inflammation (TRAF2, NFκB2 and RelB) were altered in A549L6 cells. We suggest that migration, adhesion and inflammation related genes contribute to spine metastatic capacity.
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108
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Rief H, Bruckner T, Schlampp I, Bostel T, Welzel T, Debus J, Förster R. Resistance training concomitant to radiotherapy of spinal bone metastases - survival and prognostic factors of a randomized trial. Radiat Oncol 2016; 11:97. [PMID: 27464793 PMCID: PMC4963927 DOI: 10.1186/s13014-016-0675-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the effects of resistance training versus passive physical therapy on bone survival in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to evaluate overall survival and progression-free-survival (PFS) as well as to quantify prognostic factors of bone survival after combined treatment. Methods In this randomized trial 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. We estimated patient survival using Kaplan-Meier survival method. The Wald-test was used to evaluate the prognostic importance of pathological fracture, primary site, Karnofsky performance status, localization of metastases, number of metastases, and cerebral metastases. Results Median follow-up was 10 months (range 2–35). Bone survival showed no significant difference between groups (p = .303). Additionally no difference between groups could be detected in overall survival (p = .688) and PFS (p = .295). Local bone progression was detected in 16.7 % in group B, no irradiated bone in group A showed a local progression over the course (p = 0.019). In univariate analysis breast cancer, prostate cancer, and the presence of cerebral metastases had a significant impact on bone survival in group B, while no impact could be demonstrated in group A. Conclusions In this group of patients with spinal bone metastases we were able to show that guided resistance training of the paravertebral muscles had no essential impact on survival concomitant to RT. Importantly, no local bone progression in group A was detected, nevertheless no prognostic factor for combined treatment could be evaluated. Trial registration Clinical trial identifier NCT 01409720. Registered 8 February 2011.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Hwang JA, Lee JY, Kim WS, Song JS, Rho JK, Choi CM, Lee JC. Clinical Implications of Isolated Bone Failure Without Systemic Disease Progression During EGFR-TKI Treatment. Clin Lung Cancer 2016; 17:573-580.e1. [PMID: 27378173 DOI: 10.1016/j.cllc.2016.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We investigated the characteristics of patients with epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) who had experienced isolated progression of bone metastases without aggravation of extraskeletal organs during EGFR-tyrosine kinase inhibitor (TKI) treatment. MATERIALS AND METHODS We retrospectively reviewed the data from 870 patients with EGFR-mutant NSCLC treated with EGFR-TKI from 2004 to 2014. Of these patients, 71 (8.2%), who had undergone radiation therapy to bone metastases because of skeletal-related events, impending skeletal-related events, or medically uncontrolled bone pain, were selected and defined as having bone failure (BF). BFs were classified into 2 categories according to the presence of accompanying disease progression in extraskeletal organs: isolated BF (IBF) and non-IBF. RESULTS Of the 71 BF patients, 33 (46.5%) experienced IBF without aggravation of disease in extraskeletal organs. IBF was more frequent in the clinical benefit group (responders and stable for ≥ 6 months) than in nonclinical benefit group (54.4% vs. 14.3%; P = .007). IBF was also more frequent in those with good performance status (82.5% vs. 42.9%; P = .005) and 19 deletion (68.4% vs. 35.7%; P = .024). Female sex, good performance status, and clinical benefit from TKI were more frequent in patients with IBF than in those with non-IBF (female sex, 69.7% vs. 44.7%; P = .034; Eastern Cooperative Oncology Group 0 or 1, 87.9% vs. 63.2%; P = .017; clinical benefit from TKI, 93.9% vs. 68.4%; P = .007). Clinical benefit from EGFR-TKI was an independent predictor of IBF (adjusted odds ratio, 6.647; 95% confidence interval, 1.328-33.262; P = .021). Patients with IBF tended to exhibit longer survival times from the initiation of the TKI (20.7 vs. 11.1 months; P = .2) and from the onset of BF (8.6 vs. 3.4 months; P = .186). CONCLUSION IBF without systemic disease progression frequently occurs in patients with clinical benefits from EGFR-TKI and is associated with better survival. This finding requires future studies to explore the differential activity of EGFR-TKI in the bones over time or in preference to other organs.
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Affiliation(s)
- Ji An Hwang
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Rho
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Charpidou A, Tsagouli S, Gkiozos I, Grapsa D, Moutsos M, Kiagia M, Syrigos K. Bone metastases in patients with small cell lung carcinoma: rate of development, early versus late onset, modality of treatment, and their impact on survival. A single-institution retrospective cohort study. Clin Exp Metastasis 2016; 33:453-60. [PMID: 27209468 DOI: 10.1007/s10585-016-9789-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 03/04/2016] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to further explore the impact of bone metastases (BMs) and their therapeutic management on the overall prognosis of patients with small cell lung carcinoma (SCLC). We performed a retrospective analysis of medical records of 363 patients with histologically or cytologically confirmed SCLC, diagnosed and treated in the Oncology Unit of Sotiria Athens General Hospital, between January 2003 and December 2012. Demographic and clinicopathological features, including BMs, their time point of development (early onset/at diagnosis versus late onset/at a subsequent time point), treatment modality for BMs (radiotherapy, bisphosphonates or both) and the presence of skeletal-related events (SREs), were correlated with overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, log-rank tests and Cox regression analysis. Overall, 130/363 patients (35.8 %) were diagnosed with either early-onset (97/363 cases, 26.7 %) or late-onset BMs (33/363 cases, 9.1 %). Patients with early-onset BMs had a reduced OS as compared to those with late-onset BMs [Hazard ratio (HR) 0.61; 95 % Confidence interval (CI) 0.41-0.91; p = 0.015) or those without BMs (HR 0.76; 95 % CI 0.6-0.96; p = 0.024). SREs and treatment modality of BMs had no impact on OS. Multiple Cox regression analysis showed that increased age, poor performance status (PS), presence of BMs and early onset BMs were independently associated with reduced OS. The results of our single-institution study suggest that the development of early-onset BMs may represent an independent predictor of a worse prognosis among patients with SCLC, in addition to well-established adverse prognostic factors such as poor PS.
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Affiliation(s)
- Andriani Charpidou
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Sofia Tsagouli
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Ioannis Gkiozos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Dimitra Grapsa
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Michalis Moutsos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Maria Kiagia
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece
| | - Konstantinos Syrigos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, "Sotiria" General Hospital, University of Athens, Mesogion 152, 115 27, Athens, Greece.
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Rao L, Zong Z, Chen Z, Wang X, Shi X, Yi C, Zhang X. 18F-Labeled NaF PET-CT in Detection of Bone Metastases in Patients With Preoperative Lung Cancer. Medicine (Baltimore) 2016; 95:e3490. [PMID: 27100456 PMCID: PMC4845860 DOI: 10.1097/md.0000000000003490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We compared the diagnostic accuracy of F-labeled sodium fluoride (F-NaF) PET-CT with 99m-technetium methylene diphosphonate (Tc-MDP) single photon emission computed tomography (SPECT) to detect bone metastases (BMs) in patients with preoperative lung cancer. Patients with lung cancer (n = 181) were examined with F-NaF PET-CT, and another 167 patients with lung cancer were examined with Tc-MDP SPECT. F-NaF PET-CT and Tc-MDP SPECT were evaluated by 2 experienced readers. Lesions were graded on a scale of 0 (degenerative lesion) to 4 (definite BM), and equivocal lesions were determined as indifferent (grade 3). Based on patient-based analysis, there were only 4 equivocal patients in F-NaF PET-CT detection. However, in Tc-MDP SPECT detection, there were 19 equivocal patients, which indicated a significant difference in terms of occurrence ratio (χ = 9.005, P = 0.03). Sensitivity and specificity of PET-CT was significantly better than that of SPECT when equivocal reading was categorized as malignant or benign (P < 0.05). Based on lesions-based analysis, SPECT produced 26 equivocal lesions of 333 lesions, but PET-CT produced only 5 equivocal lesions of 991 lesions. PET-CT was significantly better than SPECT in the aspect of producing equivocal patients (χ = 58.141, P < 0.001). Sensitivity and specificity of PET-CT was significantly better than that of SPECT when equivocal reading was categorized as malignant or benign (P < 0.05). F-NaF PET-CT is a highly sensitive and specific modality for the detection of BM in patients with preoperative lung cancer. It is better than conventional Tc-MDP SPECT in detecting BM in patients with preoperative lung cancer.
