A novel study investigating the therapeutic outcome of patients with lytic, mixed and sclerotic bone metastases treated with combined radiotherapy and ibandronate
To investigate the therapeutic response of patients with different types of bone metastases treated with combined radiotherapy and bisphosphonates.
Patients and methods
By using computed tomography 52 patients were grouped into groups of lytic, mixed and sclerotic bone lesions. All patients were treated with concomitant radiotherapy and ibandronate (10 monthly cycles) and underwent clinical and radiological evaluations prior to therapy and at 3, 6 and 10 months of follow up.
At baseline there were statistically significant differences between the three groups for all the evaluated parameters. From 3 months onwards differences were leveled out. Statistically significant improvements were noted at all time points of evaluation for all groups in parameters such as pain (0–10), quality of life (QOL-physical functioning, 0–100) and Karnofsky performance status (KPS). The average pain score for the lytic group was reduced from 8.1 to 1.5 points at 3 months. The corresponding reductions for the mixed and sclerotic groups were from 6.2 to 0.5 and from 4.4 to 0.3 points respectively. Complete pain responses were >76.4% at all time points for all groups. Opioid consumption was also markedly reduced. Overall, the highest clinical response was noted for the lytic group, even though the mean values of pain, QOL and KPS were worse than those of the two other groups at all time points (apart from pain score at 10 months). The percentage of patients of the lytic group experiencing a complete pain response was the least of the three groups during follow up. At 10 months bone density was almost tripled for the lytic and almost doubled for the mixed group.
Even though the therapeutic outcome for the three groups was similar, the degree of clinical response and reossification differed.
KeywordsBisphosphonates Bone density Bone metastases Computed tomography Pain Radiotherapy
- 6.Pavlakis N, Stocker M (2002) Bisphosphonates for breast cancer. In: The cochrane library, issue 1. Update Software, OxfordGoogle Scholar
- 7.Rosen L, Gordon D, Tchekmedyian S, et al (2002) Zoledronic acid (Zol) significally reduces skeletal related events in patients with bone metastases from solid tumors. Proc Am Soc Clin Oncol 21:295Google Scholar
- 12.Vassiliou V, Kalogeropoulou C, Petsas T, et al (2007) Clinical and radiological evaluation of patients with lytic, mixed and sclerotic bone metastases from solid tumors: is there a correlation between the clinical status of patients and the type of bone metastases? Clin Exp Metastasis (in press) doi:10.1007/s10585-007-9056-zGoogle Scholar
- 14.Fayers PM, Aaronson NK, Bjordal K, et al (2001) EORTC QLQ-C30 scoring manual, 3rd edn. EORTC Quality of life group, BrusselsGoogle Scholar
- 15.McQuay HJ, Collins SL, Caroll D, et al (2001) Radiotherapy for the palliation of painful bone metastases (cochrane review). In: The cochrane library. Update software, OxfordGoogle Scholar
- 18.Salazar OM, Sandhut T, da Motta MW, et al (2001) Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized phase III trial of the international atomic energy agency (IAEA). Int J Radiat Oncol Biol Phys 50(3):765–775PubMedCrossRefGoogle Scholar
- 21.Kouloulias EV, Kouvaris RJ, Antypas C, et al (2003) An intra-patient dose-escalation study of disodium pamidronate plus radiotherapy versus radiotherapy alone for the treatment of osteolytic metastases. Monitoring of recalcification using image-processing techniques. Strahlenther Onkol 179:471–479PubMedGoogle Scholar
- 22.Kouloulias V, Matsopoulos G, Kouvaris J, et al (2003) Radiotherapy in conjuction with intravenous infusion of 180mg 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 57(1):143–157PubMedCrossRefGoogle Scholar