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Gillespie EF, Vaynrub M, Yang JT. Reply to A.W. Chan et al. J Clin Oncol 2024; 42:1328-1329. [PMID: 38320232 PMCID: PMC11095854 DOI: 10.1200/jco.23.02566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Erin F. Gillespie
- Corresponding author: Erin F. Gillespie, MD, MPH, University of Washington, Department of Radiation Oncology, 1959 NE Pacific St, Seattle, WA; Twitter: @ErinGillespieMD; e-mail:
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Grosinger AJ, Alcorn SR. An Update on the Management of Bone Metastases. Curr Oncol Rep 2024; 26:400-408. [PMID: 38539021 PMCID: PMC11021281 DOI: 10.1007/s11912-024-01515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW Increasing life expectancy among patients with advanced cancer has placed a greater emphasis on optimizing pain control and quality of life. Concurrently, significant advancements in radiotherapy for bone metastases have permitted for dose escalation strategies such as stereotactic radiotherapy. This review aims to provide updated information on the management of bone metastases in light of these developments. RECENT FINDINGS We reviewed recent studies regarding the role and details of external beam radiotherapy for bone metastases, with emphasis on differences by treatment site as well as intention (palliative versus ablative for oligometastases). Conventional palliative radiotherapy remains a mainstay of management. While stereotactic radiotherapy may augment durability of pain relief and even survival time, there are significant questions remaining regarding optimal dosing and patient selection. Radiotherapy for bone metastases continues to evolve, particularly with increasing use of stereotactic radiotherapy. Future studies are needed to clarify optimal dose, fractionation, modality, and patient selection criteria among different radiotherapy approaches.
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Affiliation(s)
- Alexander J Grosinger
- Department of Radiation Oncology, University of Minnesota Medical School, Mail Code 494, 420 Delaware St. SE, Minneapolis, MN, 55455-0110, USA
| | - Sara R Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Mail Code 494, 420 Delaware St. SE, Minneapolis, MN, 55455-0110, USA.
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Guhlich M, Rieken S. [Prophylactic Radiation Therapy Versus Standard of Care for Patients With High-Risk Asymptomatic Bone Metastases]. Strahlenther Onkol 2024; 200:253-254. [PMID: 38180495 PMCID: PMC10876712 DOI: 10.1007/s00066-023-02195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Manuel Guhlich
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Stefan Rieken
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Gillespie EF, Yang JC, Mathis NJ, Marine CB, White C, Zhang Z, Barker CA, Kotecha R, McIntosh A, Vaynrub M, Bartelstein MK, Mitchell A, Guttmann DM, Yerramilli D, Higginson DS, Yamada YJ, Kohutek ZA, Powell SN, Tsai J, Yang JT. Prophylactic Radiation Therapy Versus Standard of Care for Patients With High-Risk Asymptomatic Bone Metastases: A Multicenter, Randomized Phase II Clinical Trial. J Clin Oncol 2024; 42:38-46. [PMID: 37748124 PMCID: PMC10730067 DOI: 10.1200/jco.23.00753] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/16/2023] [Accepted: 07/19/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE External-beam radiation therapy (RT) is standard of care (SOC) for pain relief of symptomatic bone metastases. We aimed to evaluate the efficacy of radiation to asymptomatic bone metastases in preventing skeletal-related events (SRE). METHODS In a multicenter randomized controlled trial, adult patients with widely metastatic solid tumor malignancies were stratified by histology and planned SOC (systemic therapy or observation) and randomly assigned in a 1:1 ratio to receive RT to asymptomatic high-risk bone metastases or SOC alone. The primary outcome of the trial was SRE. Secondary outcomes included hospitalizations for SRE and overall survival (OS). RESULTS A total of 78 patients with 122 high-risk bone metastases were enrolled between May 8, 2018, and August 9, 2021, at three institutions across an affiliated cancer network in the United States. Seventy-three patients were evaluable for the primary end point. The most common primary cancer types were lung (27%), breast (24%), and prostate (22%). At 1 year, SRE occurred in one of 62 bone metastases (1.6%) in the RT arm and 14 of 49 bone metastases (29%) in the SOC arm (P < .001). There were significantly fewer patients hospitalized for SRE in the RT arm compared with the SOC arm (0 v 4, P = .045). At a median follow-up of 2.5 years, OS was significantly longer in the RT arm (hazard ratio [HR], 0.49; 95% CI, 0.27 to 0.89; P = .018), which persisted on multivariable Cox regression analysis (HR, 0.46; 95% CI, 0.23 to 0.85; P = .01). CONCLUSION Radiation delivered prophylactically to asymptomatic, high-risk bone metastases reduced SRE and hospitalizations. We also observed an improvement in OS with prophylactic radiation, although a confirmatory phase III trial is warranted.
