Osteolytic metastases

The possibilities that cryptic prostatic carcinoma may coexist with other diseases or that a high serum alkaline phosphatase activity possesses some residual activity at pH 5.0 tend to be negated by an analysis of these five patients. One female with carcinoma of the breast and osteolytic metastases of the femur, pelvis, and spine had an elevated serum acid phosphatase activity of 4.2 K.A. units, and a second female with an unknown primary but with osteolytic lesions of the ribs and scapula had an activity of 4.1 K.A. units. The serum alkaline phosphatase activities were 17.8 Bodansky units in the first case and 5.2 Bodansky units in the second case, both above 4.2 Bodansky units, the upper limit of normal values by this method. 

Cause Shift from extra- to intracellular compartment Example Burns Hyperphosphatemia Cause Excessive intake Example Milk-Alkali syndrome Cause Decreased excretion Examples Renal insufficiency Hypoparathyroidism Vitamin D intoxication Cause Release from bony tissue Examples Osteolytic metastases Extensive bone surgery... 

A sclerotic border of a bony lesion is more obvious with MDCT than with radiograms. The presence or absence of such a sclerotic border may allow narrowing the differential diagnosis. Chondroblastomas, nonossifying fibromas, and fibrous dysplasia typically are surrounded by a sclerotic rim, while eosinophilic granulomas and osteolytic metastases are not (Fig. 35.8 Gould et al. 2007). 

Fig. 38.3. A 64-year-old female patient with two painful osteolytic metastases affecting the 12th thoracic vertebra (displayed) and the 3rd lumbar vertebra. Needle placement using online CT-fluoroscopy guidance is demonstrated. The tip of the needle is positioned within the center of the osteolytic metastasis (arrow)...

Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B et al Percutaneous vertebroplasty for osteolytic metastases and myeloma effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996 200 525-30... 

Jang JS, Lee SH (2005) Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors. J Neurosurg Spine 2(3) 243-248 Kelekis A, Lovblad KO, Mehdizade A et al (2005) Pelvic osteoplasty in osteolytic metastases technical approach under fluoroscopic guidance and early clinical results. J Vase Interv Radiol 16(l) 81-88 Klein MH, Shankman S (1992) Osteoid osteoma radiologic and pathologic correlation. Skeletal Radiol 21(1) 23-31... 

In their series of 12 adult patients with a single painful osteolytic metastasis, Callstrom et al. (2002) showed onascale of 1 to 10,mean worst pain decreased from 8.4 to 3.1 after treatment. Osteoid osteomas are well suited to RF ablation because they are small, benign, and have finite growth. Approximately 90% of patients with osteoid osteoma are permanently cured after a single treatment. In such patients, percutaneous ablation with radiofrequency is essentially equivalent to operative excision (Rosenthal et al. 1998). 

Fig. 2.10.9a,b. Patient suffering from pain due to an osteolytic metastasis of a renal cell carcinoma within his femur. After osteoplasty pain was significantly reduced... 

Fig. 6.2.A 64-year-old female patient with breast cancer and bone metastases. Pre-interventional axial CT scan shows an osteolytic metastasis in the left pedicle of the fifth lumbar vertebra (arrow). Note the pre-interventional planning...

Furthermore, peptidomimetic SH2 domain inhibitors for Src, such as AP-22408 have been designed that interfere with effector binding and thereby disrupt signal transduction. AP-22408 decreases bone resorption in animal studies and may be a promising drug to treat osteoporosis and other bone diseases, such as Paget s disease and osteolytic bone metastasis. 

Several other inhibitors of nonreceptor PTKs are currently in development but only a few of them are studied in clinical trials. Noteworthy, Dasatinib does not only inhibit c-Abl, but also potently blocks Src activity, a property that may contribute to its beneficial clinical effects in CML. Other kinase inhibitors being developed that inhibit c-Abl and/or Src are AZD-0530, AP-23994, PD-0183805, SU-6656, and Bosutinib (SKI-606). Furthermore, peptidomimetic SH2 domain inhibitors for Src, such as AP-22408 have been designed that decrease bone resorption and may be promising drugs to treat osteoporosis and other bone diseases, such as Paget s disease and osteolytic bone metastasis. 

This class of drugs is used to treat hypercalcemia in osteolytic bone cancer and metastasis in breast cancer, multiple myeloma, and Paget disease of the bone. It is used more frequently to inhibit bone resorption in postmenopausal women and therefore has the potential for widespread effects despite a relatively low risk of ADRs. 

Rabbani, S. A., Gladu, J., Harakidas, R, Jamison, B. and Goltzman, D. (1999). Over-production of parathyroid hormone-related peptide results in increased osteolytic skeletal metastasis by prostate cancer cells in vivo. Inti. J. Cancer 80, 257-264. 

Yoneda, T., Sasaki, A. and Mundy, G. R. (1994). Osteolytic bone metastasis in breast cancer. Breast Cancer Res. Treat. 32, 73-84. 

Role of CCR1 and CCR5 in homing and growth of multiple myeloma and in the development of osteolytic lesions a study in the 5TMM model. Clin Exp Metastasis 23 291. 

Recurrent cervical cancer is associated with bone metastases (Fig. 7.39) in 15%-29% of patients at autopsy [ too, 103]. Typical locations are the bony pelvis as well as the lumbar and other vertebral bodies. Bone metastases in the ribs and extremities are less common. Skeletal metastases typically have an osteolytic character and originate from locally advanced or recurrent tumor in the pelvic sidewall or arise through retrograde tumor spread in patients with para-aor-tic lymph node metastasis [104]. Hematogenous dissemination to the skeleton occurs late. MRl with unenhanced and contrast-enhanced fat-saturated Tl-weighted sequences depicts bone metastases as hyperintense lesions in the low-intensity bone marrow with a high sensitivity. CT primarily shows the extent of osseous destruction. 

In cancer patients, PC is used particularly in the symptomatic treatment of osteolytic bone metastasis and myeloma. As PC is only aimed at treating pain and consolidating weight-bearing bone, other specific tumor therapy should be carried out in conjunction for tumor management when appropriate. 

Satisfactory pain relief was obtained in 83% of PC performed in cancer patients between 1990 and 2000. PC was performed in 158 patients who suffered from painful osteolytic vertebral metastasis and myeloma, and in 38 patients with acetabular metastasis. Maximum follow-up was 6.4 years (average 7.5 months). The average volume of cement injected was 2.8 ml... 

Percutaneous alcoholization of bone metastasis is well suited in patients with extremely painful osteolytic bone metastases when conventional anticancer therapy is ineffective and high doses of opiates are necessary to control pain, and when rapid pain relief is necessary (radiation or chemotherapy usually require a 2- to 4-week delay). 

Fig. 38.7a-f. A 71-year-old male patient suffering from a painful and destabilizing osteolytic renal cell cancer metastasis of the 5th lumbar vertebra (a, d). In order to avoid radiculopathy as a result of cement contact with the adjacent nerve root and heating of the nerve tissue during tumor ablation (c, long arrow - RFA electrode within the metastasis) and the polymer-... 

Iwasaki T, Mukai M, Tsujimiffa T, Tatsuta M, Nakamiua H, Terada N, Akedo H (2002) Iprillavraie inhibits osteolytic bone metastasis of human breast cancer cells in a nude mouse model. Int J Cancer 100 381-387... 

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