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Affiliation(s)
- Liangjun Rao
- From the Department of Nuclear Medicine (LR, ZC, XW, XS, CY, XZ); Department of Radiology, the First Affiliated Hospital (LR); and Department of General Surgery, Sun Yat-sen Memorial Hospital (ZZ), Sun Yat-sen University, Guangzhou, China
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The relationship between lung cancer histology and the clinicopathological characteristics of bone metastases. Lung Cancer 2016; 96:19-24. [PMID: 27133744 DOI: 10.1016/j.lungcan.2016.03.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/03/2016] [Accepted: 03/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Lung cancer is the leading cause of death due to cancer, and bone is one of the most frequent sites of metastasis. However, there is no published evidence regarding an association between lung cancer histology and skeletal complications. Therefore, we evaluated the influence of lung cancer histology on the frequency of bone metastases (BMs), skeletal-related events (SREs), and survival after BM. MATERIAL AND METHODS This retrospective study evaluated medical records from 413 patients who were diagnosed with lung cancer between 2003 and 2012. The prevalences of BMs and SREs were calculated, and their associations with the histological subtypes were evaluated using the chi-square test, odds ratios (OR), and 95% confidence intervals (CI). Overall survivals and associations with the histological subtypes were evaluated using the Kaplan-Meier method and the log-rank test. RESULTS The prevalences of BM, synchronous BM, and SREs were 28.2%, 70.4%, and 68.7%, respectively. Adenocarcinoma was the most common histological subtype (46.7%), and was significantly more frequent among patients with BM (58.3% vs. 42.1%; p=0.003; OR: 1.92; 95% CI: 1.29-2.97). Squamous cell was significantly less frequent among patients with BM (13.0% vs. 29.8%; p=0.0004; OR: 0.35; 95% CI: 0.19-0.64). The median survival time after the first BM diagnosis was 4 months, and there was no significant difference in the survival periods for the various histological subtypes. CONCLUSION Adenocarcinoma and squamous cell were significantly associated with higher and lower risks of developing BM, respectively.
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Tang Y, Qu J, Wu J, Liu H, Chu T, Xiao J, Zhou Y. Effect of Surgery on Quality of Life of Patients with Spinal Metastasis from Non-Small-Cell Lung Cancer. J Bone Joint Surg Am 2016; 98:396-402. [PMID: 26935462 DOI: 10.2106/jbjs.o.00629] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recently, more clinicians have realized the importance of quality of life in the treatment decision-making process. The goal of this study was to determine whether surgery for patients with spinal metastases from non-small-cell lung cancer (NSCLC) could improve their quality of life and prolong survival. METHODS The study included 133 patients who had been treated for NSCLC spinal metastases between 2010 and 2014. These patients were divided into two groups according to whether or not they had received spinal surgery. Their quality of life was assessed with use of the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at the initial diagnosis (baseline) and at one, three, six, and nine months after the diagnosis. The survival times of all patients were also collected. RESULTS Of the 133 patients, eighty-six (forty-five in the surgery group and forty-one in the non-surgery group) survived for nine months and were assessed at all of the follow-up intervals. The surgery group had significantly higher total, physical well-being, emotional well-being, and functional well-being quality-of-life scores at each follow-up time point as compared with baseline (p < 0.001) as well as compared with the non-surgery group (p < 0.001). A log-rank test demonstrated that the surgery group had longer survival than the non-surgery group (p = 0.020). CONCLUSIONS The results of this study indicate that surgical treatment improved the quality of life of patients with NSCLC spinal metastases over the nine-month assessment period. The surgery group had a better quality of life and longer survival than the non-surgery group.
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Affiliation(s)
- Yu Tang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
| | - Jintao Qu
- Department of Orthopaedic Surgery, No. 44 Military Hospital, Guizhou, People's Republic of China
| | - Juan Wu
- Department of Pharmacy, General Hospital of Chengdu Military Region, Chengdu, People's Republic of China
| | - Huan Liu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
| | - Tongwei Chu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
| | - Jianru Xiao
- Department of Bone Tumors, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Yue Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
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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: 21] [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.
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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
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Singh VA, Haseeb A, Alkubaisi AAHA. Incidence and outcome of bone metastatic disease at University Malaya Medical Centre. Singapore Med J 2016; 55:539-46. [PMID: 25631896 DOI: 10.11622/smedj.2014138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Morbidity and mortality from malignant diseases are usually the result of metastasis. The bone is the third most common site of metastasis. METHODS This is a retrospective study of patients with metastatic bone disease who were referred to the Orthopaedic Department of University Malaya Medical Centre, Malaysia, between January 2004 and October 2009. RESULTS A total of 151 patients (51.0% men, 49.0% women) had metastatic bone disease, with the highest incidence at the age range of 50-59 years. The commonest primary cancer was breast (23.3%), followed by lung (21.2%), prostate (9.3%), thyroid (7.3%) and renal cell carcinoma (5.3%); unknown primary cancer was 6.6%. There was long bone involvement in 52.7% of cases, axial bone in 44.5%, and both long and axial bones in 2.8%. The majority (90.1%) were symptomatic, with pain as the commonest symptom. 106 (70.2%) patients had pathological fractures. Neurological deficit was reported in 90.7% of patients, with 41.1% having extraskeletal metastases. 67.8% of the lesions were osteolytic, 24.3% were sclerotic, and 7.9%, mixed. Palliative and therapeutic interventions were undertaken for 62.0% of patients. The mean survival times were: breast 21.0; thyroid 20.7; prostate 20.3; lung 16.0; and unknown primary cancer 32.6 months. CONCLUSION In our study, breast and lung cancers were the commonest primary cancers in metastatic bone disease. Most patients had more than one site of involvement, pain at presentation and pathological fractures. Surgery is beneficial to relieve pain and improve function and neurology. Duration of survival depends on the type of primary cancer and whether systemic metastasis is present.
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Affiliation(s)
- Vivek Ajit Singh
- NOCERAL, Department of Orthopaedics, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia.
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Santini D, Daniele S, Barni S, Sandro B, Intagliata S, Salvatore I, Falcone A, Alfredo F, Ferraù F, Francesco F, Galetta D, Domenico G, Moscetti L, Luca M, La Verde N, Nicla LV, Ibrahim T, Toni I, Petrelli F, Fausto P, Vasile E, Enrico V, Ginocchi L, Laura G, Ottaviani D, Davide O, Longo F, Flavia L, Ortega C, Cinzia O, Russo A, Antonio R, Badalamenti G, Giuseppe B, Collovà E, Elena C, Lanzetta G, Gaetano L, Mansueto G, Giovanni M, Adamo V, Vincenzo A, De Marinis F, Filippo DM, Satolli MA, Cantile F, Flavia C, Mancuso A, Andrea M, Tanca FM, Addeo R, Raffaele A, Russano M, Marco R, Sterpi M, Sterpi M, Pantano F, Francesco P, Vincenzi B, Bruno V, Tonini G, Giuseppe T. Natural History of Non-Small-Cell Lung Cancer with Bone Metastases. Sci Rep 2015; 5:18670. [PMID: 26690845 PMCID: PMC4687045 DOI: 10.1038/srep18670] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/18/2015] [Indexed: 11/09/2022] Open
Abstract
We conducted a large, multicenter, retrospective survey aimed to explore the impact of tumor bone involvement in Non-Small Cell Lung Cancer.Data on clinical-pathology, skeletal outcomes and bone-directed therapies for 661 deceased patients with evidence of bone metastasis were collected and statistically analyzed. Bone metastases were evident at diagnosis in 57.5% of patients. In the remaining cases median time to bone metastases appearance was 9 months. Biphosphonates were administered in 59.6% of patients. Skeletal-related events were experienced by 57.7% of patients; the most common was the need for radiotherapy. Median time to first skeletal-related event was 6 months. Median survival after bone metastases diagnosis was 9.5 months and after the first skeletal-related event was 7 months. We created a score based on four factors used to predict the overall survival from the diagnosis of bone metastases: age >65 years, non-adenocarcinoma histology, ECOG Performance Status >2, concomitant presence of visceral metastases at the bone metastases diagnosis. The presence of more than two of these factors is associated with a worse prognosis.This study demonstrates that patients affected by Non-Small Cell Lung Cancer with bone metastases represent a heterogeneous population in terms of risk of skeletal events and survival.
