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Mallio CA, Greco F, Gaudino F, Beomonte Zobel B, Quattrocchi CC. Computed tomography density changes of bone metastases after concomitant denosumab. Skeletal Radiol 2023:10.1007/s00256-023-04326-3. [PMID: 36961572 DOI: 10.1007/s00256-023-04326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate bone density changes at the level of normal trabecular bone and bone metastases (BMs) after denosumab (DM) treatment in oncologic patients. MATERIALS AND METHODS We retrospectively evaluated 31 consecutive adult patients with histologically confirmed solid tumors with at least one newly diagnosed bone metastatic lesion detected at CT. Patients received treatment with DM, 120 mg subcutaneous every 28 days for at least 6 months. Bone density was determined at the level of BMs and at the level of normal trabecular bone of lumbar vertebrae using a region of interest (ROI)-based approach. RESULTS A progressive increase in CT bone density was demonstrated at the level of normal trabecular bone at 6 months (18% ± 5%) and 12 months (23% ± 7%) after the treatment begins. BMs showed a significant increase in CT bone density (p < 0.05) as compared to baseline after 6 months (57% ± 15%) and 12 months (1.06 ± 0.25 times higher) after treatment. CONCLUSION We have found that long-term treatment with DM increases bone density progressively in oncologic patients. This effect can be observed not only at the level of secondary lesions but also at the level of apparently normal trabecular bone and is more pronounced for osteolytic metastases.
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Affiliation(s)
- Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
| | - Federico Greco
- U.O.C. Diagnostica per Immagini Territoriale Aziendale, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Lecce, Italy
| | - Francesco Gaudino
- U.O.S.D Diagnostica per Immagini Emergenza Urgenza, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Pereira J, Mancini I, Walker P. The Role of Bisphosphonates in Malignant Bone Pain: A Review. J Palliat Care 2019. [DOI: 10.1177/082585979801400205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- José Pereira
- Edmonton Regional Palliative Care Program, Edmonton, Alberta, Canada
| | - Isabelle Mancini
- Edmonton Regional Palliative Care Program, Edmonton, Alberta, Canada
| | - Paul Walker
- Edmonton Regional Palliative Care Program, Edmonton, Alberta, Canada
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Affiliation(s)
- Evelyn Mcintyre
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
| | - Eduardo Bruera
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
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Abou-Al-Shaar H, Adogwa O, Mehta AI. Lumbar Spinal Stenosis: Objective Measurement Scales and Ambulatory Status. Asian Spine J 2018; 12:765-774. [PMID: 30060388 PMCID: PMC6068421 DOI: 10.31616/asj.2018.12.4.765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is one of the most common affecting the elderly population that may lead to loss of function and the inability to execute basic activities of daily living. While surgical decompression remains the standard of care, choosing an optimal management strategy is usually guided by a set of clinical, radiological, and measurement indices. However, to date, there is a major uncertainty and discrepancy regarding the methodology used. There is also inconsistent adoption of outcome measures across studies, which may result in huge limitations in predicting the efficacy and cost-effectiveness of different treatment paradigms. Herein, we review the various measurement indices used for outcome assessment among patients with LSS, and delineate the major advantages and disadvantages of each index. We call for the development of a single objective outcome measure that encompasses and addresses all issues encountered in this heterogeneous group of patients, including monitoring the patient's progression after treatment.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Ripamonti C, Fulfaro F, Ticozzi C, Casuccio A, De Conno F. Role of Pamidronate Disodium in the Treatment of Metastatic Bone Disease. TUMORI JOURNAL 2018; 84:442-55. [PMID: 9824995 DOI: 10.1177/030089169808400403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Bone metastases are a common feature of advanced neoplastic disease and are considered to be among the most frequent causes of pain and complications in oncologic patients. The main objective of the treatment of such patients is to control their symptoms and improve their quality of life. Pamidronate disodium is a second-generation bisphosphonate capable of inhibiting bone resorption (particularly osteoclast activity) without affecting bone reminerali-zation. After a brief introduction concerning the pathophysiology of bone metastases and neoplastic bone pain, we herein present data on the clinical pharmacology and toxicity of bisphosphonates in general, and pamidronate in particular. We conclude by reviewing the literature on the use of pamidronate in phase II and III trials involving patients with metastatic bone disease. Methods The paper is based on a review of articles published between 1984 and 1997 selected from the Cancerline and Medline databases. Results In the considered phase II and III studies involving patients with bone metastases (breast cancer and multiple myeloma in particular), pamidronate proved to be efficacious in reducing the incidence of pain and skeletal complications, decreasing the excretion of metabolic markers of bone resorption and improving the quality of life. Intravenous infusions of 60-90 mg over a period of 2 hr every 3-4 weeks did not cause any significant toxic effects and was easily managed. Conclusions Pamidronate is a bisphosphonate that is efficacious in the treatment of symptomatic bone metastases and can be considered an important therapeutic option in association with systemic treatments, radiotherapy and normal supportive care, especially in patients with breast cancer and multiple myeloma. Further randomized studies are necessary to confirm the positive preliminary results in other neoplasms, analyze the cost/benefit ratio of the treatment, and verify the possibility that, in addition to being used for palliative purposes, pamidronate may also prevent or delay the appearance of bone metastases.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy.
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Porta-Sales J, Garzón-Rodríguez C, Llorens-Torromé S, Brunelli C, Pigni A, Caraceni A. Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project. Palliat Med 2017; 31:5-25. [PMID: 27006430 DOI: 10.1177/0269216316639793] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bisphosphonates and denosumab are well-established therapies to reduce the frequency and severity of skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications on bone pain is uncertain. AIM To identify, critically appraise and synthesize existing evidence to answer the following questions: 'In adult patients with metastatic bone pain, what is the evidence that bisphosphonates and denosumab are effective and safe in controlling pain?' and 'What is the most appropriate schedule of bisphosphonate/denosumab administration to control bone pain?'. This review also updates the 2002 Cochrane review 'Bisphosphonates for the relief of pain secondary to bone metastases'. DESIGN Standard systematic review and narrative synthesis. DATA SOURCES MEDLINE, EMBASE and Cochrane CENTRAL databases were searched for relevant articles published through 31 January 2014. A manual search was also performed. Study inclusion criteria were: a) conducted in adult patients; b) randomized controlled trial or meta-analisys; c) reported efficacy of bisphosphonates or denosumab on pain and/or decribed side effects versus placebo or other bisphosphonate; and d) English language. RESULTS The database search yielded 1585 studies, of which 43 (enrolling 8595 and 7590 patients, respectively, in bisphosphonate and denosumab trials) met the inclusion criteria. Twenty-two (79%) of the 28 placebo-controlled trials found no analgesic benefit for bisphosphonates. None of the denosumab studies assessed direct pain relief. CONCLUSION Evidence to support an analgesic role for bisphosphonates and denosumab is weak. Bisphosphonates and denosumab appear to be beneficial in preventing pain by delaying the onset of bone pain rather than by producing an analgesic effect per se.
