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Sample records for metastatic bone pain

  1. Local bone pain and osseous scintigraphic findings in patients with metastatic bone tumor

    International Nuclear Information System (INIS)

    Imaeda, Takeyoshi; Iinuma, Gen; Hirota, Keiichi; Inoue, Akemi; Sone, Yasuhiro; Seki, Matsuzo; Suzuki, Masao; Doi, Hidetaka

    1988-01-01

    Local bone pain and osseous scintigraphic findings were evaluated in patients with cancer of the lung, breast or prostate. (1) In 77-92% out of the patients with local pain, metastatic bone lesions were detected. (2) The sacrum and scapulae were the frequent sites of pain as estimated from the metastatic bone lesions. On the other hand, the incidence of pain was low in the ribs, cervical vertebrae, skull and femurs. (3) When calculated by the weight of red bone marrow, the most likely sites for bone metastases consisted of the scapulae, clavicles, sternum, humeri, ribs and cervical vertebrae, somewhat different from previous reports. Those bones involved were all proximate to the heart. (4) Extensive bone metastases were already detected in more than 50% of patients who complain of pain in the metastatic bone lesion. On the other hand, extensive bone metastases occurred in less than 6% of patients who didn't complain of pain. (5) The appearance of pain in the metastatic bone lesion was earlier in only 3% and was later in 71% than the detection of abnormal radioisotope accumulation on scintigram. (6) Majority of the patients with pain in the metastatic bone lesion showed a high degree of abnormal radioisotope accumulation which measured more than 5 cm in diameter on scintigram. On the other hand, the abnormal radioisotope accumulation in most of patients without pain was mild and mostly measured less than 5 cm in diameter. (7) The positive rate of bone metastasis amounted to 29% by plain X-ray and 41% by local bone pain as compaired to positive bone scintigram. (author)

  2. Local bone pain and osseous scintigraphic findings in patients with metastatic bone tumor

    Energy Technology Data Exchange (ETDEWEB)

    Imaeda, Takeyoshi; Iinuma, Gen; Hirota, Keiichi; Inoue, Akemi; Sone, Yasuhiro; Seki, Matsuzo; Suzuki, Masao; Doi, Hidetaka

    1988-12-01

    Local bone pain and osseous scintigraphic findings were evaluated in patients with cancer of the lung, breast or prostate. (1) In 77-92% out of the patients with local pain, metastatic bone lesions were detected. (2) The sacrum and scapulae were the frequent sites of pain as estimated from the metastatic bone lesions. On the other hand, the incidence of pain was low in the ribs, cervical vertebrae, skull and femurs. (3) When calculated by the weight of red bone marrow, the most likely sites for bone metastases consisted of the scapulae, clavicles, sternum, humeri, ribs and cervical vertebrae, somewhat different from previous reports. Those bones involved were all proximate to the heart. (4) Extensive bone metastases were already detected in more than 50% of patients who complain of pain in the metastatic bone lesion. On the other hand, extensive bone metastases occurred in less than 6% of patients who didn't complain of pain. (5) The appearance of pain in the metastatic bone lesion was earlier in only 3% and was later in 71% than the detection of abnormal radioisotope accumulation on scintigram. (6) Majority of the patients with pain in the metastatic bone lesion showed a high degree of abnormal radioisotope accumulation which measured more than 5 cm in diameter on scintigram. On the other hand, the abnormal radioisotope accumulation in most of patients without pain was mild and mostly measured less than 5 cm in diameter. (7) The positive rate of bone metastasis amounted to 29% by plain X-ray and 41% by local bone pain as compaired to positive bone scintigram.

  3. Radiopharmaceuticals in metastatic bone pain palliation

    International Nuclear Information System (INIS)

    Garcia, Enrique; Alberti, Alejandro; Cruz Arencibia, Jorge; Morin Zorrilla, Jose

    2012-01-01

    In the present work the current status of the use of Radiopharmaceuticals in the treatment of the pain provoked by bony metastasis is revised. Particular attention is devoted to the used doses, the effectiveness and security of the existent products in the market and in development. The convenience of the routine use in the case of multiple metastasis is established, since the results are adequate and the risks acceptable. The doses are examined, the adverse effects and the importance of the costs is indicated and related with it the supply of Radionuclides. Reference is made so much to the practice of countries developed as to that of countries of smaller resources. It is pointed out the Cuban experience and the perspectives of the use in our country.(author)

  4. External Beam Radiotherapy in Metastatic Bone Pain from Solid ...

    African Journals Online (AJOL)

    Key Words: Bone, metastasis, radiotherapy, pain, control randomized ... described the efficacy of external beam radiotherapy in pain .... life of patients with multiple myeloma. Eur. J. ... Rades D, Jeremic B, Hoskin PJ: The Role of ... randomised multicenter trial on single fraction ... "The subjective experience of acute pain. An.

  5. Bone pain induced by metastatic cancer: pathophysiology and treatment

    International Nuclear Information System (INIS)

    Salas-Herrera, Isaias; Huertas-Gabert, Luis Carlos

    2004-01-01

    Cancer patients who develop bone metastases are an estimated 60 to 84% . Of these 79% experienced pain syndromes are difficult to manage, of which 50% die without adequate pain relief and with a poor quality of life. Therefore, it is necessary to have accessible and effective medications for the management of this condition. The pathophysiology of pain in bone is reviewed and the drugs used most frequently in the management of this type of cancer pain are described. Furthermore an algorithm of 6 steps is presented and can guide the physician when making a therapeutic decision. (author) [es

  6. 186Re-HEDP for metastatic bone pain in breast cancer patients

    International Nuclear Information System (INIS)

    Lam, Marnix G.E.H.; Rijk, Peter P. van; Klerk, John M.H. de

    2004-01-01

    Two-thirds of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer-related pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pain palliation with bone-seeking radiopharmaceuticals has proven to be an effective treatment modality in patients with metastatic bone pain. These bone-seeking radiopharmaceuticals are extremely powerful in treating scattered painful bone metastases, for which external beam radiotherapy is impossible because of the large field of irradiation. 186 Re-hydroxyethylidene diphosphonate (HEDP) is a potentially useful radiopharmaceutical for this purpose, having numerous advantageous characteristics. Bone marrow toxicity is limited and reversible, which makes repetitive treatment safe. Studies have shown encouraging clinical results of palliative therapy using 186 Re-HEDP, with an overall response rate of ca. 70% in painful bone metastases. It is effective for fast palliation of painful bone metastases from various tumours and the effect tends to last longer if patients are treated early in the course of their disease. 186 Re-HEDP is at least as effective in breast cancer patients with painful bone metastases as in patients with metastatic prostate cancer. It is to be preferred to radiopharmaceuticals with a long physical half-life in this group of patients, who tend to have more extensive haematological toxicity since they have frequently been pretreated with bone marrow suppressive chemotherapy. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. (orig.)

  7. Samarium-153-EDTMP in the metastatic bone pain treatment

    International Nuclear Information System (INIS)

    Lins Filho, M.L.M.; Santos, A.O.; Nappi, A.P.B.; Meirelles, M.B.; Arouca, P.T.; Ramos, C.D.; Etchebehere, E.C.S.C.; Teixeira, L.C.; Netto Junior, N.R.; D'Ancona Cal; Camargo, E.E.

    1997-01-01

    Full text: Bone metastasis is the most reason of pain in prostate and mammary cancer patients. The Samarium-153-EDTMP has been showed as an alternative to the treatment of the metastasis bone pain. With the objective to evaluate the use of the Sm-153-EDTMP as a systemic therapy for the metastasis bone pain, 30 patients (19 male, 11 female, average age of 64,5 years) were studied. 19 patients with prostate cancer and 11 with mammary cancer. All the patients presented previous bone scintiscanning with multiple metastasis; interruption of the chemotherapy or radiotherapy for two or more weeks and leukocyte count higher than 2,000 leukocytes/mm 3 and platelets higher than 80,000/mm 3 . The patients were classified previously to the radioisotope therapy, as far the intensity of the pain in a scale from 0 to 10 is concerned. All the patients received 37 MBq/kg (1m Ci/kg) of weight of Sm-153-EDTMP by venous via. The evaluation 6 weeks after the therapy showed complete or partial pain relief in 22 patients (73,3%). Complete or partial pain relief has been obtained in 91,0% (10 in 11) of the patients with mammary cancer and in 62,2% (12 in 19) of the patients with prostate cancer. Transitory leukopenia (lower than 2,000 leukocytes/mm 3 ) and platelet count (lower than 80,000/mm 3 ) occurred in 33,3% of the patients. 8 patients (26,7%) did not responded to the therapy. The therapy with Samarium-153-EDTMP is a simple, safe and efficient method in the treatment of the bone pain caused by metastasis

  8. Bone-targeted cabazitaxel nanoparticles for metastatic prostate cancer skeletal lesions and pain.

    Science.gov (United States)

    Gdowski, Andrew S; Ranjan, Amalendu; Sarker, Marjana R; Vishwanatha, Jamboor K

    2017-09-01

    The aim of this study was to develop a novel cabazitaxel bone targeted nanoparticle (NP) system for improved drug delivery to the bone microenvironment. Nanoparticles were developed using poly(D,L-lactic-co-glycolic acid) and cabazitaxel as the core with amino-bisphosphonate surface conjugation. Optimization of nanoparticle physiochemical properties, in vitro evaluation in prostate cancer cell lines and in vivo testing in an intraosseous model of metastatic prostate cancer was performed. This bone targeted cabazitaxel nanocarrier system showed significant reduction in tumor burden, while at the same time maintaining bone structure integrity and reducing pain in the mouse tumor limb. This bone microenvironment targeted nanoparticle system and clinically relevant approach of evaluation represents a promising advancement for treating bone metastatic cancer.

  9. Metastatic Bone Pain Palliation with P-32 in Combination with Vitamin D: Our Preliminary Experience

    International Nuclear Information System (INIS)

    Khan, A.U.; Khan, S.U.; Iqbal, M.; Khan, A.; Shahid, S.

    2009-01-01

    Phosphorus-32 ( 32 P) is a routinely used bone pain palliation agent at our institute due to its cost, availability and proven efficacy with mild and self limiting myelo-suppression. Vitamin D is known to de-differentiate tumors and supposed to enhance calcium deposition onto metastatic foci with a hope of reducing the marrow effects. A pilot study showing an increase in the 99m Tc-MDP uptake by skeletal metastatic foci, using single pulse dose of Vitamin D, in some of the patients preceded this study and found the basis for this study. The aim of this study was to evaluate the role of 32 P alone and in combination with vitamin D in the palliation of bone pain from osseous metastases and to look for its clinical efficacy and reduction in marrow suppression in our clinical environment. 62 patients with extensive osteoblastic bone metastases were randomly divided into 3 groups. Group A received 32 P alone, group B combination therapy of 32 P and Vitamin D and group C Vitamin D alone. All these patients were evaluated by a standard protocol on broad parameters of pain reduction, reduction in analgesic consumption, improvement in quality of life and effect on bone marrow suppression at the end of 4th and 8th week post-therapy. Favorable response (≥25%) to treatment was recorded in 55% of cases in-group A, 81% in- group B and 9% in-group C. Reduction in pain score of 50% to 100% were obtained in two cases in group A and 10 in group B. A decrease in pain of 26% to 50% and ≤ 25% was observed in 10 (45%) and 4 (18%) cases respectively in group A, and 8 (36%) and 2 (9%) cases respectively in group B. Analgesic consumption was reduced in both the groups of 32 P, comparatively more in group B. The improvement in mobility and quality of life was observed to be better in group B than A and C. A decrease of white blood cells, hemoglobin level and platelets counts was observed in both groups of 32 P but no significant difference was noted in group A and B was noted at the end

  10. Metastatic Bone Pain Palliation using 177Lu-Ethylenediaminetetramethylene Phosphonic Acid

    International Nuclear Information System (INIS)

    Alavi, Mehrosadat; Omidvari, Shapour; Mehdizadeh, Alireza; Jalilian, Amir R.; Bahrami-Samani, Ali

    2015-01-01

    177 Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using 177 Lu-EDTMP for MBP palliation. 177 Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward. 177 Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed. 177 Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for

  11. Metastatic Bone Pain Palliation using (177)Lu-Ethylenediaminetetramethylene Phosphonic Acid.

    Science.gov (United States)

    Alavi, Mehrosadat; Omidvari, Shapour; Mehdizadeh, Alireza; Jalilian, Amir R; Bahrami-Samani, Ali

    2015-01-01

    (177)Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using (177)Lu-EDTMP for MBP palliation. (177)Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward. (177)Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed. (177)Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for

  12. Metastatic Bone Pain Palliation using 177Lu-Ethylenediaminetetramethylene Phosphonic Acid

    Science.gov (United States)

    Alavi, Mehrosadat; Omidvari, Shapour; Mehdizadeh, Alireza; Jalilian, Amir R.; Bahrami-Samani, Ali

    2015-01-01

    177Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using 177Lu-EDTMP for MBP palliation. 177Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward. 177Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed. 177Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for patients

  13. Dosimetric aspects of the treatment of metastatic bone pain with radiopharmaceuticals

    International Nuclear Information System (INIS)

    Garcia, T.; Marti, J. F.; Olivas, C.; Vercher, J. L.; Repetto, R.; Bello, P.

    2014-01-01

    Within the context of treatment of metastatic bone pain with bone seeking radiopharmaceuticals, this paper expounds the results of an analysis of available molecules (both approved for clinical use or still under study) intended to obtain a detailed comparison of their dosimetric characteristics. These can be used to supplement the list of already know differences between them, such as efficacy, appearance and length of the palliative effect, eventual tumoricidal effect, myelotoxicity, sale price and availability. Seven radiopharmaceuticals have been analysed, five of them are based on beta emission radionuclides: 3 2P, 1 53Sm, 1 86Re and 1 88Re and the other two ones are based on high Linear energy Transference emission radionuclides: 1 17mSn and 2 23Ra a series of estimates of the main dosimetric parameters for each radiopharmaceutical analysed have been obtained. The values obtained might be worth being incorporated to the risk/benefit analysis that precedes every choice of the specific radiopharmaceutical to be used with an individual patient. In this way, we hope these results will be of some help for those Nuclear Medicine specialists interested in the treatment of oncological bone pathologies. (Author)

  14. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    International Nuclear Information System (INIS)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P.; Goetz, Matthew P.; Rubin, Joseph

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  15. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  16. A randomized trial of three single - dose radiation therapy regimens in the treatment of metastatic bone pain

    International Nuclear Information System (INIS)

    Jeremic, Branislav; Shibamoto, Yuta; Acimovic, Ljubisa; Milicic, Biljana; Milisavljevic, Slobodan; Nikolic, Nebojsa; Aleksandrovic, Jasna; Igrutinovic, Ivan

    1998-01-01

    Purpose: To investigate efficacy of three single dose radiation therapy (RT) regimens in the treatment of painful bone metastasis. Material and Methods: Patient self-assessment by using pain chart enabled evaluation of response to treatment that consisted of either one of the three single fractions of 4 Gy (group I; n = 109), 6 Gy (group II; n = 108), or 8 Gy (group III; n = 110). Results: Patients in groups II and III had higher complete response rate than those in group I, but not significantly, and with no difference between group II and III. However, both patients in group II (73%) and group III (78%) had significantly higher overall response rates when compared to those observed in group I (59%) (I vs II, p = 0.025; I vs III, p = 0.0019), and with no difference between groups II and III (p 0.39). Patients in group III had shortest time to the occurrence of any pain relief which was significantly better than those observed in group I (Welch's t-test, p = 0.012), with no difference between group I and II and group II and III, respectively. There was no difference between the three treatment groups in duration of response and retreatment rate. No effect of histology or metastatic site treated was found. No pathological fractures or spinal cord compressions were observed during the 8 weeks post-RT. Conclusion: Results of this study seem to confirm that 8 Gy could be considered as probably 'lowest' optimal single fraction RT in the treatment of painful bone metastasis, although single fraction RT of 4 Gy should not be easily discarded due to its applicability in specific cases. Since single fraction RT of 6 Gy achieved results not different from that obtained with 8 Gy, further studies are warranted in order to get more informations about 'lowest' optimal single fraction RT in the treatment of painful bone metastasis

  17. Optimal Timing of Bisphosphonate Administration in Combination with Samarium-153 Oxabifore in the Treatment of Painful Metastatic Bone Disease

    International Nuclear Information System (INIS)

    Rasulova, Nigora; Lyubshin, Vladimir; Arybzhanov, Dauranbek; Sagdullaev, Sh.; Krylov, Valery; Khodjibekov, Marat

    2013-01-01

    While bisphosphonates are indicated for prevention of skeletal-related events, radionuclide therapy is widely used for treatment of painful bone metastases. Combined radionuclide therapy with bisphosphonates has demonstrated improved effectiveness in achieving bone pain palliation in comparison to mono therapy with radionuclides or bisphosphonates alone. However, there are conflicting reports as to whether bisphosphonates adversely influence skeletal uptake of the bone-seeking radiotracers used for therapy. Recent studies analyzing influence of Zoledronic acid on total bone uptake of Samarium-153 EDTMP (Sm-153 EDTMP) by measuring cumulative urinary activity of Sm-153 on baseline study, as well as in combination with bisphosphonates (administrated 48 hours prior to Sm-153) did not provide any statistically significant difference in urinary excretion of Sm-153 between the two groups. It may be noted that the exact temporal sequence of bisphosphonate administration vis a vis radionuclide therapy has not yet been studied. One of the side effects of bisphosphonates is transient flare effect on bone pain. Radionuclide therapy may also have similar side effect. Keeping in view the above the current study was designed with the main objective of determining the exact timing of bisphosphonate administration in patients receiving combined therapy so as to achieve optimal efficacy of bone pain palliation. Ninety-three patients suffering from metastatic bone pain who received combination therapy with Sm-153 oxabifore (an analog of Sm-153 EDTMP) and Zoledronic acid were divided into three groups according to the timing of Zoledronic acid administration: Group I: 39 patients who received Zoledronic acid 7 or more days prior to Sm-153 oxabifore treatment; Group II: 32 patients who received Zoledronic acid 48-72 hours prior to Sm-153 oxabifore treatment and Group III: 22 patients who received Zoledronic acid 7 days after Sm-153 oxabifore treatment. Sm-153 oxabifore was administered

  18. Impact of educational strategies in positioning Samarium-153 EDTMP as a treatment for metastatic bone pain

    International Nuclear Information System (INIS)

    Seminario, C.; Morales, R.; Castro, M.; Cano, R.A.; Mendoza, G.

    2005-01-01

    To educate is a difficult task but its results make efforts worthwhile. Many patients in Peru suffer from intractable bone pain due to metastases. Since 1993 radionuclides were used to palliate bone pain due to metastases in Peru. First, with the help of the IAEA, Peru participated in a clinical trial using Phosphorus 32 and Strontium 89. Then, efforts were performed to produce Samarium 153 EDMTP locally, which was achieved in 1995. Nevertheless, years passed and Samarium use did not increase proportionally to the needs of people with cancer and bone pain, mainly the poor. Educational strategies have been proven useful for delivering solutions to many health problems in other diseases and also in cancer. Health education makes patients and their relatives assume responsible care of their problems. The purpose of this work was to increase Samarium EDTMP use as palliative treatment in patients with bone pain due to metastases, using educational strategies as means to change attitudes towards this health problem. In September 2003, a task group conducted studies in order to apply several methods to achieve the goal of increasing Samarium EDTMP use. Educational strategies employed were performed to provide verbal and written information to patients, physicians, medical students, residents, pain specialists, oncologists and neurologists, as well as general public. Verbal information included radio interviews, television spots and a phone number (in charge of two secretaries, prepared for answering and if not possible, a physician was in charge of attending patient consultation), e-mail and a web page for consultation. Written material was delivered to several newspapers, including clinical use of Samarium, possibilities of being elected for treatment, benefits and risks and a photography of the product. Politics of the institution producing Samarium changed, in order to achieve minimum cost of the product and it was delivered to all publics at the lowest cost for a year

  19. Analysis of effectiveness of the palliative treatment of metastatic bone's pain with 188Re-HEDP

    International Nuclear Information System (INIS)

    Savio, E.; Zeledon, P.; Paolino, A.; De Marco, E.; Gaudino, J.