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Affiliation(s)
| | - Santini Daniele
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Barni Sandro
- Division of Medical Oncology, Department of Oncology, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | | | | | - Falcone Alfredo
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ferraù Francesco
- Division of Medical Oncology, S.Vincenzo Hospital, Taormina, Italy
| | | | - Galetta Domenico
- Medical Oncology Unit, Clinical Cancer Center, Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124 Bari, Italy
| | | | - Moscetti Luca
- Department of Oncology and Hematology, 'Belcolle' Hospital, Viterbo, Italy
| | | | - La Verde Nicla
- Department of Oncology, A.O. Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121, Milan, Italy
| | | | - Ibrahim Toni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | | | - Petrelli Fausto
- Division of Medical Oncology, Department of Oncology, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | - Vasile Enrico
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ginocchi Laura
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Ottaviani Davide
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy
| | | | - Longo Flavia
- Department of Molecular Medicine, University Sapienza, Rome, Italy
| | | | - Ortega Cinzia
- Department of Medical Oncology, Institute for Cancer Research &Treatment (IRCC), Candiolo, Torino, Italy
| | | | - Russo Antonio
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Badalamenti Giuseppe
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | - Collovà Elena
- Medical Oncology, AO Ospedale Civile di Legnano, Italy
| | | | - Lanzetta Gaetano
- Istituto Neurotraumatologico Italiano, Unità Funzionale di Oncologia, Grottaferrata, Italy
| | | | | | | | - Adamo Vincenzo
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | | | - De Marinis Filippo
- Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy
| | | | | | | | | | - Mancuso Andrea
- Department of Medical Oncology, San Camillo and Forlanini Hospitals Rome, Italy
| | | | | | | | | | - Russano Marco
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - M Sterpi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Pantano Francesco
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | | | - Vincenzi Bruno
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Hendriks LEL, Hermans BCM, van den Beuken-van Everdingen MHJ, Hochstenbag MMH, Dingemans AMC. Effect of Bisphosphonates, Denosumab, and Radioisotopes on Bone Pain and Quality of Life in Patients with Non-Small Cell Lung Cancer and Bone Metastases: A Systematic Review. J Thorac Oncol 2015; 11:155-73. [PMID: 26718881 DOI: 10.1016/j.jtho.2015.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022]
Abstract
Bone metastases are common in patients with non-small cell lung cancer (NSCLC), often causing pain and a decrease in quality of life (QoL). The effect of bone-targeted agents is evaluated by reduction in skeletal-related events in which neither pain nor QoL are included. Radioisotopes can be administered for more diffuse bone pain that is not eligible for palliative radiotherapy. The evidence that bone-targeted agents relieve pain or improve QoL is not solid. We performed a systematic review of the effect of bone-targeted agents on pain and QoL in patients with NSCLC. Our systematic literature search included original articles or abstracts reporting on bisphosphonates, denosumab, or radioisotopes or combinations thereof in patients with bone metastases (≥5 patients with NSCLC), with pain, QoL, or both serving as the primary or secondary end point. Of the twenty-five eligible studies, 13 examined bisphosphonates (one also examined denosumab) and 12 dealt with radioisotopes. None of the randomized studies on bisphosphonates or denosumab evaluated pain and QoL as the primary end point. In the single-arm studies of bisphosphonates a decrease in pain or analgesic consumption was found for 38% to 77% of patients. QoL was included in five of 13 studies, but improvement was found in only two. No high-level evidence that bisphosphonates or denosumab reduce pain or improve QoL was found. Although the data are limited, radioisotopes seem to reduce pain with a rapid onset of action and duration of response of 1 to 3 months. The evidence that bisphosphonates or denosumab reduce or prevent pain in patients with NSCLC and bone metastases or that they have an influence on QoL is very weak. Radioisotopes can be used to reduce diffuse pain, although there is no high-level evidence supporting such use.
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Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Bregtje C M Hermans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Monique M H Hochstenbag
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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García Carretero R, Sanchez-Redondo J, Barrio-Alonso MJ, Lopez-Marti MP. Lung carcinoma presenting as a solitary, painless frontal bone lump. BMJ Case Rep 2015; 2015:bcr-2015-212038. [PMID: 26677150 DOI: 10.1136/bcr-2015-212038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 50-year-old patient, a smoker, was admitted to the hospital, with a solitary scalp lump. Subcutaneous lumps of the scalp are common but usually benign; however, the painless lump in our patient turned out to be a malignant osteolytic lesion of the skull. Frontal bone was involved, and the disease had spread to the dura. Neuroimaging showed osteolytic lesions involving the axial skeleton, skull and several vertebrae. MRI showed the involvement of the second cervical vertebra, which prompted us to start treatment with dexamethasone. Since the spinal cord was not involved, Oncologists decided not to start radiotherapy treatment until we had reached the final diagnosis. A frontal bone biopsy confirmed the diagnosis of lung carcinoma. Chest X-ray did not identify the pulmonary nodule, but CT scan revealed a 1 cm peripheral, spiculated, pulmonary nodule within a pathological parenchyma (severe diffuse pulmonary emphysema).
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Affiliation(s)
| | - Jorge Sanchez-Redondo
- Department of Internal Medicine, Mostoles University Hospital, Mostoles, Madrid, Spain
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Rief H, Förster R, Rieken S, Bruckner T, Schlampp I, Bostel T, Debus J. The influence of orthopedic corsets on the incidence of pathological fractures in patients with spinal bone metastases after radiotherapy. BMC Cancer 2015; 15:745. [PMID: 26486754 PMCID: PMC4612425 DOI: 10.1186/s12885-015-1797-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical care of unstable spinal bone metastases in many centers often includes patient immobilization by means of an orthopedic corset in order to prevent pathological fractures. The aim of this retrospective analysis was to evaluate the incidence of pathological fractures after radiotherapy (RT) in patients with and without orthopedic corsets and to assess prognostic factors for pathological fractures in patients with spinal bone metastases. METHODS The incidence of pathological fractures in 915 patients with 2.195 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of computed tomography (CT) scans between January 2000 and January 2012 depending on prescription and wearing of patient-customized orthopedic corsets. RESULTS In the corset group, 6.8 and 8.0 % in no-corset group showed pathological fractures prior to RT, no significant difference between groups was detected (p = 0.473). After 6 months, patients in the corset group showed pathological fractures in 8.6 % and in no-corset group in 9.3 % (p = 0.709). The univariate and bivariate analyses demonstrated no significant prognostic factor for incidence of pathological fractures in both groups. CONCLUSIONS In this analysis, we could show for the first time in more than 900 patients, that abandoning a general corset supply in patients with spinal metastases does not significantly cause increased rates of pathological fractures. Importantly, the incidence of pathological fracture after RT was small.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Robert Förster
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Goodwin CR, Khattab MH, Sankey EW, Elder BD, Kosztowski TA, Sarabia-Estrada R, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sciubba DM. Factors Associated with Life Expectancy in Patients with Metastatic Spine Disease from Adenocarcinoma of the Lung. Global Spine J 2015; 5:417-24. [PMID: 26430597 PMCID: PMC4577314 DOI: 10.1055/s-0035-1554778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/16/2015] [Indexed: 01/15/2023] Open
Abstract
Study Design Retrospective study. Objective Our objective was to identify preoperative prognostic factors associated with survival in patients with spinal metastasis from lung carcinoma. Methods A retrospective analysis of 26 patients diagnosed with lung carcinoma metastatic to the spinal column was performed to determine factors associated with survival. We used 3 months survival as the clinical cutoff for whether surgical intervention should be performed. We analyzed patients who survived less than 3 months compared with those who survived more than 3 months. Demographic, preoperative, operative, and postoperative factors including functional scores were collected for analysis. Results The median survival for all patients in our study was 3.5 months. We found a statistically significant difference between the group that survived less than 3 months and the group that survived greater than 3 months in terms of extrathoracic metastasis, visceral metastasis, and average postoperative modified Rankin score. Conclusion Determining which patients with lung cancer spinal metastases will benefit from surgical intervention is often dictated by the patient's predicted life expectancy. Factors associated with poorer prognosis include age, functional status, visceral metastases, and extrathoracic metastases. Although the prognosis for patients with lung cancer spinal metastases is poor, some patients may experience long-term benefit from surgical intervention.
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Affiliation(s)
- C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Mohamed H. Khattab
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric W. Sankey
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Benjamin D. Elder
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas A. Kosztowski
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Rachel Sarabia-Estrada
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Timothy F. Witham
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States,Address for correspondence Daniel M. Sciubba, MD Department of Neurosurgery, Johns Hopkins University School of Medicine600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287United States
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Teke F, Teke M, Inal A, Kaplan MA, Kucukoner M, Aksu R, Urakci Z, Tasdemir B, Isikdogan A. Significance of hormone receptor status in comparison of 18F -FDG-PET/CT and 99mTc-MDP bone scintigraphy for evaluating bone metastases in patients with breast cancer: single center experience. Asian Pac J Cancer Prev 2015; 16:387-91. [PMID: 25640386 DOI: 10.7314/apjcp.2015.16.1.387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/ CT) and bone scintigraphy (BS) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in hormone receptor positive (+) and negative (-) groups of breast cancer remains ambiguous. MATERIALS AND METHODS Sixty-two patients with breast cancer, who had undergone both 18F-FDG-PET/CT and BS, being eventually diagnosed as having bone metastases, were enrolled in this study. RESULTS 18F-FDG-PET/CT had higher sensitivity and specificity than BS. Our data showed that 18F-FDG- PET/CT had a sensitivity of 93.4% and a specificity of 99.4%, whiel for BS they were 84.5%, and 89.6% in the diagnosis of bone metastases. κ statistics were calculated for 18F-FDGPET/CT and BS. The κ-value was 0.65 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the κ-values were 0.70 in the hormone receptor (+) group, and 0.51 in hormone receptor (-) group. The κ-values suggested excellent agreement between all patient and hormone receptor (+) groups, while the κ-values suggested good agreement in the hormone receptor (-) group. CONCLUSIONS The sensitivity and specificity for 18F-FDG-PET/CT were higher than BS in the screening of metastatic bone lesions in all patients. Similarly 18F-FDG-PET/CT had higher sensitivity and specificity in hormone receptor (+) and (-) groups.
