Bone metastases are common in many advanced solid tumours, being breast, prostate, thyroid, lung, and renal cancer the most prevalent. Bone metastases can produce skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, need of bone irradiation or need of bone surgery, and hypercalcaemia. Patients with bone metastases experience pain, functional impairment and have a negative impact on their quality of life. Several imaging techniques are available for diagnosis of this disease. Bone-targeted therapies include zoledronic acid, a potent biphosfonate, and denosumab, an anti-RANKL monoclonal antibody. Both reduce the risk and/or delay the development of SREs in several types of tumours. Radium 233, an alpha-particle emitter, increases overall survival in patients with bone metastases from resistant castration prostate cancer. Multidisciplinary approach is essential and bone surgery and radiotherapy should be integrated in the treatment of bone metastases when necessary. This SEOM Guideline reviews bone metastases pathogenesis, clinical presentations, lab tests, imaging techniques for diagnosis and response assessment, bone-targeted agents, and local therapies, as radiation and surgery, and establishes recommendations for the management of patients with metastases to bone.
Body JJ, Bartl R, Burchardt P, Delmas PD, Diel IJ, Fleisch H, et al. Current use of bisphosphonates in oncology. J Clin Oncol. 1998;16:3890–9. PubMed
Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2015;27:165–76. CrossRef
Rodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350:1655–64. CrossRef
Clemens M, Cole D, Gainford M. Can bone markers guide more effective treatment of bone metastases from breast cancer? Breast Cancer Res Treat. 2006;97:81–90. CrossRef
Blake GM, Park-Holohan S-J, Cook GJR, Fogelman I. Quantitative studies of bone with the use of 18 F-fluoride and 99 m Tc-methylene diphosphonate. In: Seminars in nuclear medicine. Elsevier; 2001. p. 28–49.
Palmedo H, Marx C, Ebert A, Kreft B, Ko Y, Türler A, et al. Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients. Eur J Nuclear Med Mol Imaging. 2014;41:59–67. CrossRef
Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mole Imaging. 2006;33(11):1280–4. CrossRef
Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J; ESMO Guidelines Working Group. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014;(Suppl 3); 25:iii124–iii137.
Hortobayi GN, Lipton A, Chew HC, Gradishar WJ, Sauter N, Mohanlal R, et al. Efficacy and safety of continued zoledronic acid every 4 weeks versus every 12 weeks in women with bone metastases from breast cancer: results of the OPTIMIZE-2 trial. J Clin Oncol. 2014;32:5s (suppl; abstr LBA9500). CrossRef
Himelstein AL, Qin R, Novotny PJ, Seisler DK, Khatcheressian JL, Roberts JD, et al. CALGB 70604 (Alliance): A randomized phase III study of standard dosing vs. longer interval dosing of zoledronic acid in metastatic cancer. J Clin Oncol. 2015;33 ( suppl; abstr 9501).
Rosen LS, Gordon D, Tchekmedian LS, Yanagihara R, Hirsh V, Krzakowski M, et al. Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with non small cell lung cancer and other solid tumours: a randomized, phase III trial, double-blind, placebo-controlled trial. Cancer. 2004;100(12):2613–21. CrossRefPubMed
Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 2011;29(9):1125–32. CrossRefPubMed
Cassinello J, González del Alba A, Rivera F, Holgado E. SEOM guidelines for the treatment of bone metastases from solid tumours. Clin Transl Oncol. 2012;14:505–11. CrossRef
Henry D, Vadjan-Raj S, Hirsh V, von Moos R, Hungria V, Costa L, et al. Delaying skeletal-related events in a randomized phase 3 study of denosumab versus zoledronic acid in patients with advanced cancer: an analysis of data of patients with solid tumours. Support Care Cancer. 2014;22(3):679–87. CrossRefPubMed
Sartor O, Coleman R, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, et al. Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial. Lancet Oncol. 2014;15(7):738–46. CrossRefPubMed
Hayashi S, Hoshi H, Iida T. Reirradiation with local field radiotherapy for painful bone metastases. Radiat Med. 2002;20(5):231–6. PubMed
Jhaveri P, Teh BS, Bloch C, Amato R, Butler EB, Paulino AC. Stereotactic body radiotherapy in the management of painful bone metastases. Oncology. 2008;22(7):782–8. PubMed
Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W, et al. Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys. 2011;74(3):723–31. CrossRef
Saarto T, Blomqvist C, Virkkunen P, Elomaa I. Adjuvant clodronate treatment does not reduce the frequency of skeletal metastases in node-positive breast cancer patients: 5-year results of a randomized controlled trial. J Clin Oncol. 2001;19:10–7. PubMed
Paget S. The distribution of secondary growths in cancer of the breast. 1889. Cancer Metastasis Rev. 1989;8:98–101. PubMed
Early Breast Cancer Trialists’ Collaborative Group, Coleman R, Powles T, Paterson A, Gnant M, Anderson S, et al. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386:1353–61. CrossRef
Early Breast Cancer Trialists’ Collaborative Group, Peto R, Davies C, Godwin J, Gray R, Pan HC, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012;379:432–44. CrossRef
- SEOM Clinical Guideline for bone metastases from solid tumours (2016)
M. Á. Seguí
J. A. Virizuela
- Springer International Publishing
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