    2003-01-01

    The objective of the study was to evaluate the treatment effectiveness with 188Re-HEDP in a group of 27 patients, who had received 36 doses. A pharmaceutical care programme was also added in order to improve drug follow-up after treatment. Two levels of doses were administered: 30 or 60 mCi. Initially a trace dose was given in order to estimate the therapeutic dose, which was individualise according to bone uptake of the radiopharmaceutical. Bone uptake was determined measuring radioactivity in urine samples (0, 1, 2, 4 and 6 hs), because the radiopharmaceutical showed only renal elimination. Multiple dose schedules with with 3 months between both doses were also tried. Seventy two percent showed an algesic effect during the first week post-treatment, with was kept during one month, while seven tenn (17%) percent of the patients the effect was kept for two of more months. Opioid analgesic (third level of OMS scale) were diminished in eighty two percent of the patients and AINES drugs in seventy one percent. The pharmaceutical care programme also showed the importance of the radio pharmacist role to improve treatment outcomes. 188Re-HEDP effectiveness was achieved in 100% of the patients, but with different pain palliation response in time and/or drug intake, with a suitable radiological safety

  20. Successful Use of Magnetic Resonance-Guided Focused Ultrasound Surgery for Long-Term Pain Palliation in a Patient Suffering from Metastatic Bone Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Eun; Yoon, Sang Wook; Kim, Kyoung Ah; Lee, Jong Tae [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of); Shay, Lilach [InSightec. Ltd, Hifa, (Israel); Lee, Kyong Sik [Dept. of General Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of)

    2011-08-15

    Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a clinically effective, non-invasive treatment for thermal ablation of various soft tissue tumors, and is effective in pain palliation following radiation therapy, as has been demonstrated in the initial studies of bone metastases. The current study evaluated the safety and clinical efficacy of MRgFUS for pain palliation prior to radiation therapy, in a patient with a solitary metastatic bone lesion. This is the first case report of MRgFUS treatment with a 1-year follow-up in a patient.

  1. Successful Use of Magnetic Resonance-Guided Focused Ultrasound Surgery for Long-Term Pain Palliation in a Patient Suffering from Metastatic Bone Tumor

    International Nuclear Information System (INIS)

    Lee, Ji Eun; Yoon, Sang Wook; Kim, Kyoung Ah; Lee, Jong Tae; Shay, Lilach; Lee, Kyong Sik

    2011-01-01

    Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a clinically effective, non-invasive treatment for thermal ablation of various soft tissue tumors, and is effective in pain palliation following radiation therapy, as has been demonstrated in the initial studies of bone metastases. The current study evaluated the safety and clinical efficacy of MRgFUS for pain palliation prior to radiation therapy, in a patient with a solitary metastatic bone lesion. This is the first case report of MRgFUS treatment with a 1-year follow-up in a patient.

  2. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Seung Hun; Choi, Yun Young; Cho, Suk Shin

    2001-01-01

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients

  3. Study On Preparation Of 177Lu-EDTMP For Metastatic Bone Pain Palliation Treatment

    International Nuclear Information System (INIS)

    Nguyen Thanh Binh; Dang Ho Hong Quang; Duong Van Dong; Chu Van Khoa; Nguyen Thi Hien

    2011-01-01

    Ethylene diamine tetramethylene phosphonate (EDTMP) is one of the most widely used ligands which forms stable complexes with various radionuclides and all the complexes showed high bone uptake in biodistribution studies. EDTMP has a high affinity to skeleton and osteoblastic bone metastases and many EDTMP chelates posses a considerably high stability.This stimulated application of the ligand as the in-vivo carrier of various radionuclides, intended for both therapy and diagnosis of osteoblastic lesions.The present study intends to formulate EDTMP kits, label them with 177 Lu, quality control and in-vitro stability studies. This paper presents some research results on the optimal conditions for labeling EDTMP kit with Lu-177 of low specific activity that was produced on the IVV-9 reactor at the Nuclear Research Institute. (author)

  4. Mechanisms of, and Adjuvants for, Bone Pain.

    Science.gov (United States)

    Figura, Nicholas; Smith, Joshua; Yu, Hsiang-Hsuan Michael

    2018-06-01

    Metastatic bone pain is a complex, poorly understood process. Understanding the unique mechanisms causing cancer-induced bone pain may lead to potential therapeutic targets. This article discusses the effects of osteoclast overstimulation within the tumor microenvironment; the role of inflammatory factors at the tumor-nociceptor interface; the development of structural instability, causing mechanical nerve damage; and, ultimately, the neuroplastic changes in the setting of sustained pain. Several adjuvant therapies are available to attenuate metastatic bone pain. This article discusses the role of pharmacologic therapies, surgery, kyphoplasty, vertebroplasty, and radiofrequency ablation. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. In-vivo tissue uptake and retention of Sn-117m(4+)DTPA in a human subject with metastatic bone pain and in normal mice

    International Nuclear Information System (INIS)

    Swailem, Fayez M.; Krishnamurthy, Gerbail T.; Srivastava, Suresh C.; Aguirre, Maria L.; Ellerson, Dawn L.; Walsh, T. Kent; Simpson, Laura

    1998-01-01

    Organ and tissue uptake and retention of Sn-117m(4+)DTPA were studied in a human subject treated for metastatic bone pain, and the results were compared with the biodistribution studies in five normal mice. The explanted organs from a patient who received a therapy dose of 18.6 mCi (688.2 MBq) Sn-117m(4+)DTPA and who died 47 days later were imaged with a γ-camera, and tissue samples were counted and also autoradiographed. Bone, muscle, liver, fat, lungs, kidneys, spleen, heart and pancreas tissue samples were assayed in a well counter for radioactivity. Regions of interest were drawn over bone and major organs to calculate and quantify clearance times using three in vivo Sn-117m(4+)DTPA whole-body scintigrams acquired at 1, 24 and 168 h after injection. Five normal mice injected with the same batch of Sn-117m(4+)DTPA as used for the human subject were sacrificed at 24 h, and tissue samples were collected and assayed for radioactivity for comparison with the human data. For the human subject, whole-body retention at 47 days postinjection was 81% of the injected dose, and the rest (19%) was excreted in urine. Of the whole-body retained activity at 47 days, 82.4% was in bone, 7.8% in the muscle and 1.5% in the liver, and the rest was distributed among other tissues. γ-Ray scintigrams and electron autoradiographs of coronal slices of the thoracolumbar vertebral body showed heterogenous metastatic involvement with normal bone between metastatic lesions. There was nonuniform distribution of radioactivity even within a single vertebral body, indicating normal bone between metastatic lesions. Lesion-to-nonlesion ratios ranged from 3 to 5. However, the osteoid-to-marrow cavity deposition ratio, from the microautoradiographs, was 11:1. The peak uptake in the human bone was seen at 137 h with no biological clearance. Soft tissues showed peak uptake at 1 h and exhibited three compartmental clearance components. Whole-body retention in normal mice was 38.7% of the injected

  6. Dosimetric aspects of the treatment of metastatic bone pain with radiopharmaceuticals; Aspectos dosimetricos de los tratamientos del dolor oseo metastasico con radiofarmacos

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, T.; Marti, J. F.; Olivas, C.; Vercher, J. L.; Repetto, R.; Bello, P.

    2014-02-01

    Within the context of treatment of metastatic bone pain with bone seeking radiopharmaceuticals, this paper expounds the results of an analysis of available molecules (both approved for clinical use or still under study) intended to obtain a detailed comparison of their dosimetric characteristics. These can be used to supplement the list of already know differences between them, such as efficacy, appearance and length of the palliative effect, eventual tumoricidal effect, myelotoxicity, sale price and availability. Seven radiopharmaceuticals have been analysed, five of them are based on beta emission radionuclides: {sup 3}2P, {sup 1}53Sm, {sup 1}86Re and {sup 1}88Re and the other two ones are based on high Linear energy Transference emission radionuclides: {sup 1}17mSn and {sup 2}23Ra a series of estimates of the main dosimetric parameters for each radiopharmaceutical analysed have been obtained. The values obtained might be worth being incorporated to the risk/benefit analysis that precedes every choice of the specific radiopharmaceutical to be used with an individual patient. In this way, we hope these results will be of some help for those Nuclear Medicine specialists interested in the treatment of oncological bone pathologies. (Author)

  7. Radiochemical and biological studies, including in non-human primates, towards indigenous development of 153Sm-EDTMP for metastatic bone pain palliation

    International Nuclear Information System (INIS)

    Saraswathy, P.; Mehra, K.S.; Ranganatha, D.K.; Das, M.K.; Balasubramanian, P.S.; Ananthakrishnan, M.; Ramamoorthy, N.; Gunasekaran, S.; Shanthly, N.; Retna Ponmalar, J.; Narasimhan, S.

    2001-01-01

    The combination of ease of formulation and superior biological features of 153 Sm-EDTMP in terms of safety and efficacy for metastatic bone pain palliation, together with the prospect of better logistics of production, has prompted extensive efforts by many groups world over for its preparation and evaluation. Our efforts have been directed towards exploring the feasibility for formulation of 153 Sm-EDTMP suitable for human use by neutron activation in medium flux reactors of the freely available and inexpensive natural samarium oxide target. The emphasis in biological studies was placed on tests in larger animals (monkeys) as a prelude to clinical evaluation. Feasibility to achieve reasonably high specific activity of 300-700 mCi/mg Sm at EOB with natural samarium has been adequately demonstrated. The radioeuropium contamination, estimated by γ-spectrometry to be 153 Sm-EDTMP from natural samarium at high radioactive concentrations of 40-50 mCi 153 Sm/mL, acceptable biolocalization, as revealed by both biodistribution studies in rats (femur uptake of 2-3% injected dose at 1h p.i. and retention up to 120 h p.i.) and gamma camera images in monkeys and adequate stability have been feasible. Excellent quality bone images of monkeys were recorded showing rapid clearance from blood, visualization of skeleton, clearance from kidneys within 2 hours and retention in skeleton up to 116 hours p.i. No significant activity in other soft tissues was noted. Comparative evaluation of the product prepared from enriched samarium as well as using in-house synthesized EDTMP has, likewise, revealed identical biolocalization features. EDTMP dose tolerance test in mice showed a safety factor of about 100 for a product made from natural samarium at an adult human dose of 50 mCi 153 Sm. Feasibility for production, reasonable safety and satisfactory biolocalisation of the indigenous product has been adequately established so as to warrant clinical trials in patients. (author)

  8. Pathogenesis and pharmacological treatment of bone pain in skeletal metastases

    International Nuclear Information System (INIS)

    Ripamonti, C.; Fulfaro, F.

    2001-01-01

    Sixty-five percent of patients with advanced cancer present bone metastases and most of them present a rather slow clinical course characterized by pain, mobility deficiencies and skeletal complications such as fractures and spinal cord compression. Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the firs signs of widespread neoplastic disease. The pain may originate directly from the plastic disease. The pain may originate directly from the bone, from nerve root compression or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive) even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies such as radiotherapy in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients pharmacological treatment, radiotherapy, radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy and quality of life must guide the physician in the choice of the best possible therapy

  9. Pathogenesis and pharmacological treatment of bone pain in skeletal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Ripamonti, C. [National Cancer Institute, Rehabilitation, Pain Therapy and Palliative Care Division, Milan (Italy); Fulfaro, F. [Societa' per l' Assistenza al Malato Oncologico Terminale, Palermo (Italy)

    2001-03-01

    Sixty-five percent of patients with advanced cancer present bone metastases and most of them present a rather slow clinical course characterized by pain, mobility deficiencies and skeletal complications such as fractures and spinal cord compression. Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the firs signs of widespread neoplastic disease. The pain may originate directly from the plastic disease. The pain may originate directly from the bone, from nerve root compression or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive) even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies such as radiotherapy in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients pharmacological treatment, radiotherapy, radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy and quality of life must guide the physician in the choice of the best possible therapy.

  10. Carotid body paraganglioma metastatic to bone: report of two cases

    International Nuclear Information System (INIS)

    Kawai, A.; Healey, J.H.; Wilson, S.C.; Huvos, A.G.; Yeh, S.D.J.

    1998-01-01

    Two patients with carotid body paraganglioma developed bone metastases 3 and 6 years respectively after surgical excision of the primary tumors. Plain radiographs showed ill-defined metastatic lesions. Scintigram using radiolabeled metaiodobenzylguanidine, an analogue of noradrenaline that is taken up by neurosecretary granules, showed an abnormal accumulation in the corresponding metastatic lesion. Histologically, nests of epithelioid cells with clear cytoplasm and pyknotic nuclei and abundant collagen fibers were observed within destroyed trabeculae. Treatment including external radiation and surgery provided pain relief and early local disease control. (orig.)

  11. Patient and implant survival following joint replacement because of metastatic bone disease

    DEFF Research Database (Denmark)

    Sørensen, Michala S; Gregersen, Kristine G; Grum-Schwensen, Tomas

    2013-01-01

    Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint...... replacement as the treatment for bone metastasis or hematological diseases of the extremities....

  12. Representability of metastatic bone lesions in magnification radiography

    International Nuclear Information System (INIS)

    Togawa, Takashi

    1981-01-01

    Magnification radiography, bone scintigraphy, and normal roentgenography were performed on patients with malignant tumors to detect their bone metastases, and from the results obtained, these diagnostic procedures were evaluated for the detectability and representability of metastatic bone lesions. Bone scan and normal roentgenography were performed on 90 metastatic bone lesions in 37 patients, and magnification radiography was done on 14 bone lesions noted in 10 of the 37 and another with benign osseous change. Among the three, bone scintigraphy was best, and magnification radiography and normal roentgenography did not differ significantly in detectability. In magnification radiography, some metastatic bone lesions were represented more clearly than by normal roentgeography, but some were not. As regards the representability of the ribs, magnification radiography was very useful. One case of bone destruction was detected by magnification radiography, but not by normal roentgenography. (author)

  13. Stress fractures and bone pain

    International Nuclear Information System (INIS)

    Groshar, D.; Even-Sapir, E.; Lam, M.; Israel, O.; Front, D.

    1984-01-01

    Stress fractures result from an unusual repetitive physical activity causing absorption of bone in excess of repair and bone formation. This leads to the weakening of the bone and subsequently to a fracture. It is a benign condition that if recognized in time does not need any treatment besides rest. However, if diagnosis is not made and physical activity continues it may result in severe injury to the bone and a frank fracture may result. Pain is the typical clinical feature and bone scintigraphy, being more sensitive than radiography, is done to establish early diagnosis. The presence of asymptomatic sites of abnormal bone uptake typical of stress fracture in which pain appeared only about 2 weeks after scintigraphy, drew the authors' attention to the question of how close is the relationship between stress fractures and bone pain. Sixty-four military recruits diagnosed as suffering from stress fracture were investigated in order to correlate sites with abnormal uptake of Tc-99m MDP on bone scintigraphy with sites of local pain. In 37 (58%) subjects multiple sites of abnormal uptake were recognised. Of 123 sites of abnormal uptake, 31 (25%) were asymptomatic. In three patients bone pain appeared at the site of the abnormal uptake two weeks after scintigraphy. Bone scintigraphy appears to be more sensitive than bone pain in the diagnosis of stress fractures. The osteoblastic activity which manifests itself by abnormal uptake appears in some cases earlier than the pain caused by the fracture. Present findings may suggest that under certain circumstances, in a population prone to stress fracture, bone scan should be considered as a screening method

  14. Samarium-153 Oksabifor in the treatment of metastatic bone disease

    International Nuclear Information System (INIS)

    Solodyannikova, O.; Voit, N.; Sukach, G.; Sagan, D.

    2015-01-01

    Full text of publication follows. Aim. Bone metastases (BM) are one of the most common complications of solid cancers. Frequency of metastatic bone breast cancer (BC) at different stages of the disease ranges from 47 to 85%, for prostate cancer (PC) - from 33 to 85%, for lung cancer - from 30 to 60%, kidneys - from 33 to 40%, thyroid cancer - from 28 to 60%. Initial stages of BM are often clinically asymptomatic, but later manifested with fractures and pain which greatly reduces patients' quality of life. In world practice for palliative treatment of BM are widely used isotopes 32 P, 89 Sr, 186 Re, 188 Re, 153 Sm, and 177 Lu. Materials and methods. The results of examination and treatment with 153 Sm of 25 BM patients were analyzed. Among them 5 men and 20 women, mean age 61.2 ± 7.9 (min - 51.1, max 73.0). In 4 patients PC was diagnosed, 2 - lung cancer, 17 - BC, 1 - kidney cancer, 1 - cervical cancer. All patients after preliminary survey (bone scan, blood count, blood biochemical analysis) have got administration of 153 Sm Oksabifor in doses of 1 mCi (37 MBq) per 1 kg of weight. To determine the dynamics of BM re-scan with 99m Tc Tehnefor carried out in 1.5 and 3 months after starting treatment. Results. Reduction of pain intensity appeared at 6 + 4.6 days (min 2, max-18). There was a decline consumption of analgetics. According to the assessment of bone pain scales and efficiency, we can say that the therapy was effective and 90% of patients have got pain relief for 3 months and only in 2 patients pain-free period lasted 70 days. Quality of life was assessed by Karnofsky scale and improved statistically significantly. Most patients return to normal life. Only one patient's quality of life did not change (remained at 50%) and one - has changed slightly (from 50% to 60% on the Karnofsky scale). However, this is due to progression of primary disease and not related to pain symptoms. According to our data, 10 patients had stabilization process, in 15

  15. [Effectiveness of conventional diagnostic radiology and nuclear medicine in the treatment of pain from bone metastases].

    Science.gov (United States)

    Genovese, Eugenio Annibale; Mallardo, Vania; Vaccaro, Andrea; Santagata, Mario; Raucci, Antonio; D'Agosto, Gianfranco; Fontanarosa, Antonio; Schillirò, Francesco

    2013-01-01

    Bone is one of the most common metastasis sites from solid tumors. Bone pain due to metastatic neoplastic growth is due to tumor infiltration and expansion of bone membranes. Treatment of acute and chronic pain represents one of the greatest problems in clinical oncology, requiring a multidisciplinary approach. This review focuses on the effectiveness of conventional diagnostic radiology and nuclear medicine for the detection, management and treatment of pain from bone metastasis.

  16. An electrochemical approach for removal of radionuclidic contaminants of Eu from 153Sm for effective use in metastatic bone pain palliation.

    Science.gov (United States)

    Chakravarty, Rubel; Chakraborty, Sudipta; Khan, Mohammed Sahiralam; Ram, Ramu; Sarma, Haladhar Dev; Dash, Ashutosh

    2018-03-01

    Thermal neutron activation of 152 Sm [ 152 Sm(n,γ) 153 Sm] using natural or isotopically enriched (by 152 Sm) samarium target is the established route for production of 153 Sm used for preparation of 153 Sm-EDTMP for pain palliation in cancer patients with disseminated bone metastases. However, some long-lived radionuclidic contaminants of Eu, such as, 154 Eu (t ½ =8.6y) are also produced during the target activation process. This leads to detectable amount of Eu radionuclidic contaminants in patients' skeleton even years after administration with therapeutic doses of 153 Sm-EDTMP. Further, the presence of such contaminants in 153 Sm raises concerns related to radioactive waste management. The aim of the present study was to develop and demonstrate a viable method for large-scale purification of 153 Sm from radionuclidic contaminants of Eu. A radiochemical separation procedure adopting electroamalgamation approach has been critically evaluated. The influence of different experimental parameters for the quantitative removal radionuclidic contaminants of Eu from 153 Sm was investigated and optimized. The effectiveness of the method was demonstrated by purification of ~37 GBq of 153 Sm in several batches. As a proof of concept, 153 Sm-EDTMP was administered in normal Wistar rats and ex vivo γ-spectrometry of bone samples were carried out. After carrying out the electrolysis under the optimized conditions, the radionuclidic contaminants of Eu could not be detected in purified 153 Sm solution by γ-spectrometry. The overall yield of 153 Sm obtained after the purification process was >85%. The reliability of this approach was amply demonstrated in several batches, wherein the performance remained consistent. Ex vivo γ-spectrometry of bone samples of Wistar rats administered with 153 Sm-EDTMP (prepared using electrochemically purified 153 Sm) did not show photo peaks corresponding to radionuclidic contaminants of Eu. A viable electrochemical strategy for the large

  17. Targeted Therapies for Myeloma and Metastatic Bone Cancers

    Science.gov (United States)

    2010-09-01

    Cancer J Clin 2003; 53:5. Kasugai S, Fujisawa R, Waki Y, Miyamoto K, Ohya K 2000 Selective drug delivery system to bone: small peptide (Asp)6...page. Bone targeted nanoparticles , bone cancer myeloma, mice studies, PLGA , Biodegradable materials. Targeted Therapies for Myeloma and Metastatic Bone...present results from this program at talk at the Particles 2006 –Medical/Biochemical Diagnostic , Pharmaceutical, and Drug Delivery . 3

  18. The Src family kinase inhibitor dasatinib delays pain-related behaviour and conserves bone in a rat model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Appel, Camilla Kristine; Gallego-Pedersen, Simone; Andersen, Line

    2017-01-01

    Pain is a severe and debilitating complication of metastatic bone cancer. Current analgesics do not provide sufficient pain relief for all patients, creating a great need for new treatment options. The Src kinase, a non-receptor protein tyrosine kinase, is implicated in processes involved in cancer......-induced bone pain, including cancer growth, osteoclastic bone degradation and nociceptive signalling. Here we investigate the role of dasatinib, an oral Src kinase family and Bcr-Abl tyrosine kinase inhibitor, in an animal model of cancer-induced bone pain. Daily administration of dasatinib (15 mg/kg, p...