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Affiliation(s)
- Josep Porta-Sales
- 1 Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: End of Life Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Garzón-Rodríguez
- 1 Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: End of Life Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Silvia Llorens-Torromé
- 1 Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: End of Life Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cinzia Brunelli
- 2 Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,3 European Palliative Care Research Center, Department of Cancer Research and Molecular Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alessandra Pigni
- 2 Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- 2 Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,3 European Palliative Care Research Center, Department of Cancer Research and Molecular Biology, Norwegian University of Science and Technology, Trondheim, Norway
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Pain Management for Sarcoma Patients. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Coleman R, Purohit K, Vinholes J. New Roles for Bisphosphonates in Cancer Therapy. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.1996.11746735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hoskin P, Sundar S, Reczko K, Forsyth S, Mithal N, Sizer B, Bloomfield D, Upadhyay S, Wilson P, Kirkwood A, Stratford M, Jitlal M, Hackshaw A. A Multicenter Randomized Trial of Ibandronate Compared With Single-Dose Radiotherapy for Localized Metastatic Bone Pain in Prostate Cancer. J Natl Cancer Inst 2015; 107:djv197. [PMID: 26242893 DOI: 10.1093/jnci/djv197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 06/23/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The radiotherapy or ibandronate (RIB) trial was a randomized multicenter nonblind two-arm trial to compare intravenous ibandronate given as a single infusion with single-dose radiotherapy for metastatic bone pain. METHODS Four hundred seventy prostate cancer patients with metastatic bone pain who were suitable for local radiotherapy were randomly assigned to radiotherapy (single dose, 8 Gy) or intravenous infusion of ibandronate (6mg) in a noninferiority trial. Pain was measured using the Brief Pain Inventory at baseline and four, eight, 12, 26, and 52 weeks. Pain response was assessed using World Health Organization (WHO) criteria and the Effective Analgesic Score (EAS); the maximum allowable difference was ±15%. Patients failing to respond at four weeks were offered retreatment with the alternative treatment. Quality of life (QoL) was assessed at baseline and four and 12 weeks. Because the trial was designed with a 5% one-sided test, we provide 90% confidence intervals (two-sided) for differences in pain response. RESULTS Overall, pain response was not statistically different at four or 12 weeks (WHO: -3.7%, 90% confidence interval [CI] = -12.4% to 5.0%; and 6.7%, 90% CI = -2.6 to 16.0%, respectively). Corresponding differences using the EAS were -7.5% and -3.5%. However, a more rapid initial response with radiotherapy was observed. There was no overall difference in toxicity, although each treatment had different side effects. QoL was similar at four and 12 weeks. Overall survival was similar between the two groups but was better among patients having retreatment than those who did not. CONCLUSIONS A single infusion of ibandronate had outcomes similar to a single dose of radiotherapy for metastatic prostate bone pain. Ibandronate could be considered when radiotherapy is not available.
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Affiliation(s)
- Peter Hoskin
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS).
| | - Santhanam Sundar
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Krystyna Reczko
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sharon Forsyth
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Natasha Mithal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Bruce Sizer
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - David Bloomfield
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sunil Upadhyay
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Paula Wilson
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Amy Kirkwood
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Michael Stratford
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Mark Jitlal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Allan Hackshaw
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
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Zamani E, Kordi R, Nourian R, Noorian N, Memari AH, Shariati M. Low back pain functional disability in athletes; conceptualization and initial development of a questionnaire. Asian J Sports Med 2014; 5:e24281. [PMID: 25741417 PMCID: PMC4335478 DOI: 10.5812/asjsm.24281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/15/2014] [Accepted: 04/14/2014] [Indexed: 11/30/2022] Open
Abstract
Background: Low Back Pain (LBP) is one of the most prevalent causes of disability not only in the general population but also in athletes. Despite a large number of self-reported back specific disability questionnaires, there is no specific, well documented, outcome measure for athletes suffering from back pain. Objectives: This study aimed to identify the main descriptive themes representing functional disability in athletes due to LBP. Patients and Methods: We conducted a qualitative study using in-depth interviews to characterize the experiences of athletes with LBP. Twenty athletes with LBP were recruited and the main descriptive elements of their LBP related disability were extracted. Then a preliminary questionnaire using these themes was proposed. Results: The main disability indicators were pain intensity; stretching exercises, strengthening exercises, sport specific skills, back range of motion (ROM), sitting, walking, sleep patterns, self-care, and recreational activities, fear of pain and avoidance behavior, and changes in sexual activity. Conclusions: The findings of this study suggest that apart from non-sports items, some sport related items should be included in the assessment of LBP disability levels in athletes. Our results have also been organized as a preliminary LBP disability questionnaire for athletes.
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Affiliation(s)
- Elham Zamani
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ramin Kordi, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188630228, Fax: +98-2188003539, E-mail:
| | - Ruhollah Nourian
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Noorafshar Rehabilitation and Sports Medicine Hospital, Tehran, IR Iran
| | - Negin Noorian
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amir Hossein Memari
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Shariati
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
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Patient-reported outcome instruments used to assess pain and functioning in studies of bisphosphonate treatment for bone metastases. Support Care Cancer 2012; 20:657-77. [PMID: 22302082 PMCID: PMC3297753 DOI: 10.1007/s00520-011-1356-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 12/12/2011] [Indexed: 01/22/2023]
Abstract
Purpose When treating metastatic bone disease, relief of bone pain is often a key outcome. Because pain cannot be quantified with objective clinical measures, patient-reported outcome (PRO) measures are required to assess patients' subjective experience. The goal of the current review was to examine measures used to assess pain, as well as the impact of pain on functional status and health-related quality of life (HRQL), in trials of bisphosphonates for the treatment of bone metastases. Methods A literature search focused on articles published from January 1999 to April 2009. Results A total of 49 articles were located that used PROs to assess pain-related outcomes of bisphosphonate treatment for bone metastases. The Brief Pain Inventory was the most commonly used multi-item instrument. However, the most common approach for assessing pain was to administer a single-item scale such as a visual analog scale, numerical rating scale, or verbal rating scale. Of the 49 studies, 19 included a PRO assessing functional status or HRQL. Conclusions Although pain is an important outcome of trials examining treatment for bone metastases, the current review suggests that there is little consistency in PRO measurement across studies. Furthermore, presentation of measures often lacked clear description, information on measurement properties, citations, clarity regarding method of administration, and consistent instrument names. Recommendations are provided for instrument validation within the target population, assessment of content validity, use of PRO instruments recently developed for patients with bone metastases, clear description of instruments, and implementation of measures consistent with recommendations from instrument developers.