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Affiliation(s)
- Fatma Teke
- Department of Radiation Oncology, Medical School, Dicle University, Yenisehir, Turkey E-mail :
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Liu Y, Qing H, Su X, Wang C, Li Z, Liu S. Association of CD44 Gene Polymorphism with Survival of NSCLC and Risk of Bone Metastasis. Med Sci Monit 2015; 21:2694-700. [PMID: 26356590 PMCID: PMC4573070 DOI: 10.12659/msm.894357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Previous studies have reported CD44 expression influenced the development and progression of tumors. The aim of this study was to investigate whether single-nucleotide polymorphisms (SNPs) of the CD44 gene are associated with survival of non-small cell lung cancer (NSCLC) and occurrence rate of bone metastasis. Material/Methods A total of 234 patients with NSCLC between 2003 and 2010 were enrolled in this study and 468 healthy persons were used as controls. Two polymorphisms, rs13347 and rs187115, in the CD44 gene were genotyped using DNA from blood lymphocytes. For statistical analysis we used the chi-square test, Fisher’s exact test, Kaplan-Meier method, and log-rank test. Results CD44 gene rs13347 polymorphism was not associated with NSCLC risk. For rs187115, the association with NSCLC risk was observed (P<0.001). Allele G carriers had significantly higher occurrence rates of bone metastasis (OR=0.4, 95%CI: 0.20–0.64, P<0.001) and more advanced tumor stage (OR=2.6, 95%CI: 1.50–4.45, P=0.001) compared to carriers of allele A. The survival rates for patients with AA genotype were significantly higher than for patients with the AG+GG genotypes (P<0.001). In multivariate analysis of survival in NSCLC patients, significant predictors were CD44 gene (AG+GG) (RR=0.48, 95%CI: 0.34–0.68, P<0.001), tumor stage (RR=0.45, 95%CI: 0. 0.31–0.65, P<0.001), and bone metastasis (RR=1.52, 95%CI: 1.05–2.21, P=0.027). Conclusions CD44 gene rs187115 polymorphism is a potential predictive marker of survival in NSCLC patients, and is significantly correlated with bone metastasis and tumor stage.
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Affiliation(s)
- Yaosheng Liu
- Department of Orthopedics, The PLA 307th Hospital, Beijing, China (mainland)
| | - Haifeng Qing
- Department of Pulmonary Neoplasms Internal Medicine, The PLA 307th Hospital, Beijing, China (mainland)
| | - Xiuyun Su
- Department of Orthopedics, The PLA 307th Hospital, Beijing, China (mainland)
| | - Cheng Wang
- Department of Orthopedics, The PLA 307th Hospital, Beijing, China (mainland)
| | - Zhou Li
- Department of Tissue Specimen Database, The PLA 307th Hospital, Beijing, China (mainland)
| | - Shubin Liu
- Department of Orthopedics, The PLA 307th Hospital, Beijing, China (mainland)
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Risk factors for skeletal-related events (SREs) and factors affecting SRE-free survival for nonsmall cell lung cancer patients with bone metastases. Tumour Biol 2015; 37:1131-40. [PMID: 26276360 DOI: 10.1007/s13277-015-3907-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/05/2015] [Indexed: 12/25/2022] Open
Abstract
Skeletal-related events (SREs) for nonsmall cell lung cancer (NSCLC) patients with bone metastasis lead to serious morbidity. The aim of this study was to determine risk factors for SREs in NSCLC patients with bone metastasis and the factors influencing SRE-free survival and overall survival (OS). From 2000 to 2012, we evaluated retrospectively 835 NSCLC patients. Three hundred and thirty-five of them with bone metastasis were included in the study. SREs and the other prognostic factors were evaluated by univariate and multivariate analysis for SRE-free survival and OS. SREs were detected in 244 patients (72.8 %). The most common SREs were the need for radiotherapy (43.2 %) and malignant hypercalcemia (17.6 %). The median time to first SRE was 3.5 months at the median follow-up of 17 months. A multivariate analysis showed that the presence of bone metastasis at diagnosis (p < 0.001), the number of bone metastasis (p = 0.001), baseline hypercalcemia (p = 0.004), and the presence of palliative radiotherapy (p = 0.04) were independent prognostic factors for SRE-free survival. A logistic regression analysis identified that the presence of bone metastasis at diagnosis [odds ratio (OR), 12.6], number of bone metastasis (OR, 3.05), and baseline hypercalcemia (OR, 0.33) were found to be predictive factors in the developing of SRE. The median OS time for patients with SRE was worse than that for patients without SRE (7 vs 12 months, respectively). For OS, male gender, ECOG performance status (PS), high lactate dehydrogenase (LDH) level, hypoalbuminemia, the presence of bone metastasis at diagnosis, the number of bone metastasis, the presence of SREs, the presence of bisphosphonate therapy, and palliative radiotherapy were independent prognostic indicators for OS by the multivariate analysis. Our results indicated that the frequency of SREs was high and the presence of bone metastasis at the time of diagnosis, baseline hypercalcemia, and multiple bone metastases were significant factors predicting the occurrence of SREs. If bone metastases diagnose earlier, treatments for the prevention of SREs may be initiated earlier; thus, the deterioration of quality of life may be preserved.
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Prognostic factors in patients with metastatic spinal cord compression secondary to lung cancer: a systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [DOI: 10.1007/s00586-015-4157-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Contemporary approaches for imaging skeletal metastasis. Bone Res 2015; 3:15024. [PMID: 26273541 PMCID: PMC4502405 DOI: 10.1038/boneres.2015.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/23/2015] [Indexed: 01/13/2023] Open
Abstract
The skeleton is a common site of cancer metastasis. Notably high incidences of bone lesions are found for breast, prostate, and renal carcinoma. Malignant bone tumors result in significant patient morbidity. Identification of these lesions is a critical step to accurately stratify patients, guide treatment course, monitor disease progression, and evaluate response to therapy. Diagnosis of cancer in the skeleton typically relies on indirect bone-targeted radiotracer uptake at sites of active bone remodeling. In this manuscript, we discuss established and emerging tools and techniques for detection of bone lesions, quantification of skeletal tumor burden, and current clinical challenges.
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da Silva GT, Bergmann A, Thuler LCS. Skeletal related events in patients with bone metastasis arising from non-small cell lung cancer. Support Care Cancer 2015; 24:731-736. [DOI: 10.1007/s00520-015-2835-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/22/2015] [Indexed: 01/16/2023]
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Abstract
Over a third of patients with lung cancer will develop bone metastases during the course of their disease, resulting in symptoms of pain and immobility, and skeletal-related events (SREs) such as fracture, hypercalcaemia, surgery or radiotherapy to bones, and malignant spinal cord compression. These reduce quality of life and increase mortality. Preclinical research has identified the interactions between tumour cells and bone that are key to tumour cell survival and associated osteolysis. These data have led to the development of drugs to prevent osteoclast-mediated bone breakdown, such as zoledronic acid and denosumab, which are now licensed for use in patients with bone metastases from solid tumours. Both zoledronic acid and denosumab reduce the risk of SREs and increase time to first SRE, with minimal side effects. In addition, denosumab improved survival in patients with lung cancer compared with zoledronic acid. Ongoing trials are testing whether these drugs can prevent the development of bone metastases from lung cancer. New bone-targeted agents showing promise in breast and prostate cancer include radium-223, cabozantinib and Src inhibitors. These agents require further evaluation in patients with lung cancer.
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Affiliation(s)
| | | | - Penella J Woll
- Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
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De Castro J, García R, Garrido P, Isla D, Massuti B, Blanca B, Vázquez J. Therapeutic Potential of Denosumab in Patients With Lung Cancer: Beyond Prevention of Skeletal Complications. Clin Lung Cancer 2015; 16:431-46. [PMID: 26264596 DOI: 10.1016/j.cllc.2015.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 12/29/2022]
Abstract
Approximately up to 40% of patients with lung cancer develop bone metastasis, with 22% to 59% of them experiencing skeletal-related events (SREs), which result in an important quality of life deterioration and economic burden. Denosumab, a fully human antibody that targets the receptor activator of nuclear factor-κB (RANK) ligand (RANKL), is indicated for prevention of SREs in patients with solid tumors and has demonstrated superiority in breast and prostate cancer, and in other solid tumors, in reducing the risk of first SRE by 17% versus zoledronic acid. In the subset of patients with non-small-cell lung carcinoma (NSCLC), denosumab has also shown a positive trend to SRE risk reduction. Denosumab might have direct or indirect antitumor effects. Cancer cells produce factors that stimulate increased bone resorption by osteoclasts, which in turn release tumor growth factors into the bone microenvironment, initiating a tumor/bone vicious cycle. An increasing body of evidence suggests RANK/RANKL signaling plays a role in this tumorigenesis. Both proteins are overexpressed in different tumor types including lung cancer cells. RANK/RANKL signaling activates nuclear factor-κB pathways related to lung carcinogenesis and increases intercellular adhesion molecule 1 expression and MEK/extracellular signal-regulated kinase phosphorylation, which in turn enhances tumor cell migration. In animal NSCLC models, denosumab delayed bone metastases and reduced skeletal tumor growth. In patients with lung cancer (post hoc analysis), denosumab prolonged overall survival by 1.2 months versus zoledronic acid (P = .01). This hypothesis-generating outcome warrants further investigation and 2 studies in lung cancer are ongoing to elucidate the therapeutic potential of denosumab beyond SRE prevention.