  19. Detectability of metastatic bone tumor by Ga-67 scintigraphy

    International Nuclear Information System (INIS)

    Koizumi, Kiyoshi; Uchiyama, Guio; Araki, Tsutomu; Hihara, Toshihiko; Ogata, Hitoshi; Monzawa, Shuichi; Kachi, Kenji; Matsusako, Masaki

    1989-01-01

    Ga-67 scintigrams in patients with malignant diseases sometimes reveal uptake of the tracer in the bone metastases. Detectability of Ga-67 scintigraphy for metastatic bone tumors and benign bone lesions was compared with that of Tc-99m bone scintigraphy. Countable bone metastases detected by bone scintigraphy were evaluated whether the lesion showed apparent, faint, or negative Ga-67 uptake. Of 47 lesions 23 (49%) showed apparent uptake and 17 (36%) showed negative uptake, only 7 (10%) mostly fracture/osteotomy, showed apparent uptake of the tracer. Uptake in the other benign lesions such as trauma of the ribs, spondylosis deformans, and arthrosis deformans was rather faint. In patients with multiple bone metastases, 9 patients (82%) out of 11 showed more prominent abnormal findings in Tc-99m MDP bone scintigraphy than in Ga-67 scintigraphy; that is, Ga-67 scintigraphy was not able to reveal all metastatic bone lesions. In patients with untreated or recurrent tumors, relation between Ga-67 uptake in the tumors and that in the bone metastases was evaluated. Of 7 patients with negative Ga-67 uptake in the bone metastases; that is, there seemed to be little relation between Ga-67 affinity to the primary tumors and that to the bone metastases. Mechanisms of the Ga-67 uptake in the bone metastases were discussed. Not only the tumor cells or tissues in the bone metastases but also bone mineral or osteoclasts might be the deposition sites of Ga-67. (author)

  20. Detectability of metastatic bone tumor by Ga-67 scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Koizumi, Kiyoshi; Uchiyama, Guio; Araki, Tsutomu; Hihara, Toshihiko; Ogata, Hitoshi; Monzawa, Shuichi; Kachi, Kenji; Matsusako, Masaki

    1989-03-01

    Ga-67 scintigrams in patients with malignant diseases sometimes reveal uptake of the tracer in the bone metastases. Detectability of Ga-67 scintigraphy for metastatic bone tumors and benign bone lesions was compared with that of Tc-99m bone scintigraphy. Countable bone metastases detected by bone scintigraphy were evaluated whether the lesion showed apparent, faint, or negative Ga-67 uptake. Of 47 lesions 23 (49%) showed apparent uptake and 17 (36%) showed negative uptake, only 7 (10%) mostly fracture/osteotomy, showed apparent uptake of the tracer. Uptake in the other benign lesions such as trauma of the ribs, spondylosis deformans, and arthrosis deformans was rather faint. In patients with multiple bone metastases, 9 patients (82%) out of 11 showed more prominent abnormal findings in Tc-99m MDP bone scintigraphy than in Ga-67 scintigraphy; that is, Ga-67 scintigraphy was not able to reveal all metastatic bone lesions. In patients with untreated or recurrent tumors, relation between Ga-67 uptake in the tumors and that in the bone metastases was evaluated. Of 7 patients with negative Ga-67 uptake in the bone metastases; that is, there seemed to be little relation between Ga-67 affinity to the primary tumors and that to the bone metastases. Mechanisms of the Ga-67 uptake in the bone metastases were discussed. Not only the tumor cells or tissues in the bone metastases but also bone mineral or osteoclasts might be the deposition sites of Ga-67.

  1. Super bone scans on bone scintigraphy in patients with metastatic bone tumor

    International Nuclear Information System (INIS)

    Morita, Koichi; Fukunaga, Masao; Otsuka, Nobuaki

    1988-01-01

    Eight patients with malignant tumor (3 with gastric cancer, 4 with prostatic cancer, 1 with transitional cell carcinoma), which showed diffusely increased uptake of 99m Tc labelled phosphorous compound in axial skeleton (''Super Bone Scan'') on bone scintigraphy were clinically studied. No relationship with its histological type of the tumor was recognized. All cases revealed extremely high serum ALP concentration, which might reflect increased osteoblastic activity. Furthermore, on bone roentgenograms all cases showed predominantly osteosclerotic change in the metastatic bones, while some did locally osteolytic change. In three cases with gastric cancer, although they had diffuse skeletal metastases, two had no evidence of liver metastases. Thus, it seemed that clinical study of patients with ''Super Bone Scan'' was interesting to evaluate the mechanism of accumulation of 99m Tc labelled phosphorous compound to bone and bone metabolism, and the pathophysiology in the pathway of bone metastases. (author)

  2. Cervical Spine pain as a presenting complaint in metastatic pancreatic cancer: a case report.

    Science.gov (United States)

    Rosenberg, Emily; Buchtel, Lindsey

    2016-01-01

    A 48 year-old female presented to her primary care physician with a two-month history of neck pain with negative cervical spine x-rays. During that office visit, the patient was noted to be tachycardic with EKG revealing ST depressions, which led to hospital admission. Acute coronary syndrome was ruled out, however, persistent neck pain warranted inpatient MRI of the cervical spine, which revealed a cervical spine lesion. Extensive investigation and biopsy ultimately confirmed stage IV pancreatic adenocarcinoma with metastases to the bone, liver, and likely lung. In the literature, the findings of a primary metastatic site being bone is rare with only a few case reports showing vertebral or sternal metastasis as the first clinical manifestation of pancreatic cancer. The uniqueness of this case lies in the only presenting complaint being cervical spine pain in the setting of extensive metastases to the liver, bone, and likely lung.

  3. Clinical application of CT-guided radiofrequency ablation for the treatment of metastatic bone neoplasms

    International Nuclear Information System (INIS)

    Gong Ju; Lu Zhijun; Wang Zhongmin; Zhang Liyun; Zheng Yunfeng; Chen Kemin

    2009-01-01

    Objective: To investigate the clinical efficacy of CT-guided radiofrequency ablation (RFA) for the treatment of metastatic bone neoplasms. Methods: Under intravenous aneaesthesia, CT- guided RFA was performed in 20 patients with metastatic bone tumor. The degree of pain was evaluated at 24 hours, 3 and 6 months after the operation by brief pain inventory (BPI). Results: All patients were followed up for 6 months and survived so far. The average peak pain score before the operation was 8.1 (6-10), which decreased significantly to 6.1, 4.6, 3.3 and 3.0 at 24 hours, 1, 3 and 6 months after the operation respectively (P<0.001). The mean pain score before the operation was 6.3, which decreased significantly to 4.0, 2.3, 2.13 and 1.9 at 24 hours, 1, 3 and 6 months after the operation respectively (P<0.001). After RFA treatment, the KPS scores of all patients increased while the CT values of the bone lesions decreased. No major complications occurred both during and after the operation. One patient with vertebral lamina destruction suffered from lower limb hypoesthesia after RFA procedure, and the lower limb sensation was restored within 48 hours after the injection of prednisone was employed. Conclusion: CT-guided radiofisequency ablation is a safe, effective, minimally-invasive and up-to-date technique for the treatment of metastatic bone neoplasms with excellent anti-pain effect, its short-term response is sure and reliable. (authors)

  4. Metastatic calcification of the stomach imaged on a bone scan

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, R.; Ryo, U.Y.; Pinsky, S.M.

    1984-10-01

    A whole body bone scan obtained on a 21-year-old woman with sickle cell disease and chronic renal failure showed localization of the radionuclide diffusely in the stomach. The localization of the radionuclide represented metastatic calcification of the stomach caused by secondary hyperparathyroidism.

  5. Impact of primary metastatic bone disease in germ cell tumors

    DEFF Research Database (Denmark)

    Oing, C; Oechsle, K; Necchi, A

    2017-01-01

    (multivariate Cox regression; HR, 0.32; P=0.011) with respective 2-year PFS and OS rates of 68% and 75% compared with 24% and 36% for non-seminoma patients. Conclusions: Outcome of GCT patients with primary metastatic bone disease is particularly poor in non-seminoma patients, even worse than the expected...

  6. The role of lysyl oxidase, the extracellular matrix and the pre-metastatic niche in bone metastasis

    Directory of Open Access Journals (Sweden)

    Alison Gartland

    2016-09-01

    Full Text Available Most deaths from solid cancers occur as a result of secondary metastasis to distant sites. Bone is the most frequent metastatic site for many cancer types and can account for up to 80% of cancer-related deaths in certain tumours. The progression from a discrete solid primary tumour to devastating and painful bone metastases is a complex process involving multiple cell types and steps. There is increasing evidence that modulation of the extracellular matrix plays an important role in the lethal transition from a primary to disseminated metastatic bone tumour. This review provides an overview of the current understanding on the role of role of lysyl oxidase, the extracellular matrix and the pre-metastatic niche in bone metastasis

  7. Zoledronic acid in metastatic bone disease: an audit based discussion

    International Nuclear Information System (INIS)

    Akbar, R.A.; Gosh, S.

    2010-01-01

    Background: Metastatic bone disease is a common problem in patients with advanced cancer causing significant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, can reduce morbidity in such cases. Objectives: The objectives of this study were to determine whether Zoledronic acid was administered in accordance with current recommendations for its prescribing and to produce protocols for improved patient outcomes. Methods: The study was a retrospective audit of 39 consecutive patients with metastatic bone disease secondary to solid tumours who were treated with Zoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relative to creatinine clearance. The standards for Zoledronic acid therapy were defined from best practice guidelines. Results: The commonest diagnosis in patients receiving Zoledronic acid was carcinoma prostate 19/39 (49%) followed by carcinoma breast 11/39 (28%), gastrointestinal malignancies 4/39 (10%) and renal cell carcinoma 3/39 (8%). Indications for therapy were metastatic bone disease alone 31 (79%), hypercalcaemia alone 0/39 (0%), metastatic bone disease with hypercalcaemia 5/39 (13%), and prevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate to the creatinine clearance in 25/39 (6 4%), inappropriate in 5/39 (13%) and unclear from the notes in 9/39 (23%). Conclusions: Majority of patients received Zoledronic acid for the appropriate indications. The dose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poor documentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead to major errors in prescribing. We recommend using a standard form to document each episode of therapy with Zoledronic acid. (author)

  8. Bone-scintigraphy in painful bipartite patella

    International Nuclear Information System (INIS)

    Iossifidis, A.; Brueton, R.N.; Nunan, T.O.

    1995-01-01

    Although, the use of technetium scintigraphy in the assessment of anterior knee pain has been described, no reference has been made to the scintigraphic appearances of painful bipartite patella. We report the scintigraphic-appearances of painful bipartite patella in 25-year-old man a 2 1/2 years history of unexplained patellar pain. Painful bipartite patella is a rare cause of chronic post-traumatic patellar pain. Bone scintigraphy, by demonstrating increased uptake by the painful accessory bipartite fragment, appears to be an imaging method of choice in the diagnosis of this condition. (orig./MG)

  9. Analysis of urine samples from metastatic bone cancer patients administered 153Sm-EDTMP

    International Nuclear Information System (INIS)

    Goeckeler, W.F.; Stoneburner, L.K.; Price, D.R.; Fordyce, W.A.

    1993-01-01

    153 Sm-EDTMP is currently undergoing clinical evaluation as a radiotherapeutic agent for the relief of pain associated with cancer metastatic to bone. These clinical studies have demonstrated biodistributions similar to those seen earlier in animals, namely, rapid clearance from blood, selective uptake in bone and in particular metastatic bone lesions. The radioactivity not deposited in bone is cleared through the kidneys into the urine. In this study, urine samples collected from 9 patients injected with 153 Sm-EDTMP underwent complexation analysis via Pharmacia SP-Sephadex C25 cation exchange chromatography. The results showed 96.9 ± 1.7% of the radioactivity in the urine to be present as a complex of 153 Sm. An HPLC method was developed and it was demonstrated that different complexes of 153 Sm could be separated. A non-radioactive analytical standard of the Sm-EDTMP chelate was synthesized, characterized and shown to have the same HPLC retention profile as the 153 -EDTMP drug product. HPLC analysis was performed on six urine samples and in each case a single radioactivity peak with an elution profile the same as that of a 153 Sm-EDTMP standard was observed. These results indicate that the 153 Sm-EDTMP chelate is excreted intact in the urine of patients. (Author)

  10. Evaluation of the prognosis of cancer patients with metastatic bone tumors based on serial bone scintigrams

    International Nuclear Information System (INIS)

    Ohmori, Kazuo; Matsui, Hisao; Yasuda, Taketoshi; Kanamori, Masahiko; Yudoh, Kazuo; Seto, Hikaru; Tsuji, Haruo

    1997-01-01

    We counted the lesions at the time of detection of bone metastases and calculated the rate of increase in the number of bone metastases from changes in serial bone scintigrams, and investigated the usefulness of serial scintigrams as a prognostic indicator in patients with metastatic bone tumors. Subjects were 112 patients with bone metastases from four types of primary lesion: 21 with prostate cancer, 27 breast cancer, 39 lung cancer and 25 stomach cancer. Of these, 18 (prostate), 19 (breast), nine (lung) and eight (stomach) underwent serial bone scintigrams in which bone metastases were first detected and identified as progressing. The numbers of lesions at the time of detection of bone metastases for prostate and stomach cancers were significantly greater than those for lung cancer. The rate of increase in the number of bone metastases for stomach cancer was significantly higher than that for prostate or breast cancers. There was no correlation between the survival time after the detection of bone metastases and the number of lesions at the time of detection in the four types of cancer. However, in prostate cancer, a negative correlation existed between the survival time after the detection of bone metastases and the rate of increase in the number of bone metastases. Thus, in patients with bone metastases from prostate cancer, it appears that the rate of increase in the number of bone metastases, estimated from serial bone scintigrams, was indicative of prognosis. (author)

  11. Assessment on zoledronic acid use in patients with bone metastatic breast cancer

    International Nuclear Information System (INIS)

    Soriano Garcia, Jorge L; Batista Albuerne, Noyde; Lima Perez, Mayte

    2010-01-01

    The biphosphonates are the cornerstone in the bone metastases treatment. In present paper the effectiveness and safety of the zoledronic acid (ZA) use in patients with bone metastatic breast cancer (MBC)

  12. Cancer of the prostate presenting with diffuse osteolytic metastatic bone lesions: a case report

    Directory of Open Access Journals (Sweden)

    Segamwenge Innocent Lule

    2012-12-01

    Full Text Available Abstract Introduction Prostate cancer is the second most common cancer in men and the fifth most common cancer worldwide. In the USA it is more common in African-American men than in Caucasian men. Prostate cancer frequently metastasizes to bone and the lesions appear osteoblastic on radiographs. Presentation with diffuse osteolytic bone lesions is rare. We describe an unusual presentation of metastatic prostate cancer with diffuse osteolytic bone lesions. Case presentation A 65-year-old Namibian man presented with anemia, thrombocytopenia and worsening back pains. In addition he had complaints of effort intolerance, palpitations, dysuria and mild symptoms of bladder outlet obstruction. On examination he was found to be anemic, had a swollen tender right shoulder joint and spine tenderness to percussion. On digital rectal examination he had asymmetrical enlargement of the prostate which felt nodular and hard with diffuse firmness in some parts. His prostate-specific antigen was greater than 100ng/mL and he had diffuse osteolytic lesions involving the right humerus, and all vertebral, femur and pelvic bones. His screen for multiple myeloma was negative and the prostate biopsy confirmed prostate cancer. Conclusion Prostate cancer rarely presents with diffuse osteolytic bone lesions and should be considered in the differential diagnosis when evaluating male patients with osteolytic bone lesions.

  13. International consensus on use of focused ultrasound for painful bone metastases : Current status and future directions

    NARCIS (Netherlands)

    Huisman, Merel; ter Haar, Gail; Napoli, Alessandro; Hananel, Arik; Ghanouni, Pejman; Lövey, György; Nijenhuis, Robbert J; van den Bosch, Maurice A A J; Rieke, Viola; Majumdar, Sharmila; Marchetti, Luca; Pfeffer, Raphael M; Hurwitz, Mark D

    2015-01-01

    Focused ultrasound surgery (FUS), in particular magnetic resonance guided FUS (MRgFUS), is an emerging non-invasive thermal treatment modality in oncology that has recently proven to be effective for the palliation of metastatic bone pain. A consensus panel of internationally recognised experts in

  14. Diphosphonic Acid (HEDP) Complex As A, Bone Pain Palliative Agent

    International Nuclear Information System (INIS)

    H G, Adang; Mutalib, A; Bagiawati, Sri; S, Evi; Aguawarini, Sri; Abidin

    2003-01-01

    Bone pain is a common complication for patient with bone metastases from prostate, breasts, lung and renal cancers. The systemic treatment of metastatic bone cancers can be done by using analgesic drug therapy, hormonal therapy, chemotherapy, narcotic (morphine) and radiopharmaceuticals. Samarium-153 EDTMP is one of the most widely used radiopharmaceutical for the treatment of metallics bone pain. Preparation and quality control of 186 Re-HEDP have been carried out. Radiochemical purity was analysed using paper chromatography and resulted in maximum yields more than 90 % . Complexes quite were stable for 3 days when stored at 4 o C. Rhenium-186 HEDP complex contents in the blood reach optimum activity after 5 minutes and decrease drastically at 24 hours post injection. The complex showed major renal clearance up to 41 % as perrhenate ion within 24 hours after injection, Biodistribution pattern of the injected complex in mice indicates that the accumulated optimum activity in the bone was obtained between 2 - 24 hours post injection, Sterility and pyrogenicity test indicated that the complex were sterile and pyrogen free

  15. Bone scintigraphy in painful os peroneum syndrome

    DEFF Research Database (Denmark)

    Jeppesen, Johanne B; Jensen, Frank K; Falborg, Bettina

    2011-01-01

    Lateral foot pain may be caused by various entities including the painful os peroneum syndrome. A case of a 68-year-old man is presented, who experienced a trauma with distortion of the right foot. Nine months later, he still had pain in the lateral part of the right foot. Bone scintigraphy showed...... uptake in the area where an os peroneum was located and thus confirmed the clinical assumption of painful os peroneum syndrome. Familiarity with the clinical and imaging findings can prevent undiagnosed lateral foot pain....

  16. Bone scintigraphy in painful os peroneum syndrome

    DEFF Research Database (Denmark)

    Jeppesen, Johanne B; Jensen, Frank K; Falborg, Bettina

    2011-01-01

    Lateral foot pain may be caused by various entities including the painful os peroneum syndrome. A case of a 68-year-old man is presented, who experienced a trauma with distortion of the right foot. Nine months later, he still had pain in the lateral part of the right foot. Bone scintigraphy showe...... uptake in the area where an os peroneum was located and thus confirmed the clinical assumption of painful os peroneum syndrome. Familiarity with the clinical and imaging findings can prevent undiagnosed lateral foot pain....

  17. Pain palliation therapy of bone metastases: palliative or curative?

    International Nuclear Information System (INIS)

    Fischer, M.

