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Xu L, Huang X, Lou Y, Xie W, He J, Yang Z, Yang Y, Zhang Y. Prognostic analysis of percutaneous vertebroplasty (PVP) combined with 125I implantation on lumbosacral vertebral osteoblastic metastases. World J Surg Oncol 2023; 21:391. [PMID: 38124135 PMCID: PMC10731753 DOI: 10.1186/s12957-023-03268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Lumbosacral vertebral osteoblastic metastasis is treated with percutaneous vertebroplasty (PVP) combined with 125I seed implantation and PVP alone. Compared to PVP alone, we evaluated the effects of combination therapy with PVP and 125I seed implantation on pain, physical condition, and survival and evaluated the clinical value of PVP combined with 125I particle implantation. METHODS We retrospectively analyzed 62 patients with lumbosacral vertebral osseous metastases treated at our hospital between 2016 and 2019. All the patients met the inclusion criteria for 125I implantation, and they were randomly divided into a combined treatment group and a pure PVP surgery group. The visual analog pain scale (VAS), Karnofsky Performance Status (KPS), and survival time were recorded at different time points, including preoperative, postoperative 1 day, 1 month, 3 months, 6 months, 12 months, and 36 months in each group. The variation in clinical indicators and differences between the groups were analyzed using SPSS version 20.0. Correlations between different variables were analyzed using the nonparametric Spearman's rank test. The Kaplan-Meier method was used to estimate the relationship between survival time and KPS score, VAS score, or primary tumor progression, and survival differences were analyzed using the log-rank test. Multivariate analyses were performed using a stepwise Cox proportional hazards model to identify independent prognostic factors. RESULTS Compared to the PVP treatment group, the pain level in the combined treatment group was significantly reduced (P = 0.000), and the patient's physical condition in the combination treatment group significantly improved. Kaplan-Meier analysis showed that the survival rate of the PVP group was significantly lower than that of the combination group (P = 0.038). We also found that the median survival of patients in both groups significantly increased with an increase in the KPS score (14 months vs. 33 months) (P = 0.020). Patients with more than three transfer sections had significantly lower survival rates than those with one or two segments of the section (P = 0.001). Further, Cox regression analysis showed that age (P = 0.002), the spinal segment for spinal metastasis (P = 0.000), and primary tumor growth rate (P = 0.005) were independent factors that affected the long-term survival of patients with lumbosacral vertebral osseous metastases. CONCLUSIONS PVP combined 125I seeds implantation surgery demonstrated superior effectiveness compared to PVP surgery alone in treating lumbosacral vertebral osseous metastases, which had feasibility in the clinical operation. Preoperative KPS score, spine transfer section, and primary tumor growth rate were closely related to the survival of patients with lumbosacral vertebral osteoblastic metastasis. Age, spinal segment for spinal metastasis, and primary tumor growth can serve as prognostic indicators and guide clinical treatment.
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Affiliation(s)
- Lei Xu
- Department of Orthopedics, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, Sichuan, 610213, China.
| | - Xin Huang
- Department of Orthopedics, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, Sichuan, 610213, China
| | - Yan Lou
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Xie
- Department of Orthopedics, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, Sichuan, 610213, China
| | - Jun He
- Department of Orthopedics, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, Sichuan, 610213, China
| | - Zuozhang Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, 650118, People's Republic of China.