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Quattrocchi CC, Dell'Aia P, Errante Y, Occhicone F, Longo D, Virzì V, Tonini G, Napoli N, Santini D, Beomonte Zobel B. Differential effect of zoledronic acid on normal trabecular and cortical bone density in oncologic patients with bone metastases. J Bone Oncol 2012; 1:24-9. [PMID: 26909251 PMCID: PMC4723329 DOI: 10.1016/j.jbo.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate bone density changes at the level of normal bone and bone metastases after zoledronic acid (ZA) treatment in oncologic patients. MATERIALS AND METHODS We retrospectively evaluated 72 consecutive adult patients with histologically confirmed solid tumors with at least 1 newly diagnosed bone metastatic lesion. Bone metastases were diagnosed by bone scans and confirmed with computed tomography (CT). Patients received intravenous ZA, 4 mg, by 15-min infusion every 28 day through a peripheral or a central venous access and were monitored for at least 3 months and a maximum of 24 months. Bone density was determined at the level of bone metastases and at the level of normal trabecular and cortical bone using a ROI-based approach. RESULTS A significant increase was demonstrated at the level of normal trabecular bone of the calvarium and the femoral neck. No significant increase of density was observed at the level of the normal cortical bone. Bone metastases showed a significant increase in CT density as compared to baseline up to 24 months after zoledronic acid. CONCLUSION We have found that long term treatment with ZA increases trabecular bone density in oncologic patients whereas normal cortical bone changes are not detectable.
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Affiliation(s)
- Carlo C. Quattrocchi
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Paola Dell'Aia
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Yuri Errante
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Filomena Occhicone
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Daniela Longo
- IRCCS Ospedale Pediatrico Bambino Gesù, Radiology, Piazza Sant'Onofrio, 4, Rome 00100, Italy
| | - Vladimir Virzì
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Giuseppe Tonini
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Nicola Napoli
- Endocrinology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Daniele Santini
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Bruno Beomonte Zobel
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
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A comparative study of intravenous ibandronate and pamindronate in patients with bone metastases from breast or lung cancer: effect on metastatic bone pain. Am J Ther 2012; 18:340-2. [PMID: 20634675 DOI: 10.1097/mjt.0b013e3181e70c38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We compared the effects of ibandronate and pamindronate in patients with bone metastases from breast or lung cancer and we found that ibandronate is superior to pamindronate in alleviating pain, improving mobility and quality of life, and reducing bone resorption indices in patients with bone metastases from breast or lung cancer.
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Kobayashi H, Tanaka Y, Yagi J, Minato N, Tanabe K. Phase I/II study of adoptive transfer of γδ T cells in combination with zoledronic acid and IL-2 to patients with advanced renal cell carcinoma. Cancer Immunol Immunother 2011; 60:1075-84. [PMID: 21519826 PMCID: PMC11029699 DOI: 10.1007/s00262-011-1021-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
Human Vγ2 Vδ2-bearing T cells have recently received much attention in cancer immunotherapy. In this study, we conducted a phase I/II clinical trial of the adoptive transfer of γδ T cells to patients with advanced renal cell carcinoma. Eleven patients who had undergone nephrectomy and had lung metastasis were enrolled. Peripheral blood γδ T cells obtained from the patients were stimulated ex vivo with 2-methyl-3-butenyl-1-pyrophosphate (2M3B1PP), a synthetic pyrophosphomonoester antigen, and transferred in combination with zoledronic acid (Zol) and teceleukin (recombinant human interleukin-2). Expanded γδ T cells exhibited potent cytotoxic activity against tumor cells in vitro, and the proportion of peripheral blood γδ T cells among CD3(+) cells typically peaked three to 5 days after transfer. Tumor doubling time was prolonged in all 11 patients, and the best overall responses were 1 CR, 5 SD, and 5 PD, as defined based on Response Evaluation Criteria in Solid Tumors (RECIST). Although ten patients developed adverse reactions of grade ≥3, they were likely to have been the result of the concomitant infusion of Zol and IL-2, and most symptoms swiftly reverted to normal during the course of treatment. In conclusion, this clinical trial demonstrated that our regimen for the adoptive transfer of γδ T cells in combination with Zol and IL-2 was well tolerated and that objective clinical responses could be achieved in some patients with advanced renal cell carcinoma.
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Affiliation(s)
- Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Procollagen type I N-propeptide is a predictor of skeletal morbidity in patients with malignant osteolytic bone disease on bisphosphonates. Cancer Chemother Pharmacol 2010; 67:1137-44. [DOI: 10.1007/s00280-010-1420-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
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Chow E, Hird A, Velikova G, Johnson C, Dewolf L, Bezjak A, Wu J, Shafiq J, Sezer O, Kardamakis D, van der Linden Y, Ma B, Castro M, Arnalot PF, Ahmedzai S, Clemons M, Hoskin P, Yee A, Brundage M, Bottomley A. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for patients with Bone Metastases: The EORTC QLQ-BM22. Eur J Cancer 2009; 45:1146-1152. [DOI: 10.1016/j.ejca.2008.11.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 11/11/2008] [Indexed: 11/12/2022]
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Tharmalingam S, Chow E, Harris K, Hird A, Sinclair E. Quality of life measurement in bone metastases: A literature review. J Pain Res 2008; 1:49-58. [PMID: 21197288 PMCID: PMC3004617 DOI: 10.2147/jpr.s4572] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Quality of life (QOL) has become an important consideration in the care of patients with bone metastases as prevalence, incidence and patient survival are on the rise. As a result, more interventional studies now measure patient’s QOL as a meaningful endpoint. However, well-developed bone metastases specific quality of life instruments are lacking. A literature review was conducted to better understand the nature of QOL instruments used in bone metastases trials. A total of 47 articles evaluating QOL in patients with bone metastases were identified. Twenty-five different instruments were used to evaluate QOL with study-designed questionnaires and the EORTC QLQ-C30 being most commonly employed. Many studies used more than one scale or instrument to measure QOL. This makes it difficult to compare QOL in bone metastases patients across studies and come to any formal conclusions. Therefore, this review demonstrates the need to develop a bone module that can be used across countries in future clinical trials.
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Affiliation(s)
- Sukirtha Tharmalingam
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Palmedo H, Grohé C, Ko Y, Tasci S. PET and PET/CT with F-18 fluoride in bone metastases. Recent Results Cancer Res 2008; 170:213-224. [PMID: 18019629 DOI: 10.1007/978-3-540-31203-1_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- H Palmedo
- Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Bonn, Germany
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22
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Quattrocchi CC, Santini D, Dell'aia P, Piciucchi S, Leoncini E, Vincenzi B, Grasso RF, Tonini G, Zobel BB. A prospective analysis of CT density measurements of bone metastases after treatment with zoledronic acid. Skeletal Radiol 2007; 36:1121-7. [PMID: 17912514 DOI: 10.1007/s00256-007-0388-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 08/28/2007] [Accepted: 09/04/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to prospectively determine CT density changes in bone metastases, before and after intravenous zoledronic acid for a maximum period of 12 months. PATIENTS AND METHODS Twenty-three consecutive patients presented with bone metastases and underwent therapy with zoledronic acid from December 2004. All patients underwent CT of the chest, abdomen, and pelvis. Bone density, measured in Hounsfield units (HU), was determined by segmenting lesions in the same anatomical area of the metastasis sites on the axial images of the sequential series of CT examinations. The effects of zoledronic acid were evaluated by calculating absolute and relative increases in bone density. RESULTS The patients presented with multiple metastases in 65% of the cases. When compared with the baseline, all groups demonstrated a significant increase in bone density, which significantly (p < 0.01) correlated with the number of zoledronic acid administrations. There was increased bone density of at least 100% in 57%, and an increase of at least 50% in 87% of the patients. This increase was significant in both lytic and sclerotic metastases after 3 months of therapy. No significant bone density difference was found in normal-appearing bone. CONCLUSION Bone density measured by CT increases at metastatic sites after zoledronic acid treatment, regardless of the type of metastasis, in contrast to apparently normal bone.