    2007-01-01

    In Germany the incidence of breast cancer is about 85 and of prostate cancer about 50 new patients per 100.000 inhabitants/year. In about 80% of prostate cancer patients and 75% of breast cancer patients bone metastases are observed in autopsy. Most of these patients develop severe pain syndrome from bone metastases reducing quality of life during life time. Therapy of these patients should aim at adding life to the years not years to their life. The knowledge of metastatic cell biology, of cell-cell interaction and of tumor-cell, tumor cell-skeleton interaction may modify the therapeutic procedure. Already in 1940/41, Pecher treated a patient suffering from painful prostate cancer bone metastases administering 296 MBq 89 Strontium chloride. About 10 years later, Friedell introduced 32 Phosphorus for treatment of bone metastases from breast cancer. Today in Europe 3 radionuclides are approved for pain palliation therapy as shown in Table.1. Indication: - pain palliation therapy of bone metastases from prostate cancer ( 89 Sr and 186 Re); - pain palliation of all osteoblastic metastases independent from primary tumors ( 153 Sm). Contraindications: - pregnant and lactating females - myelosuppression ( 3 granulocytes; 3 platelets); - impaired renal function (urea >12 mmol/l; creatinine > 150 mmol/l) - incontinence; - acute or chronic spinal cord compression and/or brain metastases causing neurological symptoms; - disseminated intravascular coagulopathy. The recommended activities per treatment are: 89 Sr 150 MBq, 186 Re 1.295 MBq, and 153 Sm 37 MBq/kg BW. Shortly (6-8 weeks) prior to radionuclide therapy for pain palliation no high dose chemotherapy or large field radiation therapy should be performed. Stopping unlabelled bisphosphonate therapy prior to pain palliation therapy is not necessary. This radionuclide therapy may be repeated several time, the interval between tracer administration depends on blood cell count rate. The recommended intervals are for 89 Sr

  18. Radiotherapy for pain management of bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: rezende.med@terra.com.br [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)

    2011-07-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  19. Radiotherapy for pain management of bone metastases

    International Nuclear Information System (INIS)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano

    2011-01-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  20. Disseminated breast cancer cells acquire a highly malignant and aggressive metastatic phenotype during metastatic latency in the bone.

    Directory of Open Access Journals (Sweden)

    Carolyn G Marsden

    Full Text Available BACKGROUND: Disseminated tumor cells (DTCs in the bone marrow may exist in a dormant state for extended periods of time, maintaining the ability to proliferate upon activation, engraft at new sites, and form detectable metastases. However, understanding of the behavior and biology of dormant breast cancer cells in the bone marrow niche remains limited, as well as their potential involvement in tumor recurrence and metastasis. Therefore, the purpose of this study was to investigate the tumorigenicity and metastatic potential of dormant disseminated breast cancer cells (prior to activation in the bone marrow. METHODOLOGY/PRINCIPAL FINDINGS: Total bone marrow, isolated from mice previously injected with tumorspheres into the mammary fat pad, was injected into the mammary fat pad of NUDE mice. As a negative control, bone marrow isolated from non-injected mice was injected into the mammary fat pad of NUDE mice. The resultant tumors were analyzed by immunohistochemistry for expression of epithelial and mesenchymal markers. Mouse lungs, livers, and kidneys were analyzed by H+E staining to detect metastases. The injection of bone marrow isolated from mice previously injected with tumorspheres into the mammary fat pad, resulted in large tumor formation in the mammary fat pad 2 months post-injection. However, the injection of bone marrow isolated from non-injected mice did not result in tumor formation in the mammary fat pad. The DTC-derived tumors exhibited accelerated development of metastatic lesions within the lung, liver and kidney. The resultant tumors and the majority of metastatic lesions within the lung and liver exhibited a mesenchymal-like phenotype. CONCLUSIONS/SIGNIFICANCE: Dormant DTCs within the bone marrow are highly malignant upon injection into the mammary fat pad, with the accelerated development of metastatic lesions within the lung, liver and kidney. These results suggest the acquisition of a more aggressive phenotype of DTCs during

  1. A metastatic glomus jugulare tumor. A temporal bone report

    International Nuclear Information System (INIS)

    El Fiky, F.M.; Paparella, M.M.

    1984-01-01

    The clinicopathologic findings in the temporal bone of a patient with a highly malignant metastasizing glomus jugulare tumor are reported. The patient exhibited all the symptoms of primary malignant tumors of the ear, including facial paralysis, otorrhea, pain, hearing loss, tinnitus, dizziness, and vertigo. He was treated with cobalt irradiation followed by radium implant in the ear canal for a residual tumor; then a left-sided radical mastoidectomy was performed

  2. 186Re-1,4,8,11-tetraaza cyclotetradecyl-1,4,8,11-tetramethylene phosphonic acid: a novel agent for possible use in metastatic bone-pain palliation

    International Nuclear Information System (INIS)

    Kothari, Kanchan; Samuel, Grace; Banerjee, Sharmila; Unni, P.R.; Sarma, H.D.; Chaudhari, P.R.; Unnikrishnan, T.P.; Pillai, M.R.A.

    2001-01-01

    In connection with our work on the development of 186 Re-tetra-phosphonates with optimum properties for use in bone pain palliation, a novel cyclic tetraphosphonate derivative, has been synthesized, complexed with 186 Re and evaluated with promising results. The ligand, which consists of a cyclic array of tetra-aminomethylphosphonate groups, was synthesized using orthophosphorus acid, 1,4,8,11-tetraazacyclotetradecane and formaldehyde. The labeling conditions with 186 Re have been standardized under varying reaction conditions to give maximum yield. In a reaction volume of 1 mL, maximum complexation yield of 98% was observed at pH 2 using 0.1 mg Re (37-370 MBq) for a ligand concentration at 9x10 -2 M/L, under heating at 100 deg. C for 30 min with 2 mg of stannous chloride. The complex was found to be stable for 6 days with RC purity remaining ∼97%. The complex was characterized by paper chromatography in saline and acetone, wherein the R f exhibited were 0.9 and 0, respectively. Biodistribution studies of the complex were performed in male Wistar rats. Activity in femur which was observed to be 1.8%/g (equivalent to about 23% of the injected activity in skeleton) at 3 h post injection remained almost constant up to 48 h. Minimum activity was observed in blood and other soft tissues. The complex showed major renal clearance. Scintigraphic images in rabbits after injecting 70-100 MBq of 186 Re-CTMP and using a dual head gamma camera were observed to be superior to 186 Re-HEDP, prepared by a procedure standardized by us. Insignificant activity was observed in other vital organs. The results suggest the suitability of the complex for further evaluation in higher animals for bone pain palliation

  3. [Bone metastases pain in the elderly].

    Science.gov (United States)

    Chouahnia, K; Luu, M; Baba-Hamed, N; Des Guetz, G

    2009-05-20

    Every year in Europe and in USA, more than 60% of new cases of cancer are diagnosed at the patient's of more than 65 years with a mortality of more than 70%. Pain, is a major symptom which often accompanies cancer. It is always painful and intolerable, notably when pain is linked to bone metastases to elderly patients often poly pathological. In 1/3 of cases pain is present at the time of diagnosis of cancer and in 2/3 of cases at the advanced diseases. The bone metastases occupy the third place after the pulmonary and liver metastases. They are in order of frequency linked in breast cancer, the kidney and the prostate cancer. Bone metastases are at the origin of the loss of the elderly autonomy, with for consequence an impairment of quality of life. Validated tools are at now available to assess this pain. The different treatments offered in bone metastases pain are: the chemotherapy, the surgery, radiotherapy, bisphosphonates and analgesic treatment.

  4. Knee pain and swelling: An atypical presentation of metastatic colon cancer to the patella

    Directory of Open Access Journals (Sweden)

    Bethany Gasagranda, DO

    2014-01-01

    Full Text Available Knee pain is a common reason for a patient to seek medical evaluation. Of the many causes of knee pain, malignancy is one of the least common. When malignancy is the etiology of the pain, it is usually due to a primary tumor of the osseous structures or soft tissues of the knee joint. Metastatic disease involving the knee joint is uncommon, with few cases reported in the literature. Of these reported cases, metastatic colon cancer is exceedingly rare. However, in a patient with new onset knee pain and the proper clinical history, metastatic disease should be considered as a potential explanation of symptoms. We report a case of knee pain and swelling due to metastatic colon cancer to the patella.

  5. Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

    International Nuclear Information System (INIS)

    Huisman, Merel; Bosch, Maurice A.A.J. van den; Wijlemans, Joost W.; Vulpen, Marco van; Linden, Yvette M. van der; Verkooijen, Helena M.

    2012-01-01

    Purpose: Reirradiation of painful bone metastases in nonresponders or patients with recurrent pain after initial response is performed in up to 42% of patients initially treated with radiotherapy. Literature on the effect of reirradiation for pain control in those patients is scarce. In this systematic review and meta-analysis, we quantify the effectiveness of reirradiation for achieving pain control in patients with painful bone metastases. Methods and Materials: A free text search was performed to identify eligible studies using the MEDLINE, EMBASE, and the Cochrane Collaboration library electronic databases. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain. Results: Our literature search identified 707 titles, of which 10 articles were selected for systematic review and seven entered the meta-analysis. Overall study quality was mediocre. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation. Overall, a pain response after reirradiation was achieved in 58% of patients (pooled overall response rate 0.58, 95% confidence interval = 0.49–0.67). There was a substantial between-study heterogeneity (I 2 = 63.3%, p = 0.01) because of clinical and methodological differences between studies. Conclusions: Reirradiation of painful bone metastases is effective in terms of pain relief for a small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.

  6. [Advances in radiation oncology for metastatic bone disease].

    Science.gov (United States)

    Thariat, Juliette; Fric, Danièle; Kerr, Christine; Leysalle, Axel; Angellier, Gaelle; Dejean, Catherine; Tuillier, Titien; Bensadoun, René-Jean; Lagrange, Jean-Léon

    2013-11-01

    Irradiation of bone metastases primarily aims at alleviating pain, preventing fracture in the short term. The higher doses and more conformal dose distribution achievable while saving healthy tissue with new irradiation techniques have induced a paradigm shift in the management of bone metastases in a growing number of clinical situations. A search of the English and French literature was conducted using the keywords: bone metastases, radiotherapy, interventional radiology, vertebroplasty, radiofrequency, chemoembolization. RESULTS-DISCUSSION: Stereotactic irradiation yields pain relief rates greater than 90% in Phase I/II and retrospective studies. IMRT (static, rotational, helical) and stereotactic irradiation yield local control rates of 75-90% at 2 years. Some situations previously evaluated as palliative are currently treated more aggressively with optimized radiation sometimes combined modality interventional radiology. A recommendation can only be made for stereotactic irradiation in vertebral oligometastases or reirradiation. In the absence of a sufficient level of evidence, the increasing use of conformal irradiation techniques can only reflect the daily practice and the patient benefit while integrating economic logic care. The impact of these aggressive approaches on survival remains to be formally demonstrated by interventional prospective studies or observatories including quality of life items and minimal 2-year follow-up.

  7. Bone scan features in spontaneous knee pain.

    Science.gov (United States)

    Vattimo, A; Merlo, F; Bertelli, P; Burroni, L

    1992-01-01

    In 21 patients with "spontaneous" knee pain, 99mTc-MDP bone scan was found to be more sensitive than clinical and radiographic examination in detecting alterations of the joint components. These alterations were shown by increased radionuclide uptake in the compartments where pain was present, which was most commonly the medial femorotibial compartment, although the femoropatellar compartment was also frequently affected. The authors conclude that bone scan should be the first imaging study performed on the knee in order to establish if further tests are necessary.

  8. Clinical observation on strontium-89-chloride therapy in elder patients with prostate cancer for palliation of pain from bone metastases

    International Nuclear Information System (INIS)

    Chen Weimin; Lin Tiansheng; Wang Shen; Chen Tanying

    2006-01-01

    Objective: To estimate clinical curative efficacy and adverse reaction of 89 Sr-chloride therapy for palliation of pain from bone metastases in the older patients with prostate cancer. Methods: 48 cases of older patients with metastatic prostate cancer with bone pain were studied after androgen deprivation therapy, 89 Sr- chloride were administrated iv for the palliative treatment of metastatic bone pain. The curative effects in patients were investigated, including palliation of pain, change of metastatic focus, the tumor sign of PSA, and the adverse reaction. Results: After 89 Sr-chloride therapy, the total palliation rate was 89.6%, inefficiency rate was 10.4%, while metastatic focus and PSA decreased to some extent. No severe adverse reaction occurred. Conclusions: It is shown that the curative efficacy of acesodyne is evident after 89 Sr-chloride therapy in older patients suffering from bone metastase with prostate cancer. It is an effective therapeutic method for the palliation of pain from bone metastases especially to the older patients with multiple metastatases. (authors)

  9. Radiotherapy Results of Breast Cancer Patients with Metastatic Bone Disease

    Directory of Open Access Journals (Sweden)

    Ahmet Dirier

    2006-01-01

    Full Text Available Breast cancer patients with bone metastasis who had admitted to Dicle University Department of Radiation Oncology for palliative radiation therapy between September 2001 and December 2003 were evaluated. There were 31 patients (26 female, 5 male. Median age was 43 years (range 23-79. Histopathological subtypes were infiltrating ductal carcinoma (88%, tubulolobuler carcinoma (6% and inflammatory carcinoma (6%. Loci of bone metastasis were vertebra only in twelve patients (39%, non-vertebral bones only in 8 patients (26% and both vertebral and nonvertebral bones in 11 patients (35%. Two patients had refused radiotherapy. Radiation doses were 3000 cGy with 10 fractions in 15 patients, 2000 cGy with 5 fractions in 6 patients and 800 cGy single fraction in eight patients. Complete palliation of pain was achieved in 18 patients (62% and partial palliation was achieved in 11 patients (38%. Treatment related toxicity was grade I-II dermatitis. In conclusion; same respons rates in terms of palliation can be achieved in the three radiotherapy schedules.

  10. Effect of sex in the MRMT-1 model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Al-Dihaissy, Tamara; Mezzanotte, Laura

    2015-01-01

    An overwhelming amount of evidence demonstrates sex-induced variation in pain processing, and has thus increased the focus on sex as an essential parameter for optimization of in vivo models in pain research. Mammary cancer cells are often used to model metastatic bone pain in vivo......, and are commonly used in both males and females. Here we demonstrate that compared to male rats, female rats have an increased capacity for recovery following inoculation of MRMT-1 mammary cells, thus potentially causing a sex-dependent bias in interpretation of the data....

  11. Vitamin D -prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany

    2013-01-01

    includes 12 women in the age 18-50 years, premenopausal and all suffering from bone pain, vitamin D deficiency and hyperparathyroidism. The recruitment is done through Copenhagen General Practitioners' Laboratory, which analyzes vitamin D samples daily. The study comprise of 6 visits; screening and 5....../bone surface constituted 33% (CI: 26-40)). The dietary change also affected several of the calcium metabolic and bone turnover biomarkers including significantly suppressed serum fibroblast growth factor 23 (p... vitamin D level and mortality was reverse J-shaped. In the same population, prevalence of vitamin D insufficiency and hyperparathyroidism secondary to vitamin D deficiency was 54.4% and 10.5%, respectively. These patients have potentially risked of suffering from or getting osteomalacia accompanying bone...

  12. Impact of additional SPECT in bone scanning in tumor patients with suspected metastatic bone disease

    International Nuclear Information System (INIS)

    Apostolova, I.; Goelcuek, E.; Buchert, R.; Brenner, W.; Bohuslavizki, K.H.

    2009-01-01

    The aim of this study was to investigate the additional value of single-photon emission computed tomography (SPECT) for patient staging compared to planar bone scanning in an unselected cohort of cancer patients. The study included 271 consecutive tumor patients in whom planar imaging and two-bed position SPECT of the spine and the pelvis had been performed. Retrospective image interpretation was performed independently for planar and SPECT scans. Findings were categorized as 'benign', 'equivocal', or malignant' on a lesion base, and as 'no metastatic disease', 'equivocal', or metastatic disease' on a patient base. Four hundred and forty seven lesions were detected by SPECT. Missing of lesions in planar images was rare (4.3% of all SPECT lesions). Planar findings differed from SPECT findings in 149 lesions (33.3%). Most of these 'inconsistent' lesions were rated as equivocal in the planar images but benign (14.5% of all lesions) or malignant (11.0%) by SPECT. On a patient base, 81.6% of patients with planar equivocal staging were classified as either benign (55.3%) or malignant (26.3%) by SPECT. Patients definitively staged as 'no metastatic disease' or 'metastatic disease' in planar images were staged differently by SPECT in only 3.7% of cases (up-staging in 2.6% and down-staging in 1.1%). Single-photon emission computed tomography changed a definite staging as based on planar images in less than 4% of the patients. In patients with planar equivocal staging, however, SPECT allowed a definite diagnosis in more than 80% of these cases, and, thus, should be performed routinely in patients with equivocal findings. (author)

  13. The imaging findings of metastatic neuroblastoma in the craniofacial bone in children

    International Nuclear Information System (INIS)

    Bian Xin; Wang Zhenchang; Xian Junfang; Li Mei; Yan Fei; Chen Qinghua; Yang Bentao; Chang Qinglin; Tian Qichang; Liu Zhonglin

    2009-01-01

    Objective: To investigate the characteristic imaging findings of metastatic neuroblastoma in the craniofacial bone in children. Methods: Imaging findings in 12 patients with metastatic neuroblastoma in the craniofacial bone were analyzed retrospectively. Among them, 10 patients undenvent plain CT scan, 6 underwent MRI and 7 underwent whole body single-photon emission computed tomography bone scanning. Results: In the 10 patients with CT images, lytic bone destruction and soft tissue masses were found in 9 eases, in which periosteal reaction was observed in 8 patients with spiculated periosteal reaction in 3 patients. The remaining 1 patient didn't show any abnormalities on CT images but had abnormal findings in bone scanning. Six patients with MR images showed abnormal signal intensity in the bone marrow of the craniofacial bone and adjacent soft tissue masses. Postcontrast T 1 -weighted imaging in 5 patients demonstrated remarkable enhancement of the bone marrow and soft tissue masses. Bone scanning of 7 patients showed abnormal foci of increased radionuclide activity of the craniofacial bone in 7 patients and metastasis at other body parts in 6 patients. Conclusion: The metastatic neuroblastoma in the craniofacial bone has its characteristic imaging findings which are helpful for correct diagnosis. (authors)

  14. Therapy for bone pain palliation in skeletal metastases with Samarium -153 EDTMP (Indonesian experience)

    International Nuclear Information System (INIS)

    Purnomo, E.

    2007-01-01

    Full text: Radiopharmaceutical therapy may be used for the treatment of cases with painful skeletal metastases. We evaluate and want to share an experience with application and efficacy of Sm-153 EDTMP in palliative painful bone metastases therapy. Our aim was to determine the efficacy and toxicity of single-dose Sm- 153 EDTMP as a palliative treatment for painful skeletal metastases. Material and methods: we selected 18 patients (9 male, 9 female). The average age 35-65 years weight 40- 60 kg; with metastatic bone confirmed with bone scan examination. 6 with breast cancer, 5 with nasopharyngeal cancer, 5 with prostatic cancer, 2 with lung cancer were treated with 30 mCi ( 1110 MBq) Sm-153 EDTMP. All showed extensive metastatic bone disease. The patients were given intravenous injections of 30 mCi Sm-153 EDTMP, after reconditioning, hydration . We established intensity of pain, haematological parameters, scintigraphic, Karnofsky scale. Clinical assessment was performed one month later. Responses were classified in completed (good response), partial and absent taking into account symptoms and drugs reduction. The discontinuation or the reduction of analgesic drugs like opiate dosage was also considered as successful palliative results of the treatment. Result: pain relief was obtained in 16/18 patients, Sm-153 was effective in patients with reduced drug assumption. The response to Sm-153 was good in 14/18(77,7%) of the patients and partial in 3/18(16,6%) and no response in 1/18(0,5%). The application of Sm-153 in patients with painful disseminated bone metastases has a satisfactory pain alleviating effects. Sides effects were noted, decrease hemoglobin counts and white blood cell and platelets, which gradually returned to near normal after 6 weeks. Easy application and low cost and produced in own country are important factors. Conclusion: radiopharmaceutical therapy can be recommended because of the favorable palliation effect and the low cost of Sm-153, especially

  15. Two Cases of Sternal 'Cold' Lesions on Bone Imaging in the Metastatic Skeletal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyung Gun; Seo, Bong Kwan; Lee, Hoon Yong; Lee, Myung Chul; Choi, Sung Jae; Kim, Noe Kyeong; Koh, Chang Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1983-09-15

    Traditionally, a positive bone scan shows single or multiple areas of increased uptake in them metastatic skeletal disease. The occurrence of 'cold' lytic-like or photon-deficient lesions in bone imaging is probably uncommon. Photon-deficient focus or cold lesion of the sternum was demonstrated on {sup 99m}Tc-MDP bone imaging in 2 individuals with acute myeloid leukemia and primary hepatoma, respectively.