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Affiliation(s)
| | - Rosario García
- Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Dolores Isla
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Incidence, associated factors, and survival in metastatic spinal cord compression secondary to lung cancer. Spine J 2015; 15:1263-9. [PMID: 25687415 DOI: 10.1016/j.spinee.2015.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/15/2014] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bone metastasis (BM) occurs frequently in patients with lung cancer (LC). The most affected are the bones of the spine, increasing the risk of developing metastatic spinal cord compression (MSCC). Although MSCC is one of the most disabling complications, few studies have reported relevant results related to its frequency and prognosis among patients with LC. PURPOSE The purpose of this study was to determine the incidence and associated factors of the development of MSCC after BM with LC and its prognosis. STUDY DESIGN/SETTING This is a cohort study. PATIENT SAMPLE A cohort of 112 patients with BM because of LC, whose treatment was performed exclusively at the National Cancer Institute, was analyzed. OUTCOME MEASURES Study outcome measures included incidence of MSCC, factors associated with MSCC, and survival analysis. METHODS A cohort study was performed involving patients with BM because of LC diagnosed between 2007 and 2011. Clinical and sociodemographic data were extracted from the physical and electronic medical records because of initial diagnosis (up until December 2013). The association between the independent variables and the outcomes was performed by using crude and adjusted odds ratios (ORs), assuming 95% confidence intervals (CIs). For the exploratory evaluation between the independent variables and the time until the outcomes, Kaplan-Meier survival analysis was conducted. To identify if the differences between the curves were statistically significant, a log-tank test was calculated. A Cox multiple regression model, using the forward stepwise method, was applied, aiming to estimate the factors associated with time to death in the different exposure groups. RESULTS Of the 112 patients with BM, 31 (27.7%) developed MSCC. The univariate analysis showed that patients with three or more involved vertebrae revealed a 6.1 times greater risk of developing MSCC, compared with those with up to two metastatic vertebrae involved (OR: 6.1, 95% CI: 2.5-15.1, p<.001). Among the patients who developed MSCC, the median survival time was 4.4 months (95% CI: 1.5-7.3) and 4.7 months (95% CI: 3.5-5.9) in the patients without MSCC, not being a statistically significant difference (p=.19). After the occurrence of the MSCC, the median survival time was 2.8 months (95% CI: 1.4-4.1). CONCLUSIONS In this study, a high incidence of MSCC was observed in patients with BM. The study suggests that patients with three or more involved vertebrae per metastasis are more likely to develop MSCC. No alteration in the overall survival time was noticed among the patients with or without MSCC.
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HE YIFU, LUO HUIQIN, WANG WEI, CHEN JIAN, YAO YIWEI, CAI SHANBAO, HE JIE, YAN YING, WU SHUSHENG, HU XIAOXIU, KE LIHONG, NIU JIAYU, LI HUIMIN, JI CHUSHU, HU BING. Clinical features and prognosis-associated factors of non-small cell lung cancer exhibiting symptoms of bone metastasis at the time of diagnosis. Oncol Lett 2015; 9:2706-2712. [PMID: 26137132 PMCID: PMC4473594 DOI: 10.3892/ol.2015.3081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 02/17/2015] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to analyze the clinical characteristics and prognosis-related factors of non-small cell lung cancer (NSCLC) patients with bone metastases at the time of diagnosis. A total of 46 NSCLC patients with skeletal metastases at the time of diagnosis from Anhui Provincial Hospital and Anhui Provincial Cancer Hospital Affiliated to Anhui Medical University (Hefei, China) between February 2010 and February 2012 were investigated retrospectively. The median age was 58 years, with a range of 40-80 years, the ratio of males and females was 2:1, and adenocarcinoma and squamous cell carcinoma accounted for 71.7 and 28.3% of cases, respectively. Furthermore, 84.8% of patients exhibited multiple skeletal metastases at more than two sites and 54.3% of patients experienced skeletal-related events at the time of diagnosis. The median overall survival (OS) time of the patients was 237 days, and Kaplan-Meier analysis demonstrated that patients with adenocarcinoma (P=0.002), single bone metastases (P=0.023), an Eastern Cooperative Oncology Group performance status of 0-1 (P<0.001) or positive expression of estrogen receptor (ER)-β (P=0.039) exhibited significantly longer survival times. Furthermore, multivariate analysis identified the following independent predictors of OS: Tumor subtype (P=0.022), the number of bone metastases (P=0.016) and an ER-β-positive tumor (P=0.035). In the cohort of NSCLC patients with bone metastases at the time of diagnosis, adenocarcinoma and multiple skeletal metastases were most common.
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Affiliation(s)
- YI-FU HE
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - HUI-QIN LUO
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
| | - WEI WANG
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
| | - JIAN CHEN
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
| | - YI-WEI YAO
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
| | - SHAN-BAO CAI
- Department of Orthopedics, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - JIE HE
- Department of Pathology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - YING YAN
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - SHU-SHENG WU
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - XIAO-XIU HU
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - LI-HONG KE
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - JIA-YU NIU
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - HUI-MIN LI
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, Anhui 230001, P.R. China
| | - CHU-SHU JI
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
| | - BING HU
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical Univeristy, Hefei, Anhui 230001, P.R. China
- Correspondence to: Professor Bing Hu, Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui 230001, P.R. China, E-mail:
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Kuchuk M, Kuchuk I, Sabri E, Hutton B, Clemons M, Wheatley-Price P. The incidence and clinical impact of bone metastases in non-small cell lung cancer. Lung Cancer 2015; 89:197-202. [PMID: 26003503 DOI: 10.1016/j.lungcan.2015.04.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/10/2015] [Accepted: 04/19/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) is the leading global cause of cancer death. While bone metastases (BM) commonly cause morbidity, bone-targeted agent (BTA) use is variable. We investigated the incidence and impact of BM among unselected NSCLC patients. METHODS A retrospective chart review of all NSCLC patients seen at a single institution from January 2007 to January 2008 was performed. Various clinical and pathology data were collected. In BM patients, skeletal related events (SRE), interventions and outcomes were recorded. RESULTS We identified 383 patients; median age 68 (IQR 60-76); 54% female. Initially 156 patients (41%) were treated with curative intent of whom 91 subsequently relapsed; 227 (59%) were considered palliative from time of diagnosis, including 22 with early stage disease not amenable to radical therapy. Of 296 patients with advanced NSCLC, common metastatic sites were: lung/pleura (80%), mediastinal nodes (69%), bone (39%), brain (30%), and liver (24%). Of 118 patients with BM, 69 (59%) had ≥1 SREs (range 1-18). Common SREs were radiotherapy (63%), pathologic fractures (22%), spinal cord compression (6%) or surgery to bone (5%). Opioid analgesia was required in 69% of BM patients, only 6% of patients with BM received BTA. Overall survival (OS) in pts with mNSCLC was 7.3 months (IQR 3.1-20.5). Pts with BM had significantly shorter OS compared to those without BM (5.8 versus 10.2 months, p=0.03). CONCLUSIONS BM are common in patients with advanced NSCLC and associated with shorter survival. In this cohort, despite SREs occurred in many patients, BTA were rarely used.
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Affiliation(s)
- Michael Kuchuk
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Iryna Kuchuk
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Elham Sabri
- Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul Wheatley-Price
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada.