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Affiliation(s)
- Carlo C Quattrocchi
- Department of Radiology, Centro Interdisciplinare per la Ricerca Bio-Medica, Via Longoni 47, 00155, Rome, Italy.
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Abstract
The indications of bisphosphonate therapy in breast cancer patients go from the correction of hypercalcemia to the prevention of cancer treatment-induced bone loss. Bisphosphonates are part of our therapeutic armamentarium against metastatic bone pain, and at least 50% of the patients benefit from a clinically relevant analgesic effect. Placebo-controlled trials with oral or i.v. bisphosphonates have shown that prolonged administration can reduce the frequency of skeletal-related events by 30% to 40%. The superiority of zoledronic acid compared with pamidronate has been shown by a multiple-event analysis in a large randomized trial. The short infusion time of zoledronic acid also constitutes a convenient therapy. Where available, oral ibandronate offers an interesting alternative, especially for patients receiving hormone therapy. There are some toxicity concerns with the prolonged use of bisphosphonates. The occasional renal toxicity of zoledronic acid has led to the recommendation to monitor renal function before each infusion and to adjust the dose according to creatinine clearance. Osteonecrosis of the jaw could occur in up to 2.5% of breast cancer patients during long-term bisphosphonate therapy. It is often a significant complication that seems to be linked with the duration of therapy.
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Affiliation(s)
- Jean-Jacques Body
- Department of Internal Medicine, Institut Jules Bordet, Univesité Libre de Bruxelles, Brussels, Belgium
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Abstract
Multiple myeloma (MM) is a B cell malignancy characterized by enhanced bone loss commonly associated with diffuse osteopenia, focal lytic lesions, pathologic fractures, hypercalcemia, and bony pain. Bone destruction in MM results from asynchronous bone turnover wherein increased osteoclastic bone resorption is not accompanied by a comparable increase in bone formation. Consequently, patients with MM frequently require radiation therapy, surgery, and analgesic medications. The recent development of minimally invasive surgical procedures such as kyphoplasty allows patients with myeloma with vertebral compression fractures to have immediate improvement in their quality of life with shorter hospital stays. Bisphosphonates are specific inhibitors of osteoclastic activity, and these agents have been evaluated in patients with MM with bone disease during the past 15 years. Monthly i.v. infusions of either pamidronate or zoledronic acid have reduced the skeletal complications among patients with MM and are now a mainstay of myeloma therapy. Orally administered bisphosphonates, in contrast, have shown little ability to slow the development of skeletal complications in these patients. Although preclinical studies suggest that nitrogen-containing bisphosphonates have potent antitumor effects, clinical trials will be necessary, probably at higher doses given more slowly, to establish their possible antitumor effects clinically. Moreover, recent advances in the use of bone-seeking radiopharmaceuticals make these attractive therapeutic candidates to combine with bisphosphonates or radiosensitizing drugs (e.g., bortezomib) to achieve a synergistic effect. As our understanding of the pathophysiology of myeloma bone disease continues to grow, new target therapies will continue to emerge, offering new and more advanced options for the management of myeloma bone disease.
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Affiliation(s)
- Howard S Yeh
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California 90069, USA
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Clarke NW. Management of the Spectrum of Hormone Refractory Prostate Cancer. Eur Urol 2006; 50:428-38; discussion 438-9. [PMID: 16797118 DOI: 10.1016/j.eururo.2006.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 05/12/2006] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In its advanced stages, hormone refractory prostate cancer (HRPC) is an incurable condition which consists of a spectrum of disease. This requires an integrated multidisciplinary approach by an uro-oncologic team supported by radiologists, skeletal surgeons and palliative care. Aim of this review was to critically evaluate the current and potential approaches to patients affected by HRPC. MATERIALS AND METHODS A comprehensive evaluation of available published data included analysis of published full-length papers that were identified with Medline and Cancerlit from January 1981 to January 2006. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS Most men with hormone refractory prostate cancer will die of their disease in the absence of intercurrent illness, and the various conditions arising as a consequence of local and distal cancer progression commonly lead to a spectrum of morbidity requiring treatment. Recent data regarding docetaxel-based chemotherapy have shown small but significant improvements in survival and improvement in quality of life in men receiving treatment. However, this therapy may not be suitable for all patients. New agents used alone or in combination with docetaxel currently are under trial in an attempt to provide much needed improvements in outcome. Bone-targeted treatments, particularly late-generation bisphosphonates, have added to the range of options, reducing the incidence of skeletal complications in some men. Further work is needed to target their use more effectively, to explore their efficacy in combination with existing proven therapies and to develop new approaches to treat bone metastases. Complications arising as a consequence of upper and lower tract dysfunction, haematologic, neurologic and psychologic disorders are common. These complications often are amenable to effective treatment, but interventions may engender difficult clinical and ethical decisions. CONCLUSIONS Although HRPC is incurable, it is not untreatable, and that the clinical management embraces not just chemotherapy, but many interventional and supportive therapies. A holistic and supportive approach to patient care is vital for optimal management, and is best provided by a coordinated, multidisciplinary team including urologists and oncologists.
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Affiliation(s)
- Noel W Clarke
- Christie Hospital and Salford Royal Hospitals NHS Trusts, Manchester, UK.
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Yeh HS, Berenson JR. Myeloma bone disease and treatment options. Eur J Cancer 2006; 42:1554-63. [PMID: 16797971 DOI: 10.1016/j.ejca.2005.11.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 11/30/2005] [Indexed: 01/08/2023]
Abstract
Multiple myeloma (MM) is a B-cell malignancy characterized by enhanced bone loss commonly associated with a diffuse osteopenia, focal lytic lesions, pathologic fractures, hypercalcemia, and bony pain. Bone destruction in MM results from asynchronous bone turnover wherein increased osteoclastic bone resorption is not accompanied by a comparable increase in bone formation. Recent characterization of osteoclast-activating factors (OAFs), receptor activator of nuclear factor-kappaB (RANK) ligand (RANKL)-osteoprotegerin-RANK system, and inhibitors of Wnt signaling have provided a better understanding of myeloma bone disease in molecular level. The development of minimally invasive surgical procedures such as kyphoplasty and vertebroplasty allows myeloma patients with vertebral compression fractures to have immediate improvement in quality of life and shorter hospital stays. Monthly intravenous infusion of either pamidronate or zoledronic acid have reduced the skeletal complications among MM patients and are now a mainstay of myeloma therapy. Orally administered bisphosphonates, in contrast, have shown little ability to slow the development of skeletal complications in these patients. Although pre-clinical studies suggest nitrogen-containing bisphosphonates have potent anti-tumor effects, clinical trials will be necessary, probably at higher doses given more slowly, to establish their possible anti-tumor effects clinically. As our understanding of the pathophysiology of myeloma bone disease continues to increase, new target therapies will continue to emerge offering new and more advanced options for the management of myeloma bone disease.