| | - Yihao Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, 650118, People's Republic of China
| | - Ya Zhang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, 650118, People's Republic of China
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Reddy MG, Agarwal K, Kurian R, Balakumar S, Paul J, Kapoor N, Cherian KE, Paul TV. Atypical Cause for Sclerotic Bone Disease. Indian J Endocrinol Metab 2023; 27:463-464. [PMID: 38107731 PMCID: PMC10723601 DOI: 10.4103/ijem.ijem_97_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/11/2023] [Accepted: 05/16/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Manasa G. Reddy
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Khushboo Agarwal
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reshma Kurian
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shailaja Balakumar
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jinson Paul
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kripa E. Cherian
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V. Paul
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
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Aiba H, Nakazato T, Matsuo H, Kimura H, Saito S, Sakai T, Murakami H, Kawai J, Kawasaki S, Imamura Y. Bone Metastases from Gastric Cancer Resembling Paget's Disease: A Case Report. J Clin Med 2022; 11:jcm11247306. [PMID: 36555923 PMCID: PMC9784664 DOI: 10.3390/jcm11247306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Systemic osteosclerotic lesions are frequently caused by multiple bone metastases or systemic metabolic disorders. However, bone metastasis from gastric cancer is rare. Herein, we describe such a case, with radiographic and clinical findings resembling Paget's disease. The patient was an 80-year-old Japanese woman with a history of early gastric cancer, treated by partial gastrectomy 2 years prior. The patient sought medical care for chronic low back pain. On imaging, systemic sclerotic lesions were observed throughout the spine and pelvis, with an increase in bone mineral density from 0.86 g/cm3 (2 years prior) to 1.38g/cm3 (current visit) in the lumbar spine. Elevated serum levels of osteoblastic and osteolytic markers were identified. A bone biopsy was used to confirm the diagnosis of metastatic gastric cancer. The patient was treated with TS-1 and denosumab, with normalization of abnormal metabolic markers and alleviation of the back pain. Bone metastasis is reported in only 10% of cases of gastric cancer and, thus, is relatively rare. Therefore, our case of gastric cancer recurrence presenting with mixed osteoblastic and osteolytic bone lesions similar to Paget's disease is relevant to the report. Bone biopsy is necessary for an accurate diagnosis.
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Affiliation(s)
- Hisaki Aiba
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
- Correspondence: ; Tel.: +81-52-853-8236
| | - Tomoharu Nakazato
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Hideo Matsuo
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shiro Saito
- Department of Orthopedic Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takao Sakai
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Jun Kawai
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Shingo Kawasaki
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
| | - Yasuhiro Imamura
- Department of Surgery, Saishukan Hospital, 111, Shikatanishimuramae, Kitanagoya 481-0004, Japan
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Zeng W, Swee DS. Severe and refractory hypocalcaemia secondary to osteoblastic bone metastases in bladder signet ring carcinoma: A case report and literature review. Medicine (Baltimore) 2022; 101:e29731. [PMID: 35776989 PMCID: PMC9239603 DOI: 10.1097/md.0000000000029731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Symptomatic hypocalcaemia is uncommon, occurring in <2% of patients with malignancy. Osteoblastic bone metastasis as a cause of hypocalcaemia is rare and not reported in bladder cancer. PATIENT CONCERNS We report a case of refractory hypocalcaemia in a patient with bladder cancer with extensive osteoblastic bone metastases. A 64-year-old male with a history of signet ring bladder carcinoma with osteoblastic bone metastases presented with severe hypocalcaemia with corrected calcium of 1.64 (2.09-2.46) mmol/L as well as hypomagnesemia and hypophosphatemia. He was previously treated with chemotherapy and immunotherapy. Denosumab was also initiated for the prevention of skeletal-related events. DIAGNOSES Additional investigations showed significantly elevated bone formation markers N-terminal propeptide of type I procollagen and alkaline phosphatase. Chest radiography and computed tomography scan also demonstrated extensive areas of sclerotic bone lesions suggestive of osteoblastic bone metastases. He was diagnosed with severe hypocalcaemia secondary to osteoblastic bone metastases and partly to denosumab, vitamin D deficiency, and hypomagnesemia. INTERVENTIONS He was treated aggressively with calcium and vitamin D replacement. OUTCOMES Despite prolonged intravenous calcium replacement and high doses of oral calcium, cholecalciferol, and calcitriol replacement, he had persistent hypocalcaemia with calcium levels ranging from 1.8 to 1.9 mmol/L. He died 4 months after his admission. LESSONS Osteoblastic bone metastases lead to an increased influx of calcium and phosphate into the bone leading to hypocalcaemia and should be considered as a differential in severe and refractory hypocalcaemia. It is rare and has not been described in bladder cancer. Precaution should be taken upon the initiation of antiresorptive in patients with osteoblastic bone metastases.
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Affiliation(s)
- Wanling Zeng
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Du Soon Swee
- Department of Endocrinology, Singapore General Hospital, Singapore
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