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Homann G, Mustafa DF, Ditt H, Spengler W, Kopp HG, Nikolaou K, Horger M. Improved detection of bone metastases from lung cancer in the thoracic cage using 5- and 1-mm axial images versus a new CT software generating rib unfolding images: comparison with standard ¹⁸F-FDG-PET/CT. Acad Radiol 2015; 22:505-12. [PMID: 25586709 DOI: 10.1016/j.acra.2014.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of a dedicated computed tomography (CT) software called "bone reading" generating rib unfolded images for improved detection of rib metastases in patients with lung cancer in comparison to readings of 5- and 1-mm axial CT images and (18)F-Fluordeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). MATERIALS AND METHODS Ninety consecutive patients who underwent (18)F-FDG-PET/CT and chest CT scanning between 2012 and 2014 at our institution were analyzed retrospectively. Chest CT scans with 5- and 1-mm slice thickness were interpreted blindly and separately focused on the detection of rib metastases (location, number, cortical vs. medullary, and osteoblastic vs. sclerotic). Subsequent image analysis of unfolded 1 mm-based CT rib images was performed. For all three data sets the reading time was registered. Finally, results were compared to those of FDG-PET. Validation was based on FDG-PET positivity for osteolytic and mixed osteolytic/osteoblastic focal rib lesions and follow-up for sclerotic PET-negative lesions. RESULTS A total of 47 metastatic rib lesions were found on FDG-PET/CT plus another 30 detected by CT bone reading and confirmed by follow-up CT. Twenty-nine lesions were osteolytic, 14 were mixed osteolytic/osteoblastic, and 34 were sclerotic. On a patient-based analysis, CT (5 mm), CT (1 mm), and CT (1-mm bone reading) yielded a sensitivity, specificity, and accuracy of 76.5/97.3/93, 81.3/97.3/94, and 88.2/95.9/92, respectively. On segment-based (unfolded rib) analysis, the sensitivity, specificity, and accuracy of the three evaluations were 47.7/95.7/67, 59.5/95.8/77, and 94.8/88.2/92, respectively. Reading time for 5 mm/1 mm axial images and unfolded images was 40.5/50.7/21.56 seconds, respectively. CONCLUSIONS The use of unfolded rib images in patients with lung cancer improves sensitivity and specificity of rib metastasis detection in comparison to 5- and 1-mm CT slice reading. Moreover, it may reduce the reading time.
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Zhao F, Ding G, Huang W, Li M, Fu Z, Yang G, Kong L, Zhang Y, Yu J. FDG-PET Predicts Pain Response and Local Control in Palliative Radiotherapy With or Without Systemic Treatment in Patients With Bone Metastasis From Non-small-cell Lung Cancer. Clin Lung Cancer 2015; 16:e111-9. [PMID: 25736696 DOI: 10.1016/j.cllc.2015.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/18/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED The purpose of the present study was to evaluate the prognostic value of the maximal standardized uptake value (SUVmax) from serial positron emission tomography scans in patients with bone metastases from non-small-cell lung cancer. The results showed that the pre-RT SUVmax predicted the initial pain severity and local control. Moreover, the change in the SUVmax after palliative radiotherapy predicted the pain response and local control rate. INTRODUCTION We sought to evaluate the value of fluorine-18 fluorodeoxyglucose positron emission tomography (PET) in predicting the pain severity, pain response, and in-field tumor control after palliative radiotherapy (RT) in patients with non-small-cell lung cancer (NSCLC) bone metastases. MATERIALS AND METHODS The present retrospective, institutional review board-approved study involved 74 patients with NSCLC and 185 bone metastatic lesions. All patients had undergone PET-computed tomography (CT) scans before and after RT. The pain scores were determined using a numerical rating scale, and the maximal standardized uptake value (SUVmax) at each location was recorded. The pain scores and responses to RT were compared using the pre-RT SUVmax and SUVmax changes after RT. Cox regression analyses were performed to identify the prognostic factors for in-field progression-free survival (PFS) and in-field event-free survival (EFS). RESULTS The pre-RT SUVmax correlated with the initial pain scores (r = 0.885, P < .001), and the decrease in the SUVmax after RT was associated with the pain response to RT (P = .001). During the follow-up period, 47.03% and 38.92% of the lesions showed in-field tumor radiographic progression and in-field events, respectively. The Cox regression analyses showed that a higher pre-RT SUVmax (≥ 8.2) was an independent prognostic factor of worse in-field PFS and worse in-field EFS (hazard ratio [HR] 1.42 and 1.46; P = .044 and P = .005, respectively) and that a greater SUVmax decrease (≥ 28.3%) after RT was an independent prognostic factor of better in-field PFS and better in-field EFS (HR 0.59 and 0.60, respectively; P < .001 for both). CONCLUSION In patients with NSCLC osseous metastasis treated with palliative RT, the pre-RT SUVmax predicted the initial pain severity and local control. Moreover, the change in the SUVmax after RT predicted the pain response and local control.
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Affiliation(s)
- Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Gang Ding
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan, Shandong, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Zheng Fu
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Guoren Yang
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Yan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
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Sun Y, Ai X, Shen S, Gu L, Lu S. Detection and correlation analysis of serum cytokines in non-small-cell lung cancer patients with bone and non-bone metastases. Patient Prefer Adherence 2015; 9:1165-9. [PMID: 26316721 PMCID: PMC4542409 DOI: 10.2147/ppa.s86605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To detect and analyze 13 cytokines that may be related to bone metastasis in the serum of non-small-cell lung cancer (NSCLC) patients with bone metastases and NSCLC patients with non-bone metastases. PATIENTS AND METHODS The Luminex LiquiChip system was used to detect the concentration of 13 cytokines that may be related to bone metastasis in the serum of 30 NSCLC patients with bone metastases and 30 with non-bone metastases. RESULTS The concentration of insulin-like growth factor binding protein-3 (IGFBP-3) in the serum of NSCLC patients with bone metastases was obviously higher than in non-bone metastasis patients (P=0.014). The serum concentration of other cytokines showed no significant difference (P>0.05) between the two groups. The concentration of IGFBP-3 in the serum of the bone metastasis group was positively correlated to VEGF concentration (r=0.804, P=0.009) and monocyte chemotactic protein 1 (MCP-1) concentration (r=0.785, P=0.012), but had no correlation to other factors (P>0.05). No correlation was found between serum concentrations of cytokines in bone metastasis. Concentration of IGFBP-3 in the serum of bone metastasis patients was positively correlated to the presence or absence of pain at diagnosis (r=0.701, P=0.036) and performance status (PS) score (r=0.670, P=0.048), and correlated with the number of bone metastases, sex, age, pathological characteristics, T stage, and N stage (P>0.05). CONCLUSION The findings of this study suggest important clinical implications to detect the concentration of IGFBP-3 in the serum of lung cancer patients so as to evaluate the diagnosis and degree of bone metastasis. Concentration of IGFBP-3 in the serum of bone metastasis patients was positively correlated to concentration of VEGF and MCP-1, which may be highly relevant for the development of new treatments for bone metastasis of lung cancer.
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Affiliation(s)
- Yingjia Sun
- Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Xinghao Ai
- Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Shengping Shen
- Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Linping Gu
- Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Shun Lu
- Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Shun Lu, Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, People’s Republic of China, Email
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RANKL inhibition blocks osteolytic lesions and reduces skeletal tumor burden in models of non-small-cell lung cancer bone metastases. J Thorac Oncol 2014; 9:345-54. [PMID: 24496001 DOI: 10.1097/jto.0000000000000070] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bone metastasis is a serious complication in patients with lung cancer, occurring in up to 40% of patients. Tumor cell-mediated osteolysis occurs ultimately through induction of RANK ligand (RANKL) within the bone stroma although this hypothesis has not been tested extensively in the setting of non-small-cell lung cancer (NSCLC). By using two novel NSCLC bone metastasis mouse models, we examined the effects of RANKL inhibition on osteolysis and tumor progression. METHODS We treated mice bearing skeletal NSCLC tumors with osteoprotegerin-Fc (OPG-Fc) to assess whether osteoclast inhibition through RANKL inhibition would affect bone metastases at early or late stages of bone colonization. Progression of skeletal tumor was determined by radiography, longitudinal bioluminescent imaging, and histological analyses. RESULTS OPG-Fc reduced development and progression of radiographically evident osteolytic lesions and also significantly reduced skeletal tumor progression in both NSCLC bone metastasis models. In the H1299 human NSCLC bone metastasis model, OPG-Fc plus docetaxel in combination resulted in significantly greater inhibition of skeletal tumor growth compared with either single agent alone. The observed ability of RANKL inhibition to reduce NSCLC osteolytic bone destruction or skeletal tumor burden was associated with decreases in tumor-associated osteoclasts. CONCLUSIONS These results demonstrate that RANKL is required for the development of tumor-induced osteolytic bone destruction caused by NSCLC cells in vivo. RANKL inhibition also reduced skeletal tumor burden, presumably through the indirect mechanism of blocking tumor-induced osteoclastogenesis and resultant production of growth factors and calcium from the bone microenvironment. RANKL inhibition also provided an additive benefit to docetaxel treatment by augmenting the reduction of tumor burden.