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Affiliation(s)
- Howard S Yeh
- Hematology/Oncology Department, Institute for Myeloma & Bone Cancer Research, 9201W. Sunset Blvd., Suite 300, W. Hollywood, CA 90069, USA
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Body JJ. Tumor bone disease. ANNALES D'ENDOCRINOLOGIE 2006; 67:166-72. [PMID: 16639371 DOI: 10.1016/s0003-4266(06)72576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J-J Body
- Dept of Internal Medicine, Inst. J. Bordet, Université Libre de Bruxelles, rue Héger-Bordet 1, B-1000 Brussels, Belgium.
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Costa L, Lipton A, Coleman RE. Role of Bisphosphonates for the Management of Skeletal Complications and Bone Pain from Skeletal Metastases. ACTA ACUST UNITED AC 2006; 3:143-53. [DOI: 10.3816/sct.2006.n.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brown SC, Jeavons M, Stinson J. Effectiveness of pamidronate for treating intractable chronic neuropathic pain: case report of two adolescents. Clin J Pain 2006; 21:549-52. [PMID: 16215341 DOI: 10.1097/01.ajp.0000146167.23153.b0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study is to evaluate the effectiveness of pamidronate for the treatment of chronic neuropathic pain refractory to previous management. Intravenous pamidronate (60 mg/day for 3 days) was administered to 2 adolescents with neuropathic pain refractory to previous multidisciplinary treatments. Pain intensity, functional improvement, and adverse effects were evaluated. There were no significant reductions in pain intensity or improvements in function initially or at follow-up at 1 week, 1 month and 4 months. Minor side effects included myalgia and skeletal pain that were relieved by acetaminophen. There was no long-term morbidity. In contrast to recent positive reports in adults, pamidronate was not effective in decreasing pain or improving function in 2 adolescents with chronic neuropathic pain. Pamidronate may be effective only when pain is accompanied by abnormal bone density. Future trials should include scans to document bone density pretherapy and posttherapy.
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Affiliation(s)
- Stephen C Brown
- Department of Anaesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada.
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30
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Abstract
The major clinical manifestation of multiple myeloma is related to the osteolytic bone destruction. The bone disease can lead to pathologic fractures, spinal cord compression, hypercalcemia, and pain. It is also a major cause of morbidity and mortality in these patients. These patients frequently require radiation therapy, surgery and analgesic medications. Bisphosphonates are specific inhibitors of osteoclastic activity, and these agents have been evaluated in myeloma patients with bone disease during the past 15 years. Several large randomized trials have been conducted in myeloma patients also receiving chemotherapy. Orally administered bisphosphonates have shown little ability to slow the development of skeletal complications in these patients. In contrast, more potent intravenous monthly infusions of either pamidronate or zoledronic acid have reduced the skeletal complications among these patients and are now a mainstay of myeloma therapy. A number of other types of new anti-bone-resorptive agents are also in early clinical development.
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Affiliation(s)
- James R Berenson
- Institute for Myeloma and Bone Cancer Research, 9201 W. Sunset Blvd, Suite 300, W. Hollywood, CA 90069, USA.
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Guermazi M, Mezghani M, Ghroubi S, Elleuch M, Med AOS, Poiraudeau S, Mrabet F, Dammak J, Fermanian J, Baklouti S, Sellami S, Revel M, Elleuch MH. [The Oswestry index for low back pain translated into Arabic and validated in a Arab population]. ACTA ACUST UNITED AC 2005; 48:1-10. [PMID: 15664678 DOI: 10.1016/j.annrmp.2004.06.055] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 06/03/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To translate into Arabic and validate the Oswestry index for low back pain in an Arab population. BACKGROUND No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available. DESIGN Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient. RESULTS Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2. CONCLUSION We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.
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Affiliation(s)
- M Guermazi
- Service de médecine physique et réadaptation fonctionnelle, hôpital H.-Bourguiba, université du sud, 3000 Sfax, Tunisie.
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Kim DY, Lee SH, Lee HY, Lee HJ, Chang SB, Chung SK, Kim HJ. Validation of the Korean version of the oswestry disability index. Spine (Phila Pa 1976) 2005; 30:E123-7. [PMID: 15738775 DOI: 10.1097/01.brs.0000157172.00635.3a] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Validation of a translated, culturally adapted questionnaire. OBJECTIVES To translate and culturally adapt a Korean version of the Oswestry Disability Index (ODI) and to validate its use in Korean patients. SUMMARY OF BACKGROUND DATA The ODI is one of the most widely used and validated instruments for measuring disability in spinal disorders. However, no validated Korean version of the index was available at the time our study was initiated. METHODS The study was carried out in three phases: the first was translation into Korean and cultural adaptation of the questionnaire; the second was a pilot study to assess the comprehensibility of the prefinal version and modification; the third was a reliability and validity study of the final version. The Korean version was tested on 206 patients with lumbar spinal disorders who had undergone operations at the authors' institute. Test-retest reliability, internal consistency, concurrent validity, and construct validity were investigated. Follow-up questionnaires were obtained from 39 patients at the 3-month postoperative follow-up meeting. Differences in the ODI, visual analog scale (VAS), and World Health Organization (WHO) quality of life assessment (WHOQOL-BREF) between preoperative and follow-up questionnaires were evaluated. The correlation of the postoperative ODI with the pain rating on a visual analog scale and WHOQOL-BREF was also analyzed. RESULTS Test-retest reliability was assessed with 88 patients in a time interval of 48 hours. The intraclass correlation coefficient of test-retest reliability was 0.9167. Reliability estimated by the internal consistency reached a Cronbach's alpha of 0.84. The correlation of the preoperative ODI with the pain rating on a visual analog scale (100 mm) was r = 0.425 (P = 0.0001). The correlation between three of the WHOQOL-BREF domains (physical health, psychological health, and environment) and the ODI was statistically significant. The correlation coefficient between the ODI and physical health domain of the WHOQOL-BREF was r = -0.48 (P < 0.05). The correlations with psychological health and environment domains were low with r = -0.192 and -0.160, respectively, even though statistically significant (P < 0.05). The correlation of the postoperative ODI with the pain rating on a visual analog scale (100 mm) was r = 0.626 (P = 0.0001). The correlation between all four domains of the WHOQOL-BREF and the postoperative ODI was statistically significant. CONCLUSIONS The results of this study indicate that the Korean version of the ODI is a reliable and valid instrument for the measurement of disability in Korean patients with lower back problems. The authors recommend this Korean version of the ODI for use in future clinical studies in Korea.