  16. Positive indium-III bone marrow scan in metastatic breast carcinoma. Case report

    International Nuclear Information System (INIS)

    LaManna, M.M.; Hyzinski, M.; Swami, V.K.; Parker, J.A.

    1984-01-01

    Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow in a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy

  17. Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility

    International Nuclear Information System (INIS)

    Messiou, C.; Collins, D.J.; Morgan, V.A.; DeSouza, N.M.

    2011-01-01

    To establish normal bone marrow values of apparent diffusion coefficient (ADC) over an age range, compare them with metastatic and myelomatous involvement, to establish reproducibility and to optimise b values. The ADCs of bone marrow in 7 volunteers (mean age 29.7 years), 34 volunteers (mean age 63.3 years) and 43 patients with metastatic and myelomatous involvement (mean age 65.5 years) were measured. In 9 volunteers diffusion weighted MRI was repeated within 7 days. b values were derived to optimise contrast between normal and pathological marrow. The mean ADC of bone marrow in younger volunteers was significantly higher than that of older volunteers. The coefficient of reproducibility was 14.8%. The ADC mean of metastatic and myeloma bone disease was 1054+/-456 x 10 -6 mm 2 s -1 . An ADC threshold of 655 x 10 -6 mm 2 s -1 separated normal and abnormal marrow with a sensitivity and specificity of 90% and 93% respectively. Contrast between normal and abnormal marrow was optimal at b = 1389 smm -2 . The reproducibility of ADC measurements in bone is equivalent to published data for soft tissue with a high sensitivity and specificity for separating abnormal from age matched normal bone marrow. A b value of around 1,400 smm -2 is optimal for imaging bone marrow. (orig.)

  18. Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility

    Energy Technology Data Exchange (ETDEWEB)

    Messiou, C. [Institute of Cancer Research and Royal Marsden, NHS Foundation Trust, Cancer Research UK Clinical Magnetic Resonance Research Group, Surrey (United Kingdom); Institute of Cancer Research and Royal Marsden, NHS Foundation Trust, MRI Department, Surrey (United Kingdom); Collins, D.J.; Morgan, V.A.; DeSouza, N.M. [Institute of Cancer Research and Royal Marsden, NHS Foundation Trust, Cancer Research UK Clinical Magnetic Resonance Research Group, Surrey (United Kingdom)

    2011-08-15

    To establish normal bone marrow values of apparent diffusion coefficient (ADC) over an age range, compare them with metastatic and myelomatous involvement, to establish reproducibility and to optimise b values. The ADCs of bone marrow in 7 volunteers (mean age 29.7 years), 34 volunteers (mean age 63.3 years) and 43 patients with metastatic and myelomatous involvement (mean age 65.5 years) were measured. In 9 volunteers diffusion weighted MRI was repeated within 7 days. b values were derived to optimise contrast between normal and pathological marrow. The mean ADC of bone marrow in younger volunteers was significantly higher than that of older volunteers. The coefficient of reproducibility was 14.8%. The ADC mean of metastatic and myeloma bone disease was 1054+/-456 x 10{sup -6} mm{sup 2}s{sup -1}. An ADC threshold of 655 x 10{sup -6} mm{sup 2}s{sup -1} separated normal and abnormal marrow with a sensitivity and specificity of 90% and 93% respectively. Contrast between normal and abnormal marrow was optimal at b = 1389 smm{sup -2}. The reproducibility of ADC measurements in bone is equivalent to published data for soft tissue with a high sensitivity and specificity for separating abnormal from age matched normal bone marrow. A b value of around 1,400 smm{sup -2} is optimal for imaging bone marrow. (orig.)

  19. Development of Raman spectral markers to assess metastatic bone in breast cancer

    Science.gov (United States)

    Ding, Hao; Nyman, Jeffry S.; Sterling, Julie A.; Perrien, Daniel S.; Mahadevan-Jansen, Anita; Bi, Xiaohong

    2014-11-01

    Bone is the most common site for breast cancer metastases. One of the major complications of bone metastasis is pathological bone fracture caused by chronic bone loss and degeneration. Current guidelines for the prediction of pathological fracture mainly rely on radiographs or computed tomography, which are limited in their ability to predict fracture risk. The present study explored the feasibility of using Raman spectroscopy to estimate pathological fracture risk by characterizing the alterations in the compositional properties of metastatic bones. Tibiae with evident bone destruction were investigated using Raman spectroscopy. The carbonation level calculated by the ratio of carbonate/phosphate ν1 significantly increased in the tumor-bearing bone at all the sampling regions at the proximal metaphysis and diaphysis, while tumor-induced elevation in mineralization and crystallinity was more pronounced in the metaphysis. Furthermore, the increased carbonation level is positively correlated to bone lesion size, indicating that this parameter could serve as a unique spectral marker for tumor progression and bone loss. With the promising advances in the development of spatially offset Raman spectroscopy for deep tissue measurement, this spectral marker can potentially be used for future noninvasive evaluation of metastatic bone and prediction of pathological fracture risk.

  20. The effect of foot reflexology on pain in patients with metastatic cancer.

    Science.gov (United States)

    Stephenson, Nancy; Dalton, Jo Ann; Carlson, John

    2003-11-01

    Thirty-six oncology inpatients participated in this third pilot study investigating the effects of foot reflexology in which equianalgesic dosing was calculated. Foot reflexology was found to have a positive immediate effect for patients with metastatic cancer who report pain, although there was no statistically significant effect at 3 hours after intervention or at 24 hours after intervention. Further study is suggested for foot reflexology delivered by family in the homes for management of cancer pain.

  1. Molecular Mechanisms That Contribute to Bone Marrow Pain

    Directory of Open Access Journals (Sweden)

    Jason J. Ivanusic

    2017-09-01

    Full Text Available Pain associated a bony pathology puts a significant burden on individuals, society, and the health-care systems worldwide. Pathology that involves the bone marrow activates sensory nerve terminal endings of peripheral bone marrow nociceptors, and is the likely trigger for pain. This review presents our current understanding of how bone marrow nociceptors are influenced by noxious stimuli presented in pathology associated with bone marrow. A number of ion channels and receptors are emerging as important modulators of the activity of peripheral bone marrow nociceptors. Nerve growth factor (NGF sequestration has been trialed for the management of inflammatory bone pain (osteoarthritis, and there is significant evidence for interaction of NGF with bone marrow nociceptors. Activation of transient receptor potential cation channel subfamily V member 1 sensitizes bone marrow nociceptors and could contribute to increased sensitivity of patients to noxious stimuli in various bony pathologies. Acid-sensing ion channels sense changes to tissue pH in the bone marrow microenvironment and could be targeted to treat pathology that involves acidosis of the bone marrow. Piezo2 is a mechanically gated ion channel that has recently been reported to be expressed by most myelinated bone marrow nociceptors and might be a target for treatments directed against mechanically induced bone pain. These ion channels and receptors could be useful targets for the development of peripherally acting drugs to treat pain of bony origin.

  2. Targeted Therapies for Myeloma and Metastatic Bone Cancers

    National Research Council Canada - National Science Library

    Vail, Neal

    2008-01-01

    ... done. Quantified functional groups available for ligand conjugation using S35-labeled ligands. Developed alternative assay to confirm affinity of bone-targeting nanoparticles to hydroxyapatite substrates...

  3. A novel framework for the temporal analysis of bone mineral density in metastatic lesions using CT images of the femur

    Science.gov (United States)

    Knoop, Tom H.; Derikx, Loes C.; Verdonschot, Nico; Slump, Cornelis H.

    2015-03-01

    In the progressive stages of cancer, metastatic lesions in often develop in the femur. The accompanying pain and risk of fracture dramatically affect the quality of life of the patient. Radiotherapy is often administered as palliative treatment to relieve pain and restore the bone around the lesion. It is thought to affect the bone mineralization of the treated region, but the quantitative relation between radiation dose and femur remineralization remains unclear. A new framework for the longitudinal analysis of CT-scans of patients receiving radiotherapy is presented to investigate this relationship. The implemented framework is capable of automatic calibration of Hounsfield Units to calcium equivalent values and the estimation of a prediction interval per scan. Other features of the framework are temporal registration of femurs using elastix, transformation of arbitrary Regions Of Interests (ROI), and extraction of metrics for analysis. Build in Matlab, the modular approach aids easy adaptation to the pertinent questions in the explorative phase of the research. For validation purposes, an in-vitro model consisting of a human cadaver femur with a milled hole in the intertrochanteric region was used, representing a femur with a metastatic lesion. The hole was incrementally stacked with plates of PMMA bone cement with variable radiopaqueness. Using a Kolmogorov-Smirnov (KS) test, changes in density distribution due to an increase of the calcium concentration could be discriminated. In a 21 cm3 ROI, changes in 8% of the volume from 888 ± 57mg • ml-1 to 1000 ± 80mg • ml-1 could be statistically proven using the proposed framework. In conclusion, the newly developed framework proved to be a useful and flexible tool for the analysis of longitudinal CT data.

  4. Painful os styloideum: bone scintigraphy in carpe bossu disease

    International Nuclear Information System (INIS)

    Apple, J.S.; Martinez, S.; Nunley, J.A.

    1984-01-01

    The os styloideum (ninth carpal bone) is an anatomic variant that may occur as an accessory ossicle located dorsally between the capitate and trapezoid, and the bases of the second and third metacarpals. The association of dorsal wrist pain or fatigability with an os styloideum is known as carpe bossu disease. The authors describe a woman with dorsal wrist pain in whom the diagnosis of painful os styloideum (carpe bossu disease) was made using plain radiography, bone scintigraphy and tomography

  5. Lumbar bone mass predicts low back pain in males

    NARCIS (Netherlands)

    Hoozemans, M.J.M.; Koppes, L.L.J.; Twisk, J.W.R.; Dieën, J.H. van

    2012-01-01

    STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study

  6. (153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies.

    Science.gov (United States)

    Correa-González, Luis; Arteaga de Murphy, Consuelo; Pichardo-Romero, Pablo; Pedraza-López, Martha; Moreno-García, Claudia; Correa-Hernández, Luis

    2014-05-01

    Approximately 85% of patients with cancer suffer severe metastatic bone pain for which radionuclide therapy has been employed for pain palliation. We undertook this study to evaluate the pain relief effect of (153)Sm-EDTMP in Mexican patients with severe and painful bone metastases from mainly prostate, breast, and renal cancer and other malignancies. Patients (277) with intense sustained pain caused by bone metastases were referred to the Nuclear Medicine Department of the Oncology Hospital of the Mexican Social Security Institute. The patients had to have acceptable physical conditions, a previous positive (99m)Tc-MDP scan and blood values within normal range. (153)Sm-EDTMP was prepared at the Instituto Nacional de Investigaciones Nucleares (ININ) and 37 MBq/kg of body weight was injected intravenously. Pain palliation was evaluated with a visual analogue scale (VAS) and a verbal rating scale (VRS) before treatment and 3 and 12 weeks after treatment was started. The age interval of the patients was 24-92 years with a mean age of 64 ± 12 years. Mean values for hemoglobin, leukocyte and platelet counts did not statistically differ at zero time, 3 and 12 weeks after treatment. Pain intensity and relief assessment were statistically different: 9.1 ± 0.61 units initially; 4.2 ± 1.3 units 3 weeks later (54%) and after 12 weeks the pain diminished to 2.4 ± 1.4 units (74%) in the pain relief score scales. (153)Sm-EDTMP was readily available, safe and well tolerated. We conclude that (153)Sm-EDTMP was an adequate palliative agent and was the best option for our Mexican patients to relieve their severe metastatic bone pain. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

  7. A case report of disabling bone pain after long-term kidney transplantation.

    Science.gov (United States)

    Myint, T M M; Vucak-Dzumhur, M; Ebeling, P R; Elder, G J

    2014-02-01

    A 77-year-old man, who received a renal transplant 13 years before for IgA glomerulonephritis, was referred after he developed bilateral mid-tibial aching pain that did not improve with simple analgesia. He had recently been changed from low-dose cyclosporine to tacrolimus, but the pain did not improve when this was reversed. He had a history of focal prostatic adenocarcinoma, cryptococcal lung infection, osteoporosis treated with alendronate for 2 years and multiple squamous cell carcinomas, including one requiring left neck dissection and radiotherapy. Upon physical examination, he had gouty tophi and marked bilateral tibial tenderness but had no other clinical findings. Laboratory investigations included an elevated intact parathyroid hormone value of 7.9 pmol/L (1.6 to 6.9), bone specific alkaline phosphatase of 22 µg/L (3.7 to 20.9), urinary deoxypyridinoline/creatinine ratio of 7.2 nmol/mmol (2.5 to 5.4) and C-reactive protein. Chest X-ray and tibial X-rays were normal, but there was marrow oedema and a prominent periosteal reaction on magnetic resonance imaging. A radionuclide bone scan showed increased symmetrical, linear uptake in both tibiae and the left femur, and uptake was also noted in both clinically asymptomatic humeri. Tibial bone biopsy disclosed small deposits of poorly differentiated metastatic cancer and a follow-up chest CT revealed a lung lesion. It was concluded that the bone pain and periostitis was caused by primary lung cancer with metastatic disease to bone, and an associated hypertrophic osteoarthropathy.

  8. How MMPs Impact Bone Responses to Metastatic Prostate Cancer

    Science.gov (United States)

    2011-04-30

    bone metabolism. J Biol Chem 2006;281:33814–24. 28. Wilson TJ, Nannuru KC, Singh RK. Cathepsin G-mediated activation of pro-matrix metalloproteinase 9...male mice. Nat Genet 2003;35:252–7. [47] Lynch CC, Hikosaka A, Acuff HB, Martin MD, Kawai N, Singh RK, et al. MMP-7 promotes prostate cancer-induced...described (15). A luciferase tagged 4T1 mammary tumor cell line (16) was kindly provided by Dr. Swati Biswas of Vanderbilt Center for Bone Biology. All

  9. Effect of Physical Forces on the Metastatic Bone Microenvironment

    Science.gov (United States)

    2014-12-01

    gravitational loading does not account for the skeletal effect of botulinum toxin -induced muscle inhibition suggesting a direct effect of muscle on bone...osteoblastic properties . Cancer Res 47:4961– 4966. Schmidt AF, Nielen M, Klungel OH, Hoes AW, de Boer A, Groenwold RH, Kirpensteijn J. 2013. Prognostic

  10. Deconvoluting the Complexity of Bone Metastatic Prostate Cancer via Computational Modeling

    Science.gov (United States)

    2016-09-01

    fluent in English and Spanish and have experience in IT, programming, cell culture, teaching , art, graphic design, and leadership skills. Personal...2007) Teacher programme for the translation of science into classrooms University of Notre Dame, Indiana, USA (2004-2005) One-Year Academic Exchange...integrated computational modeling approach can be used to predict the temporal behavior of bone metastatic prostate cancer heterogeneous for TGFβ and

  11. Detection of metastatic bone cancer by scintiscanning with sup(99m)Tc labelled sodium pyrophosphate

    International Nuclear Information System (INIS)

    Kromer, Bernard.

    1973-01-01

    Bone scanning with sup(99m)Tc sodium pyrophosphate was performed in 65 patients with primary neoplasms, using a gamma-camera. The scans are compared to those obtained with 85 Sr and 87 Sr. Sup(99m)Tc appears to be superior to the other two in the detection of metastatic bone lesions, mainly because of its physical characteristics (high yield of 140 KeV photons, short physical half-life). The advantages related to these characteristics are emphasized: possibility of rapid and systematic investigation of the whole skeleton using a gamma-camera; low dose irradiation of the patient which enables frequent repetitive studies to be performed [fr

  12. Bone metastasis pattern in initial metastatic breast cancer: a population-based study

    Directory of Open Access Journals (Sweden)

    Xiong Z

    2018-02-01

    Full Text Available Zhenchong Xiong,1–3,* Guangzheng Deng,1–3,* Xinjian Huang,1–3,* Xing Li,1–3 Xinhua Xie,1–3 Jin Wang,1–3 Zeyu Shuang,1–3 Xi Wang1–3 1Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; 2State Key Laboratory of Oncology in Southern China, Guangzhou, China; 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, China *These authors contributed equally to this work Purpose: Bone is one of the most common sites of breast cancer metastasis, and population-based studies of patients with bone metastasis in initial metastatic breast cancer (MBC are lacking. Materials and methods: From 2010 to 2013, 245,707 breast cancer patients and 8901 patients diagnosed with initial bone metastasis were identified by Surveillance, Epidemiology, and End Results database of the National Cancer Institute. Multivariate logistic and Cox regression were used to identify predictive factors for the presence of bone metastasis and prognosis factors. Kaplan–Meier method and log-rank test were used for survival analysis. Results: Eight thousand nine hundred one patients with initial MBC had bone involvement, accounting for 3.6% of the entire cohort and 62.5% of the patients with initial MBC. Also, 70.5% of patients with bone metastasis were hormone receptor (HR positive (HR+/human epidermal growth factor receptor 2 [HER2]−: 57.6%; HR+/HER2+: 12.9%. Patients with initial bone metastasis had a better 5-year survival rate compared to those with initial brain, liver, or lung metastasis. HR+/HER2− and HR+/HER2+ breast cancer had a propensity of bone metastasis in the entire cohort and were correlated with better prognosis in patients with initial bone metastasis. Local surgery had significantly improved overall survival in initial MBC patients with bone metastasis. Conclusion: Our study has provided population-based estimates of epidemiologic characteristics and prognosis in patients with bone metastasis at the time of

  13. Pain During Bone Marrow Aspiration: Prevalence and Prevention

    NARCIS (Netherlands)

    Vanhelleputte, P.; Nijs, K.A.N.D.; Delforge, M.; Evers, G.; Vanderschueren, S.

    2003-01-01

    The Prevalence, intensity, determinants and prevention of pain during bone marrow aspiration (BMA) in adults are not well defined. In the first part of this prospective study (observational phase), 132 adult hematological patients undergoing BMA after local anesthesia scored the procedural pain by

  14. Bone scintigraphy in children with obscure skeletal pain

    International Nuclear Information System (INIS)

    Majd, Massoud

    1979-01-01

    In a group of 82 children with focal or generalized skeletal pain of obscure etiology, the radionuclide skeletal scintigraphy was the only, or the most informative, clue to the diagnosis of a variety of benign and malignant conditions. It is strongly recommended that any unexplained bone or joint pain in children be evaluated by this non-invasive technique [fr

  15. Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules

    International Nuclear Information System (INIS)

    Gaze, Mark N.; Kelly, Charles G.; Kerr, Gillian R.; Cull, Ann; Cowie, Valerie J.; Gregor, Anna; Howard, Grahame C.W.; Rodger, Alan

    1997-01-01

    Background: The optimum dose and fractionation schedule for the palliative irradiation of painful bone metastases is controversial. Purpose: To compare the efficacy, side-effects and effect on quality of life of two commonly used radiotherapy schedules in the management of painful bone metastases. Materials and methods: In a prospective trial, 280 patients were randomised to receive either a single 10 Gy treatment or a course of 22.5 Gy in five daily fractions for the relief of localised metastatic bone pain. Results: Response rates have been calculated from 240 assessable treated sites of pain. The overall response rates were 83.7% (single treatment) and 89.2% (five fractions). The complete response rates were 38.8% (single treatment) and 42.3% (five fractions). The median duration of pain control was 13.5 weeks (single treatment) and 14.0 weeks (five fractions). None of these differences was statistically significant. There were no differences between the groups in the effect of treatment on a variety of quality of life parameters. Conclusions: It is concluded that a single 10 Gy treatment is as effective as a course of 22.5 Gy in five fractions in the management of painful bone metastases

  16. The role of disodium pamidronate in the management of bone pain due to malignancy.

    Science.gov (United States)

    Groff, L; Zecca, E; De Conno, F; Brunelli, C; Boffi, R; Panzeri, C; Cazzaniga, M; Ripamonti, C

    2001-07-01

    A number of controlled studies have recently demonstrated the role of disodium pamidronate in the prevention of skeletal complications in patients with metastatic bone disease due to breast cancer and multiple myeloma. They have also shown that it relieves pain and is well tolerated. The aim of this open prospective study was to evaluate the acceptability of a new schedule of pamidronate infusion and to assess pain, analgesic consumption and the Karnofsky Performance Status (KPS) in patients with metastatic bone pain treated with pamidronate in association or not with chemotherapy, radiotherapy, and hormone therapy. Patients with different types of cancer and at least one painful bone metastasis were treated with two cycles of 60 mg intravenous (iv) pamidronate weekly for three consecutive doses, with a 3-week interval between the two cycles (six infusions over 7 weeks), followed by one infusion every 3 weeks for a total of 24 infusions. Two hundred patients were enrolled in the study, of whom 94 received at least the first six infusions; 25 patients received all 24 infusions. Pamidronate was well tolerated in the majority of the patients both during the first six infusions and during the whole study period. In the patients under study, pain intensity decreased compared with T0 after the first two infusions (second week of treatment). The mean equivalent daily dose of oral morphine required ranged from 21.5 to 41.5 mg/day and was low and stable during the study. For the patients who remained in the study, the KPS remained around 70 during the whole treatment period and intrasubject analysis showed a substantial stability of the KPS within each subject. A first fracture occurred within 321 days in 25% of the whole population under study. Pamidronate represents a further valid therapy to add to an already consolidated list of therapies such as radiotherapy, chemotherapy, hormone therapy and orthopaedic intervention in the pain management of patients with bone

  17. Opposite prognostic roles of HIF1β and HIF2β expressions in bone metastatic clear cell renal cell cancer

    DEFF Research Database (Denmark)

    Szendroi, Attila; Szász, A. Marcell; Kardos, Magdolna

    2016-01-01

    BACKGROUND: Prognostic markers of bone metastatic clear cell renal cell cancer (ccRCC) are poorly established. We tested prognostic value of HIF1β/HIF2β and their selected target genes in primary tumors and corresponding bone metastases. RESULTS: Expression of HIF2β was lower in mRCC both at m...