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Guo Q, Wu M, An T, Zhao J, Duan J, Wang Z, Wang S, Wang J. [Characteristics and treatment of bone metastases in 322 cases non-small cell lung cancer: a retrospective study]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:656-62. [PMID: 25248706 PMCID: PMC6000505 DOI: 10.3779/j.issn.1009-3419.2014.09.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
背景与目的 骨是非小细胞肺癌最常见转移部位之一,可引起疼痛病理性骨折等,严重影响患者生活质量。本研究探讨非小细胞肺癌骨转移的临床特点及预后因素。 方法 回顾性分析我科近5年收治的600例非小细胞肺癌患者,单光子计算机断层扫描(emission computed tomography, ECT)作为筛查方法,计算机断层扫描(computed tomography, CT)/磁共振成像(magnetic resonance imaging, MRI)/X线或病理学诊断作为骨转移的确诊方法。 结果 肺腺癌发生骨转移的比率最高,脊柱、骨盆、股骨等为骨转移高发部位。ECT显示3个浓聚灶及以上者,行CT/MRI/X线可以证实骨转移,确诊骨转移的几率远远高于ECT显示1个-2个浓聚灶的患者[80.6%(203/252)vs 50.79%(32/63), P < 0.001]。出现骨转移后未发生骨相关事件(skeletal related events, SRE)的患者生存期长于发生SRE者,1年生存率和中位生存期分别为44.75%、14.74个月 vs 36.17%、12.25个月(P=0.022)。经Cox多因素分析,病理组织学诊断为非腺癌、骨转移病灶数少于3个,单纯骨转移为有益于生存期的预后因素。 结论 ECT异常浓聚灶的数目与骨转移影像学的确诊有关。病理组织学非腺癌、骨转移病灶数少于3个、单纯骨转移是非小细胞肺癌骨转移的独立预后因素。
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Affiliation(s)
- Qingzhi Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Meina Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Tongtong An
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Jianchun Duan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Zhijie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Shuhang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Jie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
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Cetin K, Christiansen CF, Jacobsen JB, Nørgaard M, Sørensen HT. Bone metastasis, skeletal-related events, and mortality in lung cancer patients: a Danish population-based cohort study. Lung Cancer 2014; 86:247-54. [PMID: 25240518 DOI: 10.1016/j.lungcan.2014.08.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate the incidence rate of bone metastasis and subsequent skeletal-related events (SREs) (radiation to bone, spinal cord compression, fracture, and surgery to bone) in lung cancer patients and to quantify their impact on mortality. MATERIALS AND METHODS We conducted a nationwide cohort study of patients diagnosed with lung cancer between 1999 and 2010 in Denmark. We computed the cumulative incidence (%) of bone metastasis and subsequent SREs (treating death as a competing risk) and corresponding incidence rates (per 1000 person-years). Survival was evaluated using the Kaplan-Meier method for three dynamic lung cancer patient cohorts-no bone metastasis; bone metastasis without SREs; and bone metastasis with SREs. Based on a Cox proportional hazards model, we computed mortality rate ratios (MRRs) comparing mortality rates between these patient cohorts, adjusting for age, comorbidity, stage, and histology. Analyses were conducted for the lung cancer patient cohort overall and by histologic subtype. RESULTS We identified 29,720 patients with incident lung cancer (median follow-up: 7.3 months). The 1-year cumulative incidence of bone metastasis was 5.9%, and the 1-year cumulative incidence of subsequent SREs was 55.0%. The incidence of bone metastasis and SREs was higher in patients with non-small cell lung cancer (NSCLC) versus SCLC. One-year survival was 37.4% in patients with no bone metastasis; 12.1% in patients with bone metastasis without SREs; and 5.1% in patients with both bone metastasis and SREs. When mortality rates between patients with bone metastasis with and without an SRE were compared, 2-month mortality rates were similar, but the >2-month adjusted MRR was 2.0 (95% confidence interval: 1.7-2.2). CONCLUSION Bone metastases predict a poor prognosis in lung cancer patients. The majority of lung cancer patients with bone metastasis will also experience an SRE, which may further increase the rate of mortality.
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Affiliation(s)
- Karynsa Cetin
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, MS 24-2-A, Thousand Oaks, CA 91320, USA.
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Århus N., Denmark
| | - Jacob Bonde Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Århus N., Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Århus N., Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Århus N., Denmark
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Murakami H, Yamanaka T, Seto T, Sugio K, Okamoto I, Sawa T, Hirashima T, Takeda K, Atagi S, Fukuoka M, Nakanishi Y, Nakagawa K, Yamamoto N. Phase II study of zoledronic acid combined with docetaxel for non-small-cell lung cancer: West Japan Oncology Group. Cancer Sci 2014; 105:989-95. [PMID: 24837137 PMCID: PMC4317856 DOI: 10.1111/cas.12448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 01/11/2023] Open
Abstract
The aim of this open-label, multicenter, randomized phase II trial was to evaluate the efficacy and safety of zoledronic acid in combination with docetaxel in previously treated patients with non-small-cell lung cancer (NSCLC) and bone metastases. In this study, patients randomly received docetaxel (60 mg/m2) with (group DZ) or without (group D) zoledronic acid every 21 days. There were 50 patients in each group, and the primary endpoint was progression-free survival. In an efficacy analysis of 94 patients (DZ, 48; D, 46), the median progression-free survival was 2.7 months (95% confidence interval [CI], 1.5–3.5 months) for the DZ group and 2.6 months (95% CI, 1.5–3.4 months) for the D group (stratified log-rank test, P = 0.89). The median overall survival was 10.4 months (95% CI, 7.0–15.8 months) for the DZ group and 9.7 months (95% CI, 6.1–12.5 months) for the D group (stratified log-rank test, P = 0.62). There were no clinically relevant differences in the frequencies of grade 3 or 4 adverse events between the two groups. No treatment-related deaths occurred in the DZ group. Zoledronic acid combined with docetaxel was well tolerated but did not meet the primary endpoint of demonstrating a longer progression-free survival in advanced NSCLC patients with bone metastases compared with docetaxel alone. This trial was registered with the University Hospital Medical Information Network (UMIN000001098).
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Affiliation(s)
- Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
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Ouyang WW, Su SF, Ma Z, Hu YX, Lu B, Li QS, Geng YC, Li HQ. Prognosis of non-small cell lung cancer patients with bone oligometastases treated concurrently with thoracic three-dimensional radiotherapy and chemotherapy. Radiat Oncol 2014; 9:147. [PMID: 24962716 PMCID: PMC4082286 DOI: 10.1186/1748-717x-9-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/21/2014] [Indexed: 11/20/2022] Open
Abstract
Background To evaluate the efficacy of three-dimensional radiotherapy for non-small cell lung cancer (NSCLC) patients with bone metastases. Methods Clinical data for 95 NSCLC patients with bone metastases were collected and prognostic factors were analyzed. All patients received radiation to their thoracic primary tumor and ≥2 cycles of chemotherapy. Results Of these 95 patients, 47 patients had only bone metastases and 48 had both bone metastases and other organ metastases. Univariate analysis showed that factors that statistically significantly contributed to patients having longer overall survival (OS) included receiving a radiation dose to the primary tumor ≥63 Gy, responding to treatment and receiving ≥4 cycles of chemotherapy (p = 0.001, p = 0.037 and p = 0.009, respectively). A radiation dose to the primary tumor ≥63 Gy remained significant for patients with bone metastases only as well as those with bone and other organ metastases when they were analyzed separately (p = 0.045 and p = 0.012, respectively). For patients with bone metastases only, those with T1-2 tumors had longer OS than those with T3-4 (p = 0.048); and patients who received ≥4 cycles chemotherapy compared with those who received <4 cycles had similar OS (p = 0.385). On multivariate analysis, only a radiation dose ≥63 Gy (p = 0.028) and having only bone metastases (p = 0.006) were independent prognostic factors for better OS. Conclusions A radiation dose to the primary tumor ≥63 Gy and having only bone metastases were associated with better OS in NSCLC patients with bone metastases. For patients with bone metastases only, besides radiation dose, T status was also correlated with OS, whereas the number of chemotherapy cycles was not. Therefore, aggressive thoracic radiation may play an important role in improving OS.
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Affiliation(s)
| | | | | | | | - Bing Lu
- Department of Thoracic Oncology, Affiliated Hospital of Guiyang Medical College, and Guizhou Cancer Hospital, 1 Beijing Road West, Guizhou Guiyang, China.
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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: 157] [Impact Index Per Article: 15.7] [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.
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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
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Rief H, Heinhold M, Bruckner T, Schlampp I, Förster R, Welzel T, Bostel T, Debus J, Rieken S. Quality of life, fatigue and local response of patients with unstable spinal bone metastases under radiation therapy--a prospective trial. Radiat Oncol 2014; 9:133. [PMID: 24917420 PMCID: PMC4060071 DOI: 10.1186/1748-717x-9-133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/29/2014] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate the local response according to stability after radiotherapy (RT) with a special focus on quality-of-life (QoL), fatigue, pain and emotional distress in patients with unstable spinal bone metastases. Methods In this prospective trial, 30 patients were treated from September 2011 until March 2013. The stability of osteolytic metastases in the thoracic and lumbar spine was evaluated on the basis of the Taneichi-score after three and six months. EORTC QLQ-BM22, EORTC QLQ-FA13, and QSC-R10 were assessed at baseline, and three months after RT. Results After 3 months, 25% (n = 6) and after 6 months 33.3% (n = 8) were classified as stable. QoL, fatigue, and emotional distress showed no difference over the course. The pain response 3 months after RT showed a significant difference (p < 0.001). Pathological fractures occurred in 8.3% of the patients (n = 2) within six months following RT. Conclusions Our trial demonstrated that RT can improve stability in one third of patients over a 6-months period with unstable spinal metastases. Importantly, for these patients pain relief was detected but RT had no impact on QoL, fatigue, and emotional distress. Trial registration Clinical trial identifier NCT01409720.