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Affiliation(s)
- Dong-Yun Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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Rodríguez Cordón M, Ferrer Albiach E, Ferrer Albiach C. [Current multidisciplinary treatment of metastatic prostatic cancer]. Actas Urol Esp 2004; 27:767-81; discussion 781-2. [PMID: 14735858 DOI: 10.1016/s0210-4806(03)73013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Prostate cancer is one of the commonest causes of cancer-related death in the western world. The morbi-mortality associated is usually a direct consequence of metastatic spread to bone, in up to 50% of patients at first presentation. The aim of treatment of metastatic patients is to alleviate and to prevent the distressing symptoms. The approach include hormone-therapy, radiotherapy, radio-nuclides, surgery, chemotherapy, bisphosphonates and new drugs (agents that inhibit angiogenesis, immunotherapy and therapies that affect the differentiation). Decisions about therapy must also take into consideration the androgen-dependent or independent, so hormone-therapy is the first step of the treatment; the number and location of bone metastases; the severity of symptoms; the available of therapies; the status performance of patient; the prognosis and the cost-effect relationship. Some treatments have established indications whereas others are still in process of study in order to determinate their efficacy, their model of treatment and their indications. This article revises and updates these treatments.
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Affiliation(s)
- M Rodríguez Cordón
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valencia
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Liberato NL, Marchetti M, Barosi G. Clinical and economic issues in the treatment of advanced breast cancer with bisphosphonates. Drugs Aging 2003; 20:631-42. [PMID: 12831288 DOI: 10.2165/00002512-200320090-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An ideal palliative therapy for bone metastases would successfully reduce skeletal complications in several thousands of breast cancer patients. Second- and third-generation bisphosphonates are effective in reducing the overall skeletal complication rate and the time to first skeletal complication. Nevertheless, not enough evidence supports their benefit on quality of life. Furthermore, bisphosphonates are expensive (up to 775 US dollars per month, 2002 value) and cost-effectiveness evaluations have been limited to pamidronate (pamidronic acid). In economic evaluations of pamidronate, resulting incremental dollar per quality-adjusted life year gained ranged from cost savings to 108,000 US dollars per quality-adjusted life year. The data were quite sensitive to quality-of-life estimates and country-specific cost values. Because of the wide range of the cost-effectiveness ratio, it is uncertain whether the universal prescription of bisphosphonates in this setting represents an efficient use of healthcare resources. Probably, country- and drug-specific policies might increase the efficiency of this treatment. Further outcomes research is required to assess these agents more fully.
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Affiliation(s)
- N W Clarke
- Christie Hospital NHS Trust and Salford Royal Hospitals NHS Trust, Manchester, UK.
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Kouloulias V, Matsopoulos G, Kouvaris J, Dardoufas C, Bottomley A, Varela M, Uzunoglu N, Antypas C, Metafa A, Moulopoulos A, Sandilos P, Vlahos L. Radiotherapy in conjunction with intravenous infusion of 180 mg of disodium pamidronate in management of osteolytic metastases from breast cancer: clinical evaluation, biochemical markers, quality of life, and monitoring of recalcification using assessments of gray-level histogram in plain radiographs. Int J Radiat Oncol Biol Phys 2003; 57:143-57. [PMID: 12909227 DOI: 10.1016/s0360-3016(03)00525-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the clinical improvement and radiographically monitor the effect of local radiotherapy in conjunction with disodium pamidronate (DP) on metastatic osteolytic disease. METHODS AND MATERIALS Thirty-three patients with osteolytic metastasis from advanced breast cancer received radiotherapy with a 6-MV linear accelerator up to a dose of 30 Gy (3 Gy/fraction, 5 d/wk) combined with 24 monthly sessions of a 180-mg DP infusion. Conventional X-rays were obtained during the first six sessions of DP treatment, retaining the same settings for each exposure. The analysis of the image attributes was based on measuring the first-order statistics of the mean value and energy of gray-level histograms in the osteolytic region. RESULTS The 6-month measurements compared with baseline showed statistically significant differences (p < 0.01, Wilcoxon test) in energy of gray-level histogram (-10.8%), mean value of gray-level histogram (+9.5%), pain score (-5.8 points), Eastern Cooperative Oncology Group status (-2.4 points), urine hydroxyproline/creatinine ratio (-41.7%), urine calcium/creatinine ratio (-58.8%), and bone alkaline phosphatase (-42.4%). Quality of life as determined by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (version 3) also improved. During follow-up, 88% of patients had complete and 12% partial responses (International Union Against Cancer radiologic criteria). On multivariate analysis, greater changes in the mean value of the gray-level histogram and negative nodal status were predictors for a reduction in the number of skeletal complications after therapy. Flu-like syndrome occurred in 13 patients (39%) and was well managed with mild antipyretics. CONCLUSION Image-processing in plain radiographs offers an objective way to assess recalcification. The image-processing indexes, along with the measurements of performance status, quality of life, and biochemical markers, improved significantly. Local radiotherapy combined with long-term high-dose DP up to 180 mg is tolerable and has a high therapeutic response.
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Oura S, Hirai I, Yoshimasu T, Kokawa Y, Sasaki R. Clinical efficacy of bisphosphonate therapy for bone metastasis from breast cancer. Breast Cancer 2003; 10:28-32. [PMID: 12525760 DOI: 10.1007/bf02967622] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bisphosphonates inhibit osteoclastic bone resorption and are being used as treatment for bone metastases from breast cancer. Intravenous bisphosphonate therapy can significantly reduce skeletal related events (SREs) when administered concurrently with chemotherapy or endocrine therapy. In addition, intravenous bisphosphonate monotherapy is also able to alleviate cancer induced bone pain, and to improve bone metastases in some patients. Oral bisphosphonates are not routinely used for the treatment of bone metastases due to their low bioavailability. However, minodronate, a bisphosphonate 100-fold more potent than pamidronate, is now in phase II clinical studies in Japan, and may alter the role of oral bisphosphonates in the treatment of bone metastasis from breast cancer. The ASCO guidelines recommend that patients with osteolytic bone metastases be treated not with bisphosphonate monotherapy, but with concurrent bisphosphonate and systemic therapy. In addition, it is also recommended that current standards of care for cancer pain, analgesics and radiotherapy, should not be replaced with bisphosphonate therapy.