  18. Pain of osteoarthritis and bone uptake - is there a correlation

    International Nuclear Information System (INIS)

    Wadhwa, S.S.; Carollan, M.; Abbati, D.; Chan, W.-L.; Bui, C.

    2003-01-01

    Full text: In patients with osteoarthritis bone scintigraphy is consistently reported as demonstrating mild, moderate or severe arthritis, particularly for the medial compartment of the knee, depending on the degree of uptake. Numerous studies however have not demonstrated a correlation between severity of bone scan findings and severity of osteoarthritis (OA) demonstrated at surgery or arthroscopy. In fact, most studies have not demonstrated any correlation between OA as assessed with imaging and subsequent surgical findings. The only positive correlation for outcome of OA of the knee appears to be the severity of pain. In this pilot study we investigate if there is correlation between pain and scintigraphic findings in medial compartment OA. 69 patients (18 - 87 years) without history of recent knee trauma or previous surgery for insertion of knee prosthesis who presented for a bone scan for any reasons were studied. All patients were asked to quantify any knee pain on a simple 4 point score i.e. no pain, non limiting pain, pain limiting daily activity and rest pain. Uptake in the medial compartment of the knee was quantified by measuring the count ratio between the medial compartment and the corresponding distal femur. 45 patients reported no pain, 20 reported non-limiting pain while 4 reported limiting pain. No patient reported pain at rest. In general pain was bilateral with no major differences. The mean knee/femur ratio for patients with no pain was 1.46 +/- 0.95 (N=90). Knee/femur ratio for patients with non-limiting pain was 1.77 +/- 0.57 (N=40) and for those with limiting pain it was 2.36 +/- 1.82 (N=8). Although the results were not statistically significant there was a clear trend towards a rising knee/femur ratio with increasing pain. The number of patients with knee pain was small and further study concentrating on this group would be required to assess the significance of the trend findings. Further study particularly in patients with significant

  19. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    International Nuclear Information System (INIS)

    Kairemo, Kalevi; Rasulova, Nigora; Suslaviciute, Justina; Alanko, Tuomo

    2014-01-01

    Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC) stage T 4 N 2 M 1b , with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume). In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18 F-FDG PET/CT. The patient received 153 Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed

  20. Utilization of Samarium-153 in bone pain and bone tumours in dog

    International Nuclear Information System (INIS)

    Martin, V. de; Marques, F.L.N.; Okamoto, M.; Guimaraes, M.I.C.C.; Dias-Neto, A.; Fonseca, A.C.

    1997-01-01

    Full text: The experimental unit of of Centro de Medicina Nuclear of the University of Sao Paulo is working on the utilization of Sm-153-EDTMP, produced by IPEN/CNEN-SP (Brazil), for the treatment of bone pain due either inflammatory process or bone tumours spontaneously developed in dogs. The effect of the injection of the radiopharmaceutical (37 MBq/kg) were analysed by observing the animal behavior against the pain and the evolution of the clinical picture of the inflammatory process. The cases where tumours were diagnosed, bone scintigraphy was performed to follow-up the evolution of those tumours. Preliminary observations indicated that, especially in inflammatory process due to disc spondylitis, there was an improvement concerning pain and consequently a better condition of the life for those animals. Bone tumours even being more difficult to evaluate, have shown a favorable evolution concerning the reduction of pain and consequently the increase in the life span of the animals

  1. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy); Ballicu, Nicola, E-mail: nicolaballicu77@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy)

    2016-01-15

    PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.

  2. Re-evaluation of bone pain in patients with type 1 Gaucher disease suggests that bone crises occur in small bones as well as long bones.

    Science.gov (United States)

    Baris, Hagit N; Weisz Hubshman, Monika; Bar-Sever, Zvi; Kornreich, Liora; Shkalim Zemer, Vered; Cohen, Ian J

    2016-09-01

    Bone crises in type 1 Gaucher disease are reported in long bones and occasionally in weight bearing bones and other bones, but rarely in small bones of the hands and feet. We retrospectively examined the incidence of bone pain in patients followed at the Rabin Medical Center, Israel, before and following the initiation of enzyme replacement therapy (ERT) and evaluated them for bone crises. Of 100 type I Gaucher disease patients, 30 (30%) experienced one or more bone crises. Small bone crises represented 31.5% of all bone crises and were always preceded by crises in other bones. While the incidence of long bone crises reduced after the initiation of ERT, small bone crises increased. Almost 60% of patients with bone crises were of the N370S/84GG genotype suggesting a greater susceptibility of N370S/84GG patients to severe bone complications. These patients also underwent the greatest number of splenectomies (70.6% of splenectomised patients). Splenectomised patients showed a trend towards increased long and small bone crises after surgery. Active investigation of acute pain in the hands and feet in patients in our cohort has revealed a high incidence of small bone crises. Physicians should consider imaging studies to investigate unexplained pain in these areas. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases

    NARCIS (Netherlands)

    Westhoff, Paulien G.; De Graeff, Alexander; Monninkhof, Evelyn M.; Pomp, Jacqueline; Van Vulpen, Marco; Leer, Jan Willem H; Marijnen, Corrie A M; Van Der Linden, Yvette M.

    2015-01-01

    Purpose: To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response. Patients and Methods: The prospectively collected data of 956 patients with breast, prostate, and lung cancer within

  4. Utility of bone SPECT in temporomandibular joint pain

    International Nuclear Information System (INIS)

    Yang, Dong Hunn; Sung, Mi Sook; Lee, Jung Whee; Chung, Soo Kyo; Shinn, Kyung Sub

    1997-01-01

    Temporomandibular (TM) joint pain results from many etiologic factors. The aim of this study was to evaluate the utility of Bone SPECT in patients with TM joint pain. The subjects were 34 patients with TM joint pain. All patients underwent plain radiography, planar bone scan, and Bone SPECT. The intensity of radioisotope uptake at TM joint was graded into three; no increased uptake above the background activity as grade 0, uptake similar to occipital bone as grade I, and uptake similar to maxillary sinus as grade II. Clinical findings and therapeutic methods were reviewed. Twenty-seven patients (80%) out of 34 patients with TM joint pain had increased uptake in bone SPECT. Twenty-one (78%) out of 27 patients had increased uptake in the mandibular condyle and remaining six patients (22%) had uptake in the mandibular and maxillary arch, which proved to be dental problem. Seven patients (21%) out of 34 were grade as 0, four (12%) were grade I, 23 (68%) were grade. II. Four patients with grade I had clicking sound and symptoms which were subsided with medication in all cases. Among 23 patients with grade II, 7 patients had clicking sound and 14 patients underwent medication and decompression therapy. With Planar bone scan, 11 cases (32%) had increased uptake in TM joint area. Plain radiography revealed narrowing, distension, erosion and limitation of TM joint in 16 cases (47%). Bone SPECT can be valuable for screening and managing the patients with TM joint pain. Patients with grade II needed intensive treatment such as joint aspiration. However degree of the radioisotope uptake did not well correlated with clinical symptoms

  5. Neuroinflammation, Bone Marrow Stem Cells, and Chronic Pain

    Directory of Open Access Journals (Sweden)

    Yul Huh

    2017-08-01

    Full Text Available Current treatments for chronic pain, such as inflammatory pain, neuropathic pain, and cancer pain are insufficient and cause severe side effects. Mounting evidence suggests that neuroinflammation in the peripheral and central nervous system (PNS and CNS plays a pivotal role in the genesis and maintenance of chronic pain. Characteristic features of neuroinflammation in chronic pain conditions include infiltration of immune cells into the PNS [e.g., the sciatic nerve and dorsal root ganglion (DRG], activation of glial cells such as microglia and astrocytes in the CNS (spinal cord and brain, and production and secretion of pro-inflammatory cytokines and chemokines [TNF, interleukin (IL-1β, IL-6, CCL2, and CXCL1]. Recent studies suggest that bone marrow stem cells or bone marrow stromal cells (BMSCs produce powerful analgesic effects in animal models of inflammatory pain, neuropathic pain, and cancer pain. We recently demonstrated that intrathecal injection of BMSCs resulted in a long-term relief of neuropathic pain for several weeks after peripheral nerve injury. Strikingly, this analgesic effect is mediated by the anti-inflammatory cytokine transforming growth factor beta secreted from BMSCs. Additionally, BMSCs exhibit potent modulation of neuroinflammation, by inhibiting monocyte infiltration, glial activation, and cytokine/chemokine production in the DRG and spinal cord. Thus, BMSCs control chronic pain by regulation of neuroinflammation in the PNS and CNS via paracrine signaling. In this review, we discuss the similar results from different laboratories of remarkable anti-nociceptive efficacy of BMSCs in animal and clinical studies. We also discuss the mechanisms by which BMSCs control neuroinflammation and chronic pain and how these cells specifically migrate to damaged tissues.

  6. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    Science.gov (United States)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  7. The Src family kinase inhibitor dasatinib delays pain-related behaviour and conserves bone in a rat model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Appel, Camilla Kristine; Gallego-Pedersen, Simone; Andersen, Line

    2017-01-01

    -induced bone pain, including cancer growth, osteoclastic bone degradation and nociceptive signalling. Here we investigate the role of dasatinib, an oral Src kinase family and Bcr-Abl tyrosine kinase inhibitor, in an animal model of cancer-induced bone pain. Daily administration of dasatinib (15 mg/kg, p...

  8. Markers of bone pain in the hemodialysis patients with renal insufficiency

    International Nuclear Information System (INIS)

    Oka, Fumitoshi; Sagawa, Hitoshi; Yabe, Kinji

    1988-01-01

    The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum contrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain. (author)

  9. Recent advances in technologies for the detection of occult metastatic cells in bone marrow of breast cancer patients

    International Nuclear Information System (INIS)

    Braun, Stephan; Harbeck, Nadia

    2001-01-01

    Approximately half of breast cancer patients with stage I–III disease will suffer metastatic disease despite resection with tumour-free margins. In 30–40% of these patients, individual carcinoma cells can already be detected at the time of primary therapy in cytological bone marrow preparations using immunocytochemistry. Numerous prospective clinical studies have shown that the presence of occult metastatic cells in bone marrow is prognostically relevant to patient survival. Only a few studies failed to do so, thus stimulating a critical discussion on the methodology and clinical value of bone marrow analysis. The potential for obtaining improved prognostic information on patient outcome, for monitoring tumour cell eradication during adjuvant and palliative systemic therapy, and for specifically targeting tumour biological therapies are intriguing clinical opportunities that may be afforded by bone marrow analysis. Standardized and robust methodology is a prerequisite for clinical application of these techniques, however

  10. The rate of 99m Tc-MDP uptake in metastatic bone lesions before and after 89m Sr therapy

    International Nuclear Information System (INIS)

    Souza, Joseane Fonseca; Braga, Francisco J.H.N.

    1996-01-01

    The rate of 99m Tc-MDP uptake is studied in metastatic bone lesions, before and after 89m Sr therapy. Eight hopeless patients (age between 56 and 74) presenting disseminated carcinoma of the prostate are evaluated. No hormonal therapy and a limited radiotherapy were considered. It is concluded that therapeutical doses of 89m Sr reduces MDP uptake

  11. Experimental ex-vivo validation of PMMA-based bone cements loaded with magnetic nanoparticles enabling hyperthermia of metastatic bone tumors

    Directory of Open Access Journals (Sweden)

    Mariem Harabech

    2017-05-01

    Full Text Available Percutaneous vertebroplasty comprises the injection of Polymethylmethacrylate (PMMA bone cement into vertebrae and can be used for the treatment of compression fractures of vertebrae. Metastatic bone tumors can cause such compression fractures but are not treated when injecting PMMA-based bone cement. Hyperthermia of tumors can on the other hand be attained by placing magnetic nanoparticles (MNPs in an alternating magnetic field (AMF. Loading the PMMA-based bone cement with MNPs could both serve vertebra stabilization and metastatic bone tumor hyperthermia when subjecting this PMMA-MNP to an AMF. A dedicated pancake coil is designed with a self-inductance of 10 μH in series with a capacitance of 0.1 μF that acts as resonant inductor-capacitor circuit to generate the AMF. The thermal rise is appraised in beef vertebra placed at 10 cm from the AMF generating circuit using optical temperatures sensors, i.e. in the center of the PMMA-MNP bone cement, which is located in the vicinity of metastatic bone tumors in clinical applications; and in the spine, which needs to be safeguarded to high temperature exposures. Results show a temperature rise of about 7 °C in PMMA-MNP whereas the temperature rise in the spine remains limited to 1 °C. Moreover, multicycles heating of PMMA-MNP is experimentally verified, validating the technical feasibility of having PMMA-MNP as basic component for percutaneous vertebroplasty combined with hyperthermia treatment of metastatic bone tumors.

  12. Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: a prospective study using quality-of-life assessment

    International Nuclear Information System (INIS)

    Cheung, G.; Chow, E.; Holden, L.; Vidmar, M.; Danjoux, C.; Yee, A.J.M.; Connolly, R.; Finkelstein, J.

    2006-01-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive outpatient procedure whereby vertebral compression fractures are stabilized by the injection of bone cement, or polymethyl methacrylate (PMMA). Rapid partial or complete pain relief can usually be achieved through this procedure. We prospectively evaluate the efficacy of PVP in the relief of pain and improvement in quality of life of patients with intractable pain from osteoporotic and metastatic fractures. Patients with intractable pain from vertebral metastases (many resistant to palliative radiation therapy) and patients with intractable painful osteoporotic fractures were treated with parapedicular or transpedicular injection of PMMA. Plane X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan were performed on all patients. With a reflex hammer, percussion pain was correlated to the imaging abnormalities. The preplanning CT scan was used to calculate the exact entry point and angle of the bone-biopsy needle. All patients were assessed before and after the procedure for quality of life and amount of pain. The following measures were used: 1) the Edmonton Symptom Assessment System (ESAS), for global pain, nausea, tiredness, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath; 2) a site-specific pain score (SSPS); 3) the amount of analgesic intake in morphine equivalents in the last 24 hours; and 4) the Townsend Functional Assessment Scale (TFAS), ascertaining mobility. A postprocedural CT scan was performed the same day on all patients. Follow-up assessment consisted of a phone call at Days 1, 2, and 4 and Weeks 1, 2, 4, 8, and 12. Patients with recurrent back pain or complications were followed in the bone metastases clinic. Thirty patients (19 women, 11 men) were evaluated. Their median age was 68 years (range 31 to 87 years). Thirty procedures (n=30) at 45 vertebral levels were performed; 13 were for pathologic fractures, and 17 were for

  13. Treatment of pains from bone metastases with 90Y

    International Nuclear Information System (INIS)

    Kutzner, J.; Daehnert, W.; Schreyer, T.; Grimm, W.; Brod, K.H.; Becker, M.

    1981-01-01

    For palliation of pain caused by bone metastases beta radiation isotope therapy was successful. As shown in experimental work on animals bone uptake of 90 Y with its shorter half-life is high when it is administered as a citrate complex. 90 Y can be eluted with high purity from a 90 Sr cow. The retention in man was found by whole-body counting to be higher than 80%. In preliminary trials on 16 patients the analgetic effect was the same as that of 89 Sr. The properties of 90 Y therapy are discussed. (orig.) [de

  14. Radiation therapy for metastatic lesions from breast cancer. Breast cancer metastasis to bone

    International Nuclear Information System (INIS)

    Hayashi, Shinya; Hoshi, Hiroaki

    2000-01-01

    This paper summarizes radiation therapy in the treatment of bone metastases from breast cancer. Bone metastasis occurs in approximately 70% of breast cancer patients, and the goals of radiation therapy for bone metastasis are: palliation of pain, prevention and treatment of neuropathic symptoms, and prevention of pathologic fractures. The prognosis of bone metastasis from breast cancer is known to be better than that of bone metastasis from other solid tumors. Local-field radiation, hemibody (or wide-field) radiation, and systemic radionuclide treatment are the major methods of radiation therapy for pain palliation. Although many studies have shown that breast cancer is more responsive to radiation therapy for pain palliation than other solid tumors, some studies found no significant difference. Local-field radiation therapy, which includes multi-fraction irradiation and single-fraction irradiation, is currently the most generally used method of radiotherapy for pain palliation. Pain palliation has been reported to be achieved in approximately 80% to 90% of patients treated with local-field external beam irradiation. Three types of multi-fraction irradiation therapy are administered depending on the prognosis: high-dose fraction irradiation (36-50 Gy/12-25 Fr/2.4-5 wk), short-course irradiation (20-30 Gy/10-15 Fr/2-3 wk), and ultra-short-course irradiation (15-25 Gy/2-5 Fr/1 wk). The most common irradiation schedule is 30 Gy/10 Fr/2 wk. Although many reports indicate no significant difference in pain palliation according to the dose, the percentage of patients who show a complete cure is significantly higher in those treated with doses of 30 Gy or more, and thus the total irradiation dose should be at least 30 Gy. High-dose fraction irradiation is indicated for patients with an expected survival time of 6 months or more while short-course or single-fraction irradiation is indicated for those with an expected survival time of 3 months or more. Single

  15. Radiation therapy for metastatic lesions from breast cancer. Breast cancer metastasis to bone

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Shinya; Hoshi, Hiroaki [Gifu Univ. (Japan). School of Medicine

    2000-10-01

    This paper summarizes radiation therapy in the treatment of bone metastases from breast cancer. Bone metastasis occurs in approximately 70% of breast cancer patients, and the goals of radiation therapy for bone metastasis are: palliation of pain, prevention and treatment of neuropathic symptoms, and prevention of pathologic fractures. The prognosis of bone metastasis from breast cancer is known to be better than that of bone metastasis from other solid tumors. Local-field radiation, hemibody (or wide-field) radiation, and systemic radionuclide treatment are the major methods of radiation therapy for pain palliation. Although many studies have shown that breast cancer is more responsive to radiation therapy for pain palliation than other solid tumors, some studies found no significant difference. Local-field radiation therapy, which includes multi-fraction irradiation and single-fraction irradiation, is currently the most generally used method of radiotherapy for pain palliation. Pain palliation has been reported to be achieved in approximately 80% to 90% of patients treated with local-field external beam irradiation. Three types of multi-fraction irradiation therapy are administered depending on the prognosis: high-dose fraction irradiation (36-50 Gy/12-25 Fr/2.4-5 wk), short-course irradiation (20-30 Gy/10-15 Fr/2-3 wk), and ultra-short-course irradiation (15-25 Gy/2-5 Fr/1 wk). The most common irradiation schedule is 30 Gy/10 Fr/2 wk. Although many reports indicate no significant difference in pain palliation according to the dose, the percentage of patients who show a complete cure is significantly higher in those treated with doses of 30 Gy or more, and thus the total irradiation dose should be at least 30 Gy. High-dose fraction irradiation is indicated for patients with an expected survival time of 6 months or more while short-course or single-fraction irradiation is indicated for those with an expected survival time of 3 months or more. Single

  16. Gastric carcinoma metastatic to the bone marrow: immunoperoxidase identification of KMO-1 antigen in MGG-destained aspirate.