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Affiliation(s)
- Harald Rief
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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143
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Deberne M, Ropert S, Billemont B, Daniel C, Chapron J, Goldwasser F. Inaugural bone metastases in non-small cell lung cancer: a specific prognostic entity? BMC Cancer 2014; 14:416. [PMID: 24913188 PMCID: PMC4057924 DOI: 10.1186/1471-2407-14-416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/22/2014] [Indexed: 11/26/2022] Open
Abstract
Background In non-small cell lung cancer patients (NSCLC), median survival from the time patients develop bone metastasis is classically described being inferior to 6 months. We investigated the subcategory of patients having an inaugural skeletal-related-event revealing NSCLC. The purpose of this study was to assess the impact of bone involvement on overall survival and to determine biological and tumoral prognosis factors on OS and PFS. An analysis of the subgroup of solitary bone metastasis patients was also performed. Methods In a population of 1208 lung cancer patients, 55 consecutive NSCLC patients revealed by inaugural bone metastasis and treated between 2003 and 2010, were retrospectively analysed. Survival was measured with a Kaplan-Meyer curve. Univariate and multivariate analysis were performed using the Stepwise Cox proportional hazard regression model. A p value of less than 0,05 was considered statistically significant. Results Estimated incidence of revealing bone metastasis is 4,5% among newly diagnosed lung cancer patients. Median duration of skeletal symptoms before diagnosis was 3 months and revealing bone site was located on axial skeleton in 70% of the cases. Histology was adenocarcinoma (78%), with small primary tumors Tx-T1-2 accounting for 71% of patients. Rate of second SRE is 37%. Median overall survival was 8.15 months, IQR [5–16 months], mean survival 13.4 months, and PFS was 3.5 months. In multivariate analysis, variables significantly associated with shortened survival were advanced T stage (HR = 2.8; p = 0.004), weight loss > 10% (HR = 3.1; p = 0.02), inaugural spinal epidural metastasis (HR 2.5; p = 0.0036), elevated C-reactive protein (HR = 4.3; p = 0.002) and TTF-1 status (HR = 2.42; p = 0.004). Inaugural spinal epidural metastasis is a very strong adverse pronostic factor in these cases, with a 3 months median survival. Single bone metastasis patients showed prolonged survival of 14.2 months versus 7.6 months, only in univariate analysis (HR = 0.42; p = 0.0059). Conclusion Prognosis of lung cancer patients with inaugural SRE remains pejorative. Accurately estimating the survival of this population is helpful for bone surgical decision-making at diagnosis. The trend for a higher proportion of adenocarcinoma in NSCLC patients should result with an increasing number of patients with inaugural SRE at diagnosis.
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Affiliation(s)
- Mélanie Deberne
- Radiation Oncology Department, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
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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.
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145
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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.
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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
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Roato I. Bone metastases: When and how lung cancer interacts with bone. World J Clin Oncol 2014; 5:149-155. [PMID: 24829862 PMCID: PMC4014787 DOI: 10.5306/wjco.v5.i2.149] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/21/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
Bone metastasis is a common and debilitating consequence of lung cancer: 30%-40% of patients with non-small cell lung cancer develop bone metastases during the course of their disease. Lung cancer cells find a favorable soil in the bone microenvironment due to factors released by the bone matrix, the immune system cells, and the same cancer cells. Many aspects of the cross-talk among lung tumor cells, the immune system, and bone cells are not clear, but this review aims to summarize the recent findings in this field, with particular attention to studies conducted to identify biomarkers for early detection of lung cancer bone metastases.
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147
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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: 37] [Impact Index Per Article: 3.7] [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.
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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
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Sun Y, Guan Z, Liao M, Yu X, Wang C, Wang J, Niu X, Shi Y, Zhi X, Liu Y, Liu M, Zhang Y, Yang Y, Shen J, Chen G, Zhou Q, Zhou C, Guo Q, Tang L, Duan J, Liang J, Zhang Y, Cheng Y. [Expert consensus on the diagnosis and treatment of bone metastasis in lung cancer (2014 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:57-72. [PMID: 24581154 PMCID: PMC6000054 DOI: 10.3779/j.issn.1009-3419.2014.02.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yan Sun
- Cancer Hospital, Chinese Aacademy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhongzhen Guan
- SunYat-Sen University Cancer Center,Guangzhou 510060, China
| | - Meilin Liao
- Shanghai Chest Hospital, Shanghai, 200030, China
| | - Xin Yu
- Department of psychiatry, Peking University Sixth Hospital, Beijing 100191, China
| | - Changli Wang
- Department of Lung Cancer Surgery, Tianjin Cancer Hospital, Tianjin 300060, China
| | - Jie Wang
- Department of Thoracic Medical Oncology, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Aacademy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Beijing Lung Cancer Center, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yunpeng Liu
- Departmentof Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Mengzhong Liu
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yue Yang
- Department of Thoracic Surgery, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jingnan Shen
- Department of Orthopedic Oncology Surgery, the First Affiliated Hospital Sun Yat-Sen University, Guangzhou 510080, China
| | - Gongyan Chen
- Department of Medical Oncology, Haerbin Medical University Cancer Hospital, Haerbin 150081, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Caicun Zhou
- Departmentof Medical Oncology, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Qisen Guo
- Department of Medical Oncology, Shandong Province cancer Hospital, Jinan 250117, China
| | - Lili Tang
- Department of rehabilitation, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jianchun Duan
- Department of Thoracic Medical Oncology, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jun Liang
- Department of Medical Oncology, the Affiated Hospital of Qingdao University, Qingdao 266003, China
| | - Yingjian Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Cancer Hospital, Changchun 130012, China
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149
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Comparison of whole-body MRI and skeletal scintigraphy for detection of bone metastatic tumors: a meta-analysis. Surg Oncol 2013; 22:261-6. [PMID: 24210143 DOI: 10.1016/j.suronc.2013.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 09/24/2013] [Accepted: 10/07/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE We performed a meta-analysis to investigate and compare diagnostic performance of whole-body MRI and skeletal scintigraphy for detection of bone metastatic tumors. MATERIALS AND METHODS PubMed and Embase were searched for relevant articles. We calculated sensitivities, specificities, diagnostic odds ratios (DOR), positive likelihood ratios (PLR), negative likelihood ratios (NLR), and constructed summary receiver operating characteristic curves using bivariate models for whole-body MRI and skeletal scintigraphy, respectively. RESULTS Across 7 studies (332 patients), whole-body MRI have similar patient-based sensitivity (0.84 vs 0.83), specificity (0.96 vs 0.94), DOR (137.0 vs 70.2), PLR (23.3 vs 13.0) and NLR (0.17 vs 0.19) with skeletal scintigraphy. Area under curves for whole-body MRI and skeletal scintigraphy was 0.94 and 0.89, respectively. CONCLUSION Both whole-body MRI and skeletal scintigraphy have good diagnostic performance for detecting bone metastatic tumors. It remains inconclusive whether whole-body MRI or bone scintigraphy is superior in detecting bone metastatic tumors.
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150
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The role of the tumor-microenvironment in lung cancer-metastasis and its relationship to potential therapeutic targets. Cancer Treat Rev 2013; 40:558-66. [PMID: 24176790 DOI: 10.1016/j.ctrv.2013.10.001] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/06/2013] [Indexed: 12/14/2022]
Abstract
Non-small cell lung cancer (NSCLC) accounts for >80% of lung cancer cases and currently has an overall five-year survival rate of only 15%. Patients presenting with advanced stage NSCLC die within 18-months of diagnosis. Metastatic spread accounts for >70% of these deaths. Thus elucidation of the mechanistic basis of NSCLC-metastasis has potential to impact on patient quality of life and survival. Research on NSCLC metastasis has recently expanded to include non-cancer cell components of tumors-the stromal cellular compartment and extra-cellular matrix components comprising the tumor-microenvironment. Metastasis (from initial primary tumor growth through angiogenesis, intravasation, survival in the bloodstream, extravasation and metastatic growth) is an inefficient process and few released cancer cells complete the entire process. Micro-environmental interactions assist each of these steps and discovery of the mechanisms by which tumor cells co-operate with the micro-environment are uncovering key molecules providing either biomarkers or potential drug targets. The major sites of NSCLC metastasis are brain, bone, adrenal gland and the liver. The mechanistic basis of this tissue-tropism is beginning to be elucidated offering the potential to target stromal components of these tissues thus targeting therapy to the tissues affected. This review covers the principal steps involved in tumor metastasis. The role of cell-cell interactions, ECM remodeling and autocrine/paracrine signaling interactions between tumor cells and the surrounding stroma is discussed. The mechanistic basis of lung cancer metastasis to specific organs is also described. The signaling mechanisms outlined have potential to act as future drug targets minimizing lung cancer metastatic spread and morbidity.
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