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Affiliation(s)
- Shoji Oura
- First Department of Surgery, Wakayama Medical University, Japan
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Iwase M, Takemi T, Manabe M, Nagumo M. Hypercalcemic complication in patients with oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003; 32:174-80. [PMID: 12729778 DOI: 10.1054/ijom.2002.0261] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypercalcemia is one of the metabolic complications associated with cancer. To assess the frequency of hypercalcemia in patients with squamous cell carcinoma (SCC), 242 patients who were evaluated as having SCC in the oral cavity between July 1995 and June 2001 were investigated. All patients were periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dl. By this definition, hypercalcemia was detected in 12 of the 242 patients (5.0%). All 12 patients were at an advanced stage of oral SCC. In these 12 patients, the serum level of parathyroid hormone-related protein (PTH-rP) was also significantly elevated. Therefore, we diagnosed these diseases as humoral hypercalcemia of malignancy (HHM). Moreover, we studied the efficacy of anti-hypercalcemic therapy on the quality of life (QOL). The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 was used for estimation of QOL. The patients with HHM who were administrated drugs such as bisphosphonate and calcitonin showed a reduction in their Ca and PTH-rP levels, and the six of ten EORTC QLQ-C30 subscales (emotional functioning, cognitive functioning, fatigue, dyspnoea, nausea/vomiting and appetite loss) were also improved after the anti-hypercalcemic therapy. However, these suppressive effects were temporary. The median survival time after the diagnosis of HHM was only 54.9+/-18.3 days (range 27-86 days). Therefore, HHM in SCC appears to be an ominous prognostic sign. Although anti-hypercalcemic therapy has a palliative role, the patients may be in less discomfort during the terminal stage of their illness.
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Affiliation(s)
- M Iwase
- Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
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Heidenreich A, Elert A, Hofmann R. Ibandronate in the treatment of prostate cancer associated painful osseous metastases. Prostate Cancer Prostatic Dis 2003; 5:231-5. [PMID: 12496987 DOI: 10.1038/sj.pcan.4500574] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2001] [Accepted: 12/20/2001] [Indexed: 11/09/2022]
Abstract
The aim of our study was to assess the clinical efficacy and toxicity of ibandronate in the management of symptomatic skeletal metastases due to prostate cancer (PCA). Twenty-five patients with painful osseous metastases due to hormone refractory PCA (HRPCA) were treated with 6 mg ibandronate every 4 weeks in an open prospective non-randomized clinical study. Primary study endpoint was pain reduction documented by the use of a 10-point visual analog scale. Palliative response with significant reduction in pain score from 6.5 (5-10) to 2.0 [(0-4), P<0.001] was achieved in 23 (92%) patients; nine patients (39%) were completely pain free. Bisphosphonate treatment of painful osseous metastases due to HRPCA resulted in a significant pain reduction and a significant decrease of daily consumption of analgesics in 92% of the patients. Both characteristics are paralleled by an increase in Karnofsky index mainly due to better mobility. Bisphosphonates should have a definite role in the palliative management of symptomatic HRPCA.
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Affiliation(s)
- A Heidenreich
- Department of Urology, Philipps - University Marburg, Baldingerstrasse, Marburg, Germany.
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Groot MT, Boeken Kruger CGG, Pelger RCM, Uyl-de Groot CA. Costs of prostate cancer, metastatic to the bone, in the Netherlands. Eur Urol 2003; 43:226-32. [PMID: 12600424 DOI: 10.1016/s0302-2838(03)00007-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To quantify medical costs associated with bone metastases in patients with prostate cancer. Bone metastases in patients with prostate cancer are associated with considerable morbidity, negatively impact quality of life, and can add substantially to medical costs, given a median survival of 30-35 months from diagnosis of bone metastases. METHODS A retrospective cost analysis from both a community and university hospital in The Netherlands was conducted. Twenty-eight patient records (14 from each hospital) were investigated to assess the impact of skeletal-related events (SREs), including fractures, spinal cord compression, and radiotherapy, on total direct medical costs and cost of hospitalization. Costs are given in EUROS (Euros). RESULTS The average total cost of treatment was Euros 13,051 per patient over the 24-month follow-up period, which includes an average cost of Euros 6973 per patient to treat SREs. Treatment of SREs more than doubled total treatment costs. Patients in this analysis experienced, on average, one SRE per year, and the cost of SREs varied from Euros 1187 to Euros 40,948. CONCLUSIONS Occurrence of SREs contributes significantly to the cost of care for patients with advanced prostate cancer. These data suggest that bisphosphonates, which can reduce pain and SREs, may reduce healthcare costs.
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Affiliation(s)
- M T Groot
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, Room L3-105, 3000 DR Rotterdam, The Netherlands.
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Brown JE, Coleman RE. Assessment of the effects of breast cancer on bone and the response to therapy. Breast 2002; 11:375-85. [PMID: 14965699 DOI: 10.1054/brst.2002.0442] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2002] [Accepted: 03/19/2002] [Indexed: 11/18/2022] Open
Abstract
The skeleton is the most frequent site of metastatic disease in breast cancer and also the site of greatest morbidity. In addition, there is now recognition that accelerated bone loss associated with chemotherapy or hormonal therapy leads to an increased risk of osteoporosis in long-term breast cancer survivors. An improved range of treatment options is available and assessment of skeletal response both to the disease and to therapy is therefore of growing importance. Plain radiographs remain widely used to assess response, but are of limited sensitivity. The isotope bone scan is more sensitive, but lacks specificity. Computerised tomography, magnetic resonance imaging and positron emission tomography all have an increasing role. In treatment-induced osteoporosis, bone mineral density is now readily measured by DEXA scanning. Tumour markers such as CEA, CA 15-3, CA 549 and TPA may have a role in assessing response, but probably in combination rather than individually, using an appropriate quantitative model. Several trials have shown that bone markers, especially markers of bone resorption such as Ntx, Ctx, PYD and DPD, appear to have strong potential as rapid, convenient and inexpensive measures of response. There is also evidence that they may be used as predictive or prognostic indicators. Evidence is accumulating that the reduction of bone resorption markers into the normal range results in substantially reduced morbidity in metastatic breast cancer and that this should be a major target of therapy.
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Affiliation(s)
- Janet E Brown
- Yorkshire Cancer Research Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield S10 2SJ, UK.
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Pelger RC, Soerdjbalie-Maikoe V, Hamdy NA. Strategies for management of prostate cancer-related bone pain. Drugs Aging 2002; 18:899-911. [PMID: 11888345 DOI: 10.2165/00002512-200118120-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prostate cancer is one of the most common malignancies and a leading cause of cancer-related death in men worldwide. In the majority of cases, prostate cancer metastases to the skeleton, in which case cancer-related bone pain becomes a major cause of morbidity. Androgen ablation is the treatment of choice for securing regression of skeletal metastases in the majority of cases. Intermittent androgen ablation is an attractive alternative, aimed at minimising adverse effects of hormone deprivation but also potentially delaying hormone-refractoriness. The development of hormone-refractoriness is heralded by a significant increase in morbidity largely because of escalating bone pain caused by the progression of the metastatic process. Skillful use of analgesics is initially successful but eventually fails to control symptoms. Localised metastases are best treated with local radiotherapy that is rapidly effective. Over the last few years, it has become clear that therapeutic modalities using bone-seeking radionuclides or bisphosphonates have been effective in the palliation of prostate cancer-related bone pain, although not affecting survival. The main limiting factor with the use of radionuclides is bone marrow suppression, also a feature of the very late stages of prostate cancer. Bisphosphonates do not carry this disadvantage. Results of large double-blind, placebo-controlled studies should be awaited, however, before advocating the widespread use of these agents in the management of patients with prostate cancer and skeletal metastases.