    Science.gov (United States)

    Kobayashi, T K; Yakushiji, M

    1991-01-01

    A case is presented that illustrates the application of the immunoperoxidase technique to the May-Grünwald-Giemsa (MGG)-destained bone marrow aspirate. The cytologic findings in a MGG-stained smear of the bone marrow suggested a metastatic epithelial tumor. Subsequently, a positive reaction to KMO-1, a monoclonal antibody raised against a colon carcinoma cell line, was demonstrated in tumor cells in the MGG-destained smear sample as well as in the paraffin-embedded section of the primary gastric cancer. The demonstration of the cancer-associated antigen in the MGG-destained material may be useful in establishing the diagnosis of metastatic tumor in the bone marrow.

  17. Effect of music therapy on pain behaviors in rats with bone cancer pain.

    Science.gov (United States)

    Gao, Ji; Chen, Shaoqin; Lin, Suyong; Han, Hongjing

    2016-01-01

    To investigate the effects of music therapy on the pain behaviors and survival of rats with bone cancer pain and analyze the mediating mechanism of mitogen activated protein kinase (MAPK) signal transduction pathway. Male Wistar rats aged 5-8 weeks and weighing 160-200 g were collected. The rat models of colorectal cancer bone cancer pain was successfully established. Animals were divided into experimental and control group, each with 10 rats. The animals in the observation group were given Mozart K448 sonata, sound intensity of 60 db, played the sonata once every 1 hr in the daytime, stopped playing during the night, and this cycle was kept for 2 weeks. On the other hand, rats in the control group were kept under the same environment without music. Animals in the experimental group consumed more feed and gained significant weight in comparison to the control group. The tumor volume of the experimental group was significantly smaller than that of the control group (pMusic therapy may improve the pain behaviors in rats with bone cancer pain, which might be related with low expression of p38á and p38β in the MAPK signal transduction pathway.

  18. Improved conditions for labeling EDTMP with 188Re for bone pain palliation

    International Nuclear Information System (INIS)

    Faintuch, B.L.; Osso, J.A. Jr.; Muramoto, E.; Faintuch, S.

    2002-01-01

    Introduction: Ethilenediamine tetramethylene phosphonate (EDTMP) is a tetraphosphonate ligand which, when labeled with 188 Re, can be used for relief of metastatic bone pain. The preferential localization of phosphonate complexes in bone is attributed to their affinity for calcium, and tetraphosphonates may be equal or superior to diphosphonates in this regard. In the present study, it was aimed to determine optimal conditions for preparation of a kit of EDTMP to be labeled with 188 Re. Methods: EDTMP was dissolved in NaOH 1N, and alkalinity was reversed with HCl till pH 2, when SnCl 2 . 2H 2 0 and also ascorbic acid were introduced in the mixture, followed by Na 188 ReO 4 . The preparation was incubated in water bath for 30 minutes and after cooling radiochemical purity was assessed. Optimization of the process consisted in varying the values of EDTMP mass (20, 30, 40 mg) SnCl 2 .2H 2 0 concentration (0.5, 1.0, 2.0 and 3.0 mg/mL), and reaction time (15 and 30 minutes). Radiochemical purity and stability were ascertained in vitro and also in Swiss mice. Bone/muscle uptake ratio was calculated from %ID/g of these organs. Results: The best 188 Re-EDTMP complex was obtained with 40 mg of the ligand and 2 mg/mL of stannous chloride heated during 15 minutes, and the product was radiochemically stable during 24 hours. Kidney and bone uptake were very significant (respectively 4.5 ± 0.5% and 3.1 ± 0.3 %ID/g). Bone/muscle ratio observed four hours post-injection was also very adequate (28.5). Conclusions: A stable and biologically useful complex of 188 Re-EDTMP can be prepared with high concentration of EDTMP and considerable uptake by bone. It compares favorably with 153 Sm-EDTMP, as 188 Re has more advantageous radioisotopic properties than 153 Sm, and it can be recommended for further studies in conditions of painful bone metastases

  19. Single-dose radiotherapy for painful bone metastases

    International Nuclear Information System (INIS)

    Kal, H.B.

    1999-01-01

    Background: External beam radiotherapy is frequently applied for palliative treatment of painful bone lesions with a variety of fractionation schemes. There is a continuous interest to administer only 1 or a few dose fractions for inducing pain relief. Methods: A review of the literature was made with the aim to determine whether a treatment can be deduced that is simple and effective. The linear-quadratic (L-Q) concept was applied to compare reported therapy schemes which each other for the iso-effect pain relief. Results: Single-dose and fractionated radiotherapy resulted in partial or complete pain relief in about 80% of the patients. Complete responses have been observed in about 43% of the patients. For patients responding to treatment, the duration of pain relief is at least 3 to 4 months with reported duration of up to 1 year or even longer. Conclusion: Based on this review of literature data concerning randomized trials a treatment with a single dose of 8 Gy is effective for inducing pain relief. (orig.) [de

  20. Use of articulated registration for response assessment of individual metastatic bone lesions

    International Nuclear Information System (INIS)

    Yip, Stephen; Jeraj, Robert

    2014-01-01

    Accurate skeleton registration is necessary to match corresponding metastatic bone lesions for response assessment over multiple scans. In articulated registration (ART), whole-body skeletons are registered by auto-segmenting individual bones, then rigidly aligning them. Performance and robustness of the ART in lesion matching were evaluated and compared to other commonly used registration techniques. Sixteen prostate cancer patients were treated either with molecular targeted therapy or chemotherapy. Ten out of the 16 patients underwent the double baseline whole-body [F-18]NaF PET/CT scans for test-retest (TRT) evaluation. Twelve of the 16 patients underwent pre- and mid-treatment [F-18]NaF PET/CT scans. Skeletons at different time points were registered using ART, rigid, and deformable (DR) registration algorithms. The corresponding lesions were contoured and identified on successive PET images based on including the voxels with the standardized uptake value over 15. Each algorithm was evaluated for its ability to accurately align corresponding lesions via skeleton registration. A lesion matching score (MS) was measured for each lesion, which quantified the per cent overlap between the lesion's two corresponding contours. Three separate sensitivity studies were conducted to investigate the robustness of ART in matching: sensitivity of lesion matching to various contouring threshold levels, effects of imperfections in the bone auto-segmentation and sensitivity of mis-registration. The performance of ART (MS = 82% for both datasets, p ≪ 0.001) in lesion matching was significantly better than rigid (MS TRT  = 53%, MS Response  = 46%) and DR (MS TRT  = 46%, MS Response  = 45%) algorithms. Neither varying threshold levels for lesion contouring nor imperfect bone segmentation had significant (p∼0.10) impact on the ART matching performance as the MS remained unchanged. Despite the mis-registration reduced MS for ART, as low as 67% (p ≪ 0.001), the

  1. Clinical benefit of bone-targeted radiometabolic therapy with 153Sm-EDTMP combined with chemotherapy in patients with metastatic hormone-refractory prostate cancer

    International Nuclear Information System (INIS)

    Ricci, Sergio; Pastina, Ilaria; Cianci, Claudia; Orlandini, Cinzia; Chioni, Aldo; Di Donato, Samantha; Boni, Giuseppe; Genovesi, Dario; Grosso, Mariano; AlSharif, Abedallatif; Mariani, Giuliano; Francesca, Francesco

    2007-01-01

    Bone metastases are responsible for most of the morbidity associated with hormone-refractory prostate cancer (HRPC). 153 Sm-ethylenediaminetetramethylene phosphonate ( 153 Sm-EDTMP) has been approved for palliation of painful skeletal metastases. We retrospectively investigated the possible synergistic effect on survival of 153 Sm-EDTMP (given to HRPC patients for bone pain palliation) and chemotherapy. Forty-five HRPC patients were evaluated, with a median age of 71 years. The number of metastatic bone sites was ≤10 in 25 patients and >10 in 20 patients. Median serum PSA was 224 ng/ml. Bone pain was mild in 6 patients, moderate in 16, severe in 22 and intolerable in 1. Fifteen patients were only treated with 153 Sm-EDTMP (group A), while 30 patients also received chemotherapy (estramustine phosphate or mitoxantrone plus prednisone) at variable times: between 3 and 5 months after 153 Sm-EDTMP (14 patients, group B) or within 1 month after 153 Sm-EDTMP (16 patients, group C). Haematological toxicities observed after either regimen were in general mild, consistent with common observations after either 153 Sm-EDTMP or chemotherapy, and without any additive adverse effects in the patients receiving both 153 Sm-EDTMP and chemotherapy. Bone pain palliation to some degree was induced by 153 Sm-EDTMP in 32/45 patients (71.1%), the proportion of patients with a favourable clinical response being significantly higher in group C than in group A (87.5% vs 53.3%, p = 0.0388). Also in terms of biochemical response (serum PSA levels), patients of group C performed significantly better than patients of group A (p = 0.0235). Overall median survival from the time of administration of 153 Sm-EDTMP was 15 months in the total cohort of 45 patients, and was significantly longer in group C than in either group B (30 months vs 11 months, p = 0.023) or group A (30 months vs 10 months, p = 0.008). The results of this study confirm that 153 Sm-EDTMP is effective in terms of pain relief and

  2. Bone-targeted therapy for metastatic breast cancer—Where do we go from here? A commentary from the BONUS 8 meeting

    Directory of Open Access Journals (Sweden)

    Xiaofu Zhu

    2014-03-01

    Full Text Available The annual Bone and The Oncologist New Updates (BONUS 8 conference focuses on the current understanding and dilemmas in the treatment and prevention of bone metastasis in cancer, as well as novel research on bone homeostasis and cancer-induced bone loss. We present commentaries from experts for their own take on where they feel the field of bone-targeted therapies for metastatic breast cancer is moving, or needs to move, if we are to make further progress.

  3. Retrospective Audit: Does Prior Assessment by Oral and Maxillofacial Surgeons Reduce the Risk of Osteonecrosis of The Jaw in Patients Receiving Bone-Targeted Therapies for Metastatic Cancers to the Skeleton?--Part II.

    Science.gov (United States)

    Turner, Bruce; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

    2016-01-01

    Men who receive bone-targeted therapy for metastatic prostate cancer are at increased risk of osteonecrosis of the jaw (ONJ). Development of ONJ has been associated with the administration of bone-targeted therapies in association with other risk factors. ONJ can be distressing for a patient because it can cause pain, risk of jaw fracture, body image disturbance, difficultly eating, and difficulty maintaining good oral hygiene. The aim of this article is to report results of an audit of prior assessment by oral and maxillofacial surgeons (OMFS) before initiation of bone-targeted therapies and whether it may reduce the risk of ONJ in patients receiving bone-targeted therapies for advanced cancers.

  4. [Magnetic resonance guided focused ultrasound surgery for pain palliation of bone metastases: early experience of clinical application in China].

    Science.gov (United States)

    Gu, Jianjun; Wang, Han; Tang, Na; Hua, Yingqi; Yang, Haiyan; Qiu, Yimin; Ge, Renbin; Zhou, Ying; Wang, Wenwen; Zhang, Guixiang

    2015-11-03

    To evaluate the safety and efficacy of magnetic resonance guided focused ultrasound surgery (MRgFUS) in treatment for pain palliation of bone metastases. Eighty-one patients of painful bone metastases were volunteered to screen for this study in Shanghai General Hospital from June 2014 to February 2015. Twenty-three patients among them were treated by MRgFUS, who was more than 18-years old, having the ability to fully understand the informed consent of the research, suffering with pain of numeric rating scale (NRS) ≥ 4, non-received radiotherapy or chemotherapy for pain palliation of bone metastases in the past two weeks. The NRS, the standard question of Brief Pain Inventory (BPI-QoL), and the standard question of Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Bone Metastases 22 (EORTC QLQ-BM22) were respectively recorded before and 1-week, 1-month, 3-month after the treatment. The related adverse events of MRgFUS were observed and recorded in 3 months after the treatment as well. (1)Twenty-three metastatic bone tumor lesions of 23 patients were treated by MRgFUS, the treatment data was as follows: the mean treatment time was (88 ± 33) minutes, the mean sonication number was 13 ± 8. (2) Adverse events included: pain in therapy area 3/23, which spontaneous relieving within one week; numbness in lower limb (1/23), which relieved after physiotherapy. (3) The NRS of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 6.0 ± 1.5, 3.7 ± 1.7,3.1 ± 2.0, and 2.2 ± 1.0,which significantly decreased after the treatment (P<0.01). (4) The BPI-QoL score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 39 ± 16, 27 ± 18, 26 ± 18, and 21 ± 18, which significantly decreased after the treatment (P<0.01). (5) The EORTC QLQ-BM22 score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 52 ± 13, 44 ± 12, 42 ± 12, and 39

  5. A Tissue Engineering Approach to Study the Progression of Breast Tumor Metastasis in Bone

    National Research Council Canada - National Science Library

    Che, Mingxin; Nie, Daotai

    2005-01-01

    Most patients dying of breast cancer suffer painful bone metastasis. It is our hypothesis that the invasive growth and progression of breast metastatic lesions in bone requires the participation of various constituents from "soil...

  6. A Tissue Engineering Approach to Study the Progression of Breast Tumor Metastasis in Bone

    National Research Council Canada - National Science Library

    Che, Mingxin; Nie, Daotai

    2006-01-01

    Most patients dying of breast cancer suffer painful bone metastasis. It is our hypothesis that the invasive growth and progression of breast metastatic lesions in bone requires the participation of various constituents from "soil...

  7. Randall Selitto pressure algometry for assessment of bone-related pain in rats

    DEFF Research Database (Denmark)

    Falk, S.; Ipsen, D. H.; Appel, C. K.

    2015-01-01

    Background: Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute and patholog...

  8. Magnification bone scan of knees for knee pain evaluation

    International Nuclear Information System (INIS)

    Lee, Myoung Hoon; Park, Chan H.; Yoon, Seok Nam; Hwang, Kyung Hoon

    2001-01-01

    Knee pain is one of the common complaints of patients seen in our orthopedic clinic. Routine anterior and posterior views of whole body bone scan (WBBS) is often not sufficient in the evaluation of these patients. An ideal bone scan using pinhole collimator or single photon emission tomography (SPECT), however, is impractical and time consuming in busy nuclear medicine department with limited resources. Therefore, the aim of the study is to assess limited bone scan of knees with magnification (LNSKM) for knee pain evaluation. Technical aspect of LBSKM and diagnostic efficacy are discussed on this poster. Adult patients with knee pain were reffered for LBSKM from an orthopedic surgen specializing knees. Four hundred fifteen LBSKMs were performed since 1999. patients were given 740 MBq (20mCi) Tc-99m MDP intravenously and 3 hours later LBSKM was performed using a low energy high resolution parallel hole collimator and Siemens Orbitor camera. (Simens medical systems. Inc., Hoffman Estates, III., USA). Anterior view of the knees was taken for 5 min, without magnification and both lateral views of symptomatic knees were obtained with electronic magnification (1.25, upto 2.0) for 8 min each. Disease processes such as DJD, traumatic arthritis, P-F tendonitis, SONK, meniscus tear are detected and illustrated along with normal knee scan finding. We believe LBSKM may not be as good as SPECT or pinhole imaging of the knees in the evaluation of knee pain but superior to routine WBBS in the nuclear medicine department with limited resources of instrumentation and manpower

  9. Targeting the S1P/S1PR1 axis mitigates cancer-induced bone pain and neuroinflammation.

    Science.gov (United States)

    Grenald, Shaness A; Doyle, Timothy M; Zhang, Hong; Slosky, Lauren M; Chen, Zhoumou; Largent-Milnes, Tally M; Spiegel, Sarah; Vanderah, Todd W; Salvemini, Daniela

    2017-09-01

    Metastatic bone pain is the single most common form of cancer pain and persists as a result of peripheral and central inflammatory, as well as neuropathic mechanisms. Here, we provide the first characterization of sphingolipid metabolism alterations in the spinal cord occurring during cancer-induced bone pain (CIBP). Following femoral arthrotomy and syngenic tumor implantation in mice, ceramides decreased with corresponding increases in sphingosine and the bioactive sphingolipid metabolite, sphingosine 1-phosphate (S1P). Intriguingly, de novo sphingolipid biosynthesis was increased as shown by the elevations of dihydro-ceramides and dihydro-S1P. We next identified the S1P receptor subtype 1 (S1PR1) as a novel target for therapeutic intervention. Intrathecal or systemic administration of the competitive and functional S1PR1 antagonists, TASP0277308 and FTY720/Fingolimod, respectively, attenuated cancer-induced spontaneous flinching and guarding. Inhibiting CIBP by systemic delivery of FTY720 did not result in antinociceptive tolerance over 7 days. FTY720 administration enhanced IL-10 in the lumbar ipsilateral spinal cord of CIBP animals and intrathecal injection of an IL-10 neutralizing antibody mitigated the ability of systemic FTY720 to reverse CIBP. FTY720 treatment was not associated with alterations in bone metabolism in vivo. Studies here identify a novel mechanism to inhibit bone cancer pain by blocking the actions of the bioactive metabolites S1P and dihydro-S1P in lumbar spinal cord induced by bone cancer and support potential fast-track clinical application of the FDA-approved drug, FTY720, as a therapeutic avenue for CIBP.

  10. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial

    DEFF Research Database (Denmark)

    Bahl, A; Oudard, S; Tombal, B

    2013-01-01

    Cabazitaxel significantly improves overall survival (OS) versus mitoxantrone in patients with metastatic castration-resistant prostate cancer after docetaxel failure. We examined patient survival at 2 years and tumour-related pain with cabazitaxel versus mitoxantrone....

  11. SU-D-303-01: Spatial Distribution of Bone Metastases In Metastatic Castrate-Resistant Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Perk, T; Bradshaw, T; Harmon, S; Perlman, S; Liu, G; Jeraj, R [University of Wisconsin, Madison, WI (United States)

    2015-06-15

    Purpose: Identification of metastatic bone lesions is critical in prostate cancer, where treatments may be more effective in patients with fewer lesions. This study aims characterize the distribution and spread of bone lesions and create a probability map of metastatic spread in bone. Methods: Fifty-five metastatic castrate-resistant prostate cancer patients received up to 3 whole-body [F-18]NaF PET/CT scans. Lesions were identified by physician on PET/CT and contoured using a threshold of SUV>15. An atlas-based segmentation method was used to create CT regions, which determined skeletal location of lesions. Patients were divided into 3 groups with low (N<40), medium (40100) numbers of lesions. A combination of articulated and deformable registrations was used to register the skeletal segments and lesions of each patient to a single skeleton. All the lesion data was then combined to make a probability map. Results: A total of 4038 metastatic lesions (mean 74, range 2–304) were identified. Skeletal regions with highest occurrence of lesions included ribs, thoracic spine, and pelvis with 21%, 19%, and 15% of the total number lesions and 8%, 18%, and 31 % of the total lesion volume, respectively. Interestingly, patients with fewer lesions were found to have a lower proportion of lesions in the ribs (9% in low vs. 27% in high number of lesions). Additionally, the probability map showed specific areas in the spine and pelvis where over 75% of patients had metastases, and other areas in the skeleton with a less than 2% of metastases. Conclusion: We identified skeletal regions with higher incidence of metastases and specific sub-regions in the skeleton that had high or low probability of occurrence of metastases. Additionally, we found that metastatic lesions in the ribs and skull occur more commonly in advanced disease. These results may have future applications in computer-aided diagnosis. Funding from the Prostate Cancer Foundation.

  12. Evidence for the prevention of bone loss in elderly and old early non-metastatic breast cancer patients treated with aromatase inhibitors

    DEFF Research Database (Denmark)

    Gunmalm, V.; Jørgensen, N. R.; Abrahamsen, B.

    2017-01-01

    Breast cancer (BC) is the most common cancer amongst women worldwide. Bone health is emerging as an important issue for BC survivors. In this literature study, we focus on agents for preventing bone loss in early non-metastatic estrogen receptor positive BC in treatment with aromatase inhibitors...... (AI) and to assess the evidence for antiresorptive treatment of bone loss in early non-metastatic breast cancer. We included randomized controlled trials (RCT's) comparing: (a) bisphosphonates and control; (b) different bisphosphonates; (c) denosumab and control and (d) bisphosphonates vs. denosumab...... in early non-metastatic BC women in AI treatment. Among antiresorptives, zoledronic acid currently has the highest evidence for prevention of AI associated bone loss in early non-metastatic BC. Data on fracture prevention among all patients, elderly and old is sparse. More randomized controlled studies...

  13. TH and DCX mRNAs in peripheral blood and bone marrow predict outcome in metastatic neuroblastoma patients.

    Science.gov (United States)

    Yáñez, Yania; Hervás, David; Grau, Elena; Oltra, Silvestre; Pérez, Gema; Palanca, Sarai; Bermúdez, Mar; Márquez, Catalina; Cañete, Adela; Castel, Victoria

    2016-03-01

    In metastatic neuroblastoma (NB) patients, accurate risk stratification and disease monitoring would reduce relapse probabilities. This study aims to evaluate the independent prognostic significance of detecting tyrosine hydroxylase (TH) and doublecortin (DCX) mRNAs by reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) in peripheral blood (PB) and bone marrow (BM) samples from metastatic NB patients. RT-qPCR was performed on PB and BM samples from metastatic NB patients at diagnosis, post-induction therapy and at the end of treatment for TH and DCX mRNAs detection. High levels of TH and DCX mRNAs when detected in PB and BM at diagnosis independently predicted worse outcome in a cohort of 162 metastatic NB. In the subgroup of high-risk metastatic NB, TH mRNA detected in PB remained as independent predictor of EFS and OS at diagnosis. After the induction therapy, high levels of TH mRNA in PB and DCX mRNA in BM independently predicted poor EFS and OS. Furthermore TH mRNA when detected in BM predicted worse EFS. TH mRNA in PB samples at the end of treatment is an independent predictor of worse outcome. TH and DCX mRNAs levels in PB and BM assessed by RT-qPCR should be considered in new pre-treatment risk stratification strategies to reliable estimate outcome differences in metastatic NB patients. In those high-risk metastatic NB, TH and DCX mRNA quantification could be used for the assessment of response to treatment and for early detection of progressive disease or relapses.

  14. Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter Frederik; Hovgaard, Thea Bechmann

    2015-01-01

    tumor resection for metastatic bone disease during a 4-year period from 2010 to 2013 (n = 105 patients). Results. Intravenous antibiotic prophylaxis was administrated for an extended duration of a mean of 7.4 days. The overall infection rate was 3.6% (4/111 implants), infection free survival was 96...... suggest that extended postoperative antibiotic prophylaxis may reduce the risk of PJI in patients undergoing tumor resection and endoprosthetic replacement for metastatic bone disease associated impending or de facto pathologic fractures of the proximal femur.......Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic...

  15. PrognosticValue of PINP,BoneAlkaline Phosphatase, CTX-I, andYKL-40 in Patients With Metastatic Prostate Carcinoma

    DEFF Research Database (Denmark)

    Brasso, Klaus; Christensen, Ib Jarle; Johansen, Julia S

    2006-01-01

    Prognostic value of PINP, bone alkaline phosphatase, CTX-I, and YKL-40 in patients with metastatic prostate carcinoma. Prostate. 2006 Apr 1;66(5):503-13. PMID: 16372331 [PubMed - indexed for MEDLINE]......Prognostic value of PINP, bone alkaline phosphatase, CTX-I, and YKL-40 in patients with metastatic prostate carcinoma. Prostate. 2006 Apr 1;66(5):503-13. PMID: 16372331 [PubMed - indexed for MEDLINE]...

  16. Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

    Directory of Open Access Journals (Sweden)

    Santanu Pal

    2014-01-01

    Full Text Available Background: The primary aim of this prospective non-randomized study was to evaluate the effect of hemi-body irradiation (HBI on pain and quality of life in cancer patients with extensive bone metastases. The secondary aim was to evaluate side-effects and cost-effectiveness of the treatment. Materials and Methods: Between March 2008 and December 2010, a total of 23 (male = 14, female = 9, median age = 60 years diagnosed cases of metastatic cancer patients (prostate = 11, breast = 6, and lung = 6 received HBI, which was delivered as lower (n = 7 (dose = 8 Gy, upper (n = 8 (dose = 6 Gy, or sequential HBI (n = 8 with a Telecobalt unit (Theratron 780C. Among them, one lung cancer patient died at 2 months and one prostate cancer patient defaulted after the second follow-up. Thus, 21 patients (male = 13, female = 8, median age = 65 years (prostatic cancer = 10, breast cancer = 6, and lung cancer = 5 were followed up for a minimum of 6 months. Evaluations were performed before and at 2, 4, 8, 16, and 24 weeks after treatment. Pain evaluation was done by Visual Analogue Scale (VAS, Verbal Rating Scale (VRS, Percentage of Pain Relief (PRR, and Global Pain Score (GPS. Toxicity was assessed by CTC v-3 toxicity scores in the medical record. Assessment of oral morphine consumption was done before and after radiation using paired t-test, and correlation analysis was also done with decrease of morphine consumption and reduction of pain score using statistical analysis. Results: Response (control of pain was partial (PR in 67% and complete (CR in 22% of patients. For most patients, the pain control lasted throughout the follow-up period (6 months. From 66.66% patients requiring 13 or more Morphine (10 mg tablets per day prior to HBI, none of the patients required to consume 13 or more Morphine (10 mg tablets per day following HBI, which was correlated with significant reduction in various pain scores (P < 0.05. One way ANOVA with Dunnett′s Multiple Comparison

  17. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril

    2005-01-01

    Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

  18. Quality of Life and Utility in Patients with Metastatic Soft Tissue and Bone Sarcoma: The Sarcoma Treatment and Burden of Illness in North America and Europe (SABINE Study

    Directory of Open Access Journals (Sweden)

    Peter Reichardt

    2012-01-01

    Full Text Available The aim of the study was to assess health-related quality of life (HRQoL among metastatic soft tissue (mSTS or bone sarcoma (mBS patients who had attained a favourable response to chemotherapy. We employed the EORTC QLQ-C30, the 3-item Cancer-Related Symptoms Questionnaire, and the EQ-5D instrument. HRQoL was evaluated overall and by health state in 120 mSTS/mBS patients enrolled in the SABINE study across nine countries in Europe and North America. Utility was estimated from responses to the EQ-5D instrument using UK population-based weights. The mean EQ-5D utility score was 0.69 for the pooled patient sample with little variation across health states. However, patients with progressive disease reported a clinically significant lower utility (0.56. Among disease symptoms, pain and respiratory symptoms are common. This study showed that mSTS/mBS is associated with reduced HRQoL and utility among patients with metastatic disease.

  19. Interleukin-6: a bone marrow stromal cell paracrine signal that induces neuroendocrine differentiation and modulates autophagy in bone metastatic PCa cells.

    Science.gov (United States)

    Delk, Nikki A; Farach-Carson, Mary C

    2012-04-01

    Autophagy reallocates nutrients and clears normal cells of damaged proteins and organelles. In the context of metastatic disease, invading cancer cells hijack autophagic processes to survive and adapt in the host microenvironment. We sought to understand how autophagy is regulated in the metastatic niche for prostate cancer (PCa) cells where bone marrow stromal cell (BMSC) paracrine signaling induces PCa neuroendocrine differentiation (NED). In PCa, this transdifferentiation of metastatic PCa cells to neuronal-like cells correlates with advanced disease. Because autophagy provides a survival advantage for cancer cells and promotes cell differentiation, we hypothesized that autophagy mediates PCa NED in the bone. Thus, we determined the ability of paracrine factors in conditioned media (CM) from two separate BMSC subtypes, HS5 and HS27a, to induce autophagy in C4-2 and C4-2B bone metastatic PCa cells by characterizing the autophagy marker, LC3. Unlike HS27a CM, HS5 CM induced LC3 accumulation in PCa cells, suggesting autophagy was induced and indicating that HS5 and HS27a secrete a different milieu of paracrine factors that influence PCa autophagy. We identified interleukin-6 (IL-6), a cytokine more highly expressed in HS5 cells than in HS27a cells, as a paracrine factor that regulates PCa autophagy. Pharmacological inhibition of STAT3 activity did not attenuate LC3 accumulation, implying that IL-6 regulates NED and autophagy through different pathways. Finally, chloroquine inhibition of autophagic flux blocked PCa NED; hence autophagic flux maintains NED. Our studies imply that autophagy is cytoprotective for PCa cells in the bone, thus targeting autophagy is a potential therapeutic strategy.

  20. Prognostic value of biochemical variables for survival after surgery for metastatic bone disease of the extremities.

    Science.gov (United States)

    Sørensen, Michala Skovlund; Hovgaard, Thea Bechman; Hindsø, Klaus; Petersen, Michael Mørk

    2017-03-01

    Prediction of survival in patients having surgery for metastatic bone disease in the extremities (MBDex) has been of interest in more than two decades. Hitherto no consensus on the value of biochemical variables has been achieved. Our purpose was (1) to investigate if standard biochemical variables have independent prognostic value for survival after surgery for MBDex and (2) to identify optimal prognostic cut off values for survival of biochemical variables. In a consecutive cohort of 270 patients having surgery for MBDex, we measured preoperative biochemical variables: hemoglobin, alkaline phosphatase, C-reactive protein and absolute, neutrophil and lymphocyte count. ROC curve analyses were performed to identify optimal cut off levels. Independent prognostic factors for variables were addressed with multiple Cox regression analyses. Optimal cut off levels were identified as: hemoglobin 7.45 mmol/L, absolute lymphocyte count 8.5 × 10 9 /L, neutrophil 5.68 × 10 9 /L, lymphocyte 1.37 × 10 9 /L, C-reactive protein 22.5 mg/L, and alkaline phosphatase 129 U/L. Regression analyses found alkaline phosphatase (HR 2.49) and neutrophil count (HR 2.49) to be independent prognostic factors. We found neutrophil count and alkaline phosphatase to be independent prognostic variables in predicting survival in patients after surgery for MBDex. © 2016 Wiley Periodicals, Inc.

  1. Advantages and Disadvantages of Bone Protective Agents in Metastatic Prostate Cancer: Lessons Learned

    Directory of Open Access Journals (Sweden)

    Christian Thomas

    2016-08-01

    Full Text Available Nine out of ten metastatic prostate cancer (PCa patients will develop osseous metastases. Of these, every second will suffer from skeletal-related events (SRE. SRE are associated with an increased risk for death, which is markedly increased in the presence of pathological fracture. Moreover, health insurance costs nearly double in the presence of SRE. Zoledronic acid and denosumab are both approved drugs for the prevention or delay of SRE in castration-resistant prostate cancer (CRPC patients with osseous metastases. However, long-term treatment with one of these two drugs is associated with the development of medication-related osteonecrosis of the jaw (MRONJ. Routine inspections of the oral cavity before and during treatment are mandatory in these patients. Regarding imaging techniques, bone scintigraphy seems to be a promising tool to detect early stage MRONJ. Zoledronic acid does not reduce the incidence of SRE in hormone-sensitive PCa. First data shows 3-monthly application of zoledronic acid to be equi-effective to monthly application.

  2. Results after therapy of pain from bone metastases with Samarium-153 in our centers in Lima, Peru

    International Nuclear Information System (INIS)

    Alvarado, N.; Eskenazi, S.; Valle, M.P.; Montoya, J.; Castro, M.; Montiel, L.; Velarde, V.; Jauregui, I.; Cueto, C.

    2004-01-01

    Full text: 105 patients with bone metastases from prostate and breast cancer; between 42 and 78 years age (median 61 years) were evaluated. Patients had intense pain that could not be managed with combinations of analgesic and anti tumoral drugs. All patients received 1.2 mCi/kg of Samarium-153 intravenously as treatment for pain due to bony metastases. The isotope obtained from atomic reactor placed in Lima - Peru, was provided by Peruvian Nuclear Energy Institute (IPEN). One week before therapy, all the patients had a bone scan study with Tc99m-MDP that showed the presence of multiple bone metastases with high blastic activity. Haematology and biochemical parameter checked were: Creatinine ( 150,000 mm3), Leukocytes (> 5,000 mm3), Red cells (>3,500,000 mm3). No problems were encountered during intravenous administration of the radioisotope. The side effects after treatment were: Primary effects: 16 cases of nausea, 2 of vomiting, 3 of headache, 28 had increment of pain, 6 had flushing. 50 patients did not have the primary symptoms. Secondary effects: 3 Patients showed drop in leukocyte count between 2nd and 3rd week of therapy. Red cells showed 10-15% decrease between 6th to 8th week. Platelets showed a decrease of about 15% with one peak between 1st and 2nd week post Samarium therapy. Data was analysed using an analogue visual scale of the pain with values from 0 - 10 (0-no pain; 10-maximum pain) and in the same way using the E.C.O.G. scale (Eastern Cooperative Oncology Group) in relationship with the Karnofsky index in order to establish functional recovery for each patient. The decrease of pain was seen between 4th-7th days (average 8 days). A second dose was given after 60 days in 12 patients and a third dose in 3 cases.11 patients died due to different causes between 30 - 60 days post treatment. The analgesic dose came down significantly in 80% of patients. We conclude that palliative therapy of metastatic bone pain in Peru is possible with radionuclides. It

  3. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D. [Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Passalacqua, Matthew; Patel, Indravadan; Bohnert, Nathan [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David J. [University Hospitals Case Medical Center, Departments of Radiology and Biomedical Engineering, Cleveland, OH (United States)

    2014-11-15

    The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome - including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease. (orig.)

  4. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

    International Nuclear Information System (INIS)

    Prologo, J.D.; Passalacqua, Matthew; Patel, Indravadan; Bohnert, Nathan; Corn, David J.

    2014-01-01

    The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome - including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease. (orig.)

  5. Therapy assessment of bone metastatic disease in the era of {sup 223}radium

    Energy Technology Data Exchange (ETDEWEB)

    Etchebehere, Elba; Brito, Ana Emilia [The University of Campinas, Division of Nuclear Medicine, Campinas (Brazil); Rezaee, Alireza; Langsteger, Werner [St. Vincent' s Hospital, Department of Nuclear Medicine and Endocrinology, PET - CT Center LINZ, Ordensklinikum, Linz (Austria); Beheshti, Mohsen [St. Vincent' s Hospital, Department of Nuclear Medicine and Endocrinology, PET - CT Center LINZ, Ordensklinikum, Linz (Austria); Paracelsus Medical University, Department of Nuclear Medicine and Endocrinology, Salzburg (Austria)

    2017-08-15

    Defining an optimal imaging modality for assessment of therapy and the best time of evaluation are pivotal for ideal patient's management. {sup 223}Ra (Xofigo registered, formerly Alpharadin) has been approved by the FDA and European Medicines Agency for treatment of metastatic castration-resistant prostate cancer with painful osseous involvement. PET/CT imaging using various radiotracers such as {sup 18}F-FDG, {sup 18}F-FCH, {sup 68}Ga-PSMA and {sup 18}F-NaF have been investigated to mitigate the limitations of conventional imaging modalities. Diagnostic radiotracers that have properties similar to a therapeutic radiotracer will precisely assess of the possibility and efficacy of a treatment; this is the theranostic concept. An example of a diagnostic test employed for selecting targeted therapy is the combined use of {sup 18}F-fluoride PET/CT for evaluation of possible therapy with {sup 223}Ra. This review examines the most recent publications related to this topic. (orig.)

  6. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.

    2010-01-01

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  7. Metastases to bone in medulloblastoma

    International Nuclear Information System (INIS)

    Vieco, P.T.; Azouz, E.M.; Hoeffel, J.C.

    1989-01-01

    Medulloblastoma is a relatively common intracranial neoplasm in childhood. Its extraneural spread was, until recently, thought to be a rare occurrence. Metastases are most commonly to bone. Five patients with medulloblastoma metastatic to bone are presented, and findings are compared to those of previous reports. Two of the five cases showed patchy extensive osteosclerosis of the pelvis and/or proximal femora. One case had concurrent lymph node involvement. In patients with past or present medulloblastoma and bone pain, metastases to bone should be excluded. Medulloblastoma metastatic to bone is a rare cause of extensive osteosclerosis. (orig.)

  8. Suppression of asparaginyl endopeptidase attenuates breast cancer-induced bone pain through inhibition of neurotrophin receptors.

    Science.gov (United States)

    Yao, Peng; Ding, Yuanyuan; Han, Zhenkai; Mu, Ying; Hong, Tao; Zhu, Yongqiang; Li, Hongxi

    2017-01-01

    Objective Cancer-induced bone pain is a common clinical problem in breast cancer patients with bone metastasis. However, the mechanisms driving cancer-induced bone pain are poorly known. Recent studies show that a novel protease, asparaginyl endopeptidase (AEP) plays crucial roles in breast cancer metastasis and progression. We aim to determine the functions and targeted suppress of AEP in a mouse model of breast cancer-induced bone pain. Methods Breast cancer cells with AEP knocked-down or overexpression were constructed and implanted into the intramedullary space of the femur to induce pain-like behavior in mice. AEP-specific inhibitors or purified AEP proteins were further used in animal model. The histological characters of femur and pain ethological changes were measured. The expressions of AEP and neurotrophin receptors (p75NTR and TrkA) in dorsal root ganglion and spinal cord were examined. Results Femur radiographs and histological analysis revealed that cells with AEP knocked-down reduced bone destruction and pain behaviors. However, cells with AEP overexpression elevated bone damage and pain behaviors. Further, Western blot results found that the expressions of p75NTR and TrkA in dorsal root ganglions and spinal cords were reduced in mice inoculated with AEP knocked-down cells. Targeted suppression of AEP with specific small compounds significantly reduced the bone pain while purified recombinant AEP proteins increased bone pain. Conclusions AEP aggravate the development of breast cancer bone metastasis and bone pain by increasing the expression of neurotrophin receptors. AEP might be an effective target for treatment of breast cancerinduced bone pain.

  9. The Role of Purinergic Receptors in Cancer-Induced Bone Pain

    Directory of Open Access Journals (Sweden)

    Sarah Falk

    2012-01-01

    Full Text Available Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular mechanisms underlying cancer-induced bone pain including the involvement of ATP and the purinergic receptors in the progression of the pain state. In nociception, ATP acts as an extracellular messenger to transmit sensory information both at the peripheral site of tissue damage and in the spinal cord. Several of the purinergic receptors have been shown to be important for the development and maintenance of neuropathic and inflammatory pain, and studies have demonstrated the importance of both peripheral and central mechanisms. We here provide an overview of the current literature on the role of purinergic receptors in cancer-induced bone pain with emphasis on some of the difficulties related to studying this complex pain state.

  10. Use of 153Sm-EDTMP in the treatment of painful bone metastasis (Tunis experience about 80 cases)

    International Nuclear Information System (INIS)

    Mhiri, A.; Hassad, R.; Ben Slimene, M.F.; Sellem, A.; Hammami, H.; Mahersi, M.

    2006-01-01

    Metabolic radiotherapy is a good therapeutic alternative presently proposed for the treatment of disseminated painful bone metastasis. 153 Sm-EDTMP (Quadramet is the radiopharmaceutical used in Tunisia for this indication since October 2001. We are presenting here the results of a 40-month multicentric and retrospective study carried out on 80 patients receiving this new therapy for painful bone metastasis related with various primary carcinoma. All patients received a dose of thirty seven mega-becquerel per kilogram of weight and per treatment (37 MBq/kg/treatment). Our aim was to evaluate four parameters: therapeutic efficiency, factors influencing the response to the treatment, treatment toxicity and sources of treatment failure. A positive response on pain was obtained for 82.5% of cases. This response was complete for 33.9% of them. The average duration of the antalgic protection for each injection was three months, with limits varying from 3 weeks to 12 months. The response was not influenced by the primary type, nor by the number of metastatic lesions, the previously received therapy other than chemotherapy or the general state of the patient prior to treatment. The results obtained after multiple treatments show that the therapies could be repeated with comparable results to those of the first treatment. The only toxicity was of haematological order: It was often mild and reversible with an average complete recovery after 8 weeks. Conclusion: the therapeutic efficiency of Quadramet is at least equivalent to the other therapeutical means, with nearly no side effects. Its early introduction in the management of metastatic patients would