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Affiliation(s)
- Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Joanna C. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Washington University in St Louis, St Louis, MO
| | - Noah J. Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine B. Marine
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlie White
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christopher A. Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Alyson McIntosh
- Department of Radiation Oncology, Lehigh Valley Cancer Institute, Allentown, PAa
| | - Max Vaynrub
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meredith K. Bartelstein
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M. Guttmann
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel S. Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yoshida J. Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zachary A. Kohutek
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Vanderbilt University, Nashville, TN
| | - Simon N. Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CA
| | - Jonathan T. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Liu Y, Yang P, Pi Y, Jiang L, Zhong X, Cheng J, Xiang Y, Wei J, Li L, Yi Z, Cai H, Zhao Z. Automatic identification of suspicious bone metastatic lesions in bone scintigraphy using convolutional neural network. BMC Med Imaging 2021; 21:131. [PMID: 34481459 PMCID: PMC8417997 DOI: 10.1186/s12880-021-00662-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background We aimed to construct an artificial intelligence (AI) guided identification of suspicious bone metastatic lesions from the whole-body bone scintigraphy (WBS) images by convolutional neural networks (CNNs). Methods We retrospectively collected the 99mTc-MDP WBS images with confirmed bone lesions from 3352 patients with malignancy. 14,972 bone lesions were delineated manually by physicians and annotated as benign and malignant. The lesion-based differentiating performance of the proposed network was evaluated by fivefold cross validation, and compared with the other three popular CNN architectures for medical imaging. The average sensitivity, specificity, accuracy and the area under receiver operating characteristic curve (AUC) were calculated. To delve the outcomes of this study, we conducted subgroup analyses, including lesion burden number and tumor type for the classifying ability of the CNN. Results In the fivefold cross validation, our proposed network reached the best average accuracy (81.23%) in identifying suspicious bone lesions compared with InceptionV3 (80.61%), VGG16 (81.13%) and DenseNet169 (76.71%). Additionally, the CNN model's lesion-based average sensitivity and specificity were 81.30% and 81.14%, respectively. Based on the lesion burden numbers of each image, the area under the receiver operating characteristic curve (AUC) was 0.847 in the few group (lesion number n ≤ 3), 0.838 in the medium group (n = 4–6), and 0.862 in the extensive group (n > 6). For the three major primary tumor types, the CNN-based lesion identifying AUC value was 0.870 for lung cancer, 0.900 for prostate cancer, and 0.899 for breast cancer. Conclusion The CNN model suggests potential in identifying suspicious benign and malignant bone lesions from whole-body bone scintigraphic images. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00662-9.
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Affiliation(s)
- Yemei Liu
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Pei Yang
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Yong Pi
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, China
| | - Lisha Jiang
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Xiao Zhong
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Junjun Cheng
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Yongzhao Xiang
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Jianan Wei
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, China
| | - Lin Li
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Zhang Yi
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, China
| | - Huawei Cai
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.
| | - Zhen Zhao
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.
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