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Affiliation(s)
- R C Pelger
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
BACKGROUND Bisphosphonates form part of standard therapy for hypercalcemia and the prevention of skeletal events in some cancers. However, the role of bisphosphonates in pain relief for bony metastases remains uncertain. OBJECTIVES To determine the effectiveness of bisphosphonates for the relief of pain from bone metastases. SEARCH STRATEGY MEDLINE (1966-1999), EMBASE (1980-1999), CancerLit (1966-1999), the Cochrane library (Issue 1, 2000) and the Oxford Pain Database were searched using the strategy devised by the Cochrane Pain, Palliative and Supportive Care Group with additional terms 'diphosphonate', 'bisphosphonate', 'multiple myeloma' and 'bone neoplasms'. (Last search: January 2000). SELECTION CRITERIA Randomized trials of bisphosphonates compared with open, blinded, or different doses/types of bisphosphonates in cancer patients were included where pain and/or analgesic consumption were outcome measures. Studies where pain was reported only by observers were excluded. DATA COLLECTION AND ANALYSIS Article eligibility, quality assessment and data extraction were undertaken by both reviewers. The proportions of patients with pain relief at 4, 8 and 12 weeks were assessed. The proportion of patients with analgesic reduction, the mean pain score, mean analgesic consumption, adverse drug reactions, and quality of life data were compared as secondary outcomes. MAIN RESULTS Thirty randomized controlled studies (21 blinded, four open and five active control) with a total of 3682 subjects were included. For each outcome, there were few studies with available data. For the proportion of patients with pain relief (eight studies) pooled data showed benefits for the treatment group, with an NNT at 4 weeks of 11[95% CI 6-36] and at 12 weeks of 7 [95% CI 5-12]. In terms of adverse drug reactions, the NNH was 16 [95% CI 12-27] for discontinuation of therapy. Nausea and vomiting were reported in 24 studies with a non-significant trend for greater risk in the treatment group. One study showed a small improvement in quality of life for the treatment group at 4 weeks. The small number of studies in each subgroup with relevant data limited our ability to explore the most effective bisphosphonates and their relative effectiveness for different primary neoplasms. REVIEWER'S CONCLUSIONS There is evidence to support the effectiveness of bisphosphonates in providing some pain relief for bone metastases. There is insufficient evidence to recommend bisphosphonates for immediate effect; as first line therapy; to define the most effective bisphosphonates or their relative effectiveness for different primary neoplasms. Bisphosphonates should be considered where analgesics and/or radiotherapy are inadequate for the management of painful bone metastases.
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Affiliation(s)
- R Wong
- Radiation Oncology, Princess Margaret Hospital, 5th Floor, 610 University Avenue, Toronto, Ontario, Canada, M5G 2M9.
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Abstract
The treatment of cancer pain is improving, but pain remains a significant problem. Although better analgesics with greater efficacy and fewer side effects are needed, the most significant problem regarding the appropriate management of cancer pain remains a lack of knowledge among physicians treating cancer patients. Cancer management should be undertaken within a palliative care model, in which autonomy and respect for individuals and their families guides all aspects of care.
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Affiliation(s)
- D J Hewitt
- Emory Clinic/University Medical Center, Atlanta, Georgia 30322, USA.
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Kato Y, Tanaka Y, Miyagawa F, Yamashita S, Minato N. Targeting of tumor cells for human gammadelta T cells by nonpeptide antigens. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2001; 167:5092-8. [PMID: 11673519 DOI: 10.4049/jimmunol.167.9.5092] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Human Vgamma2/Vdelta2(+) gammadelta T cells respond to low molecular-mass nonpeptide Ags in a gammadelta TCR-dependent manner. Although requirements of Ag presentation have remained controversial, we have indicated that specific responses of the primary gammadelta T cells to pamidronate were dependent on monocytic adherent cells for Ag presentation. Here, we show that human tumor cells can efficiently present aminobisphosphonate and pyrophosphomonoester compounds to gammadelta T cells, inducing specific proliferation and IFN-gamma production. gammadelta TCR dependency of the response to Ag-pulsed tumor cells was confirmed by using a Jurkat line transfected with a Vgamma2/Vdelta2 gammadelta TCR. Furthermore, gammadelta T cells exhibited markedly enhanced cytotoxicity against the Ag-pulsed tumor cells as compared with untreated tumor cells. Survey of a number of human tumor cell lines of different origins revealed that the majority of them became susceptible for gammadelta T cell-mediated cytotoxicity following the Ag pulsing except for breast cancer lines so far examined, while normal PHA blast cells remained resistant. The results not only imply a unique mode of nonpeptide Ag recognition by human gammadelta T cells but also may provide a novel strategic clue for immunotherapy of human malignancy.
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Affiliation(s)
- Y Kato
- Department of Immunology and Cell Biology, Graduate School of Biostudies, and Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Jagdev SP, Purohit P, Heatley S, Herling C, Coleman RE. Comparison of the effects of intravenous pamidronate and oral clodronate on symptoms and bone resorption in patients with metastatic bone disease. Ann Oncol 2001; 12:1433-8. [PMID: 11762816 DOI: 10.1023/a:1012506426440] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is considerable debate as to the optimum schedule of bisphosphonate treatment in advanced malignancy. Short term studies using symptomatic response and biochemical markers of bone resorption may provide useful insight into differences between agents. PATIENTS AND METHODS Fifty-one patients with metastatic bone disease were randomly allocated to either oral clodronate 1,600 mg daily (group 1), intravenous clodronate followed by the same schedule of oral clodronate (group 2). or intravenous pamidronate 90 mg monthly (group 3). No radiotherapy was delivered or other systemic anticancer treatments were allowed except for long term endocrine therapy. Bone resorption was assessed by measurement of urinary collagen crosslinks. At each visit a pain score was recorded. RESULTS Symptomatic response was more frequent in the pamidronate group than in patients receiving clodronate. Nine of sixteen patients experienced a sustained improvement in pain score in the pamidronate-treated group, in contrast to only 4 of 16 and 2 of 11 patients in groups 1 and 2, respectively. There was a significant improvement in pain scores in the pamidronate arm compared with the clodronate treated patients after both three months of treatment (P <0.01) and at the last measurement (P <0.05). Biochemical changes correlated with changes in the pain score (P = 0.01). CONCLUSION Intravenous pamidronate appears to be more effective than oral clodronate in both controlling symptoms and suppressing bone resorption.
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Affiliation(s)
- S P Jagdev
- Yorkshire Cancer Research Department of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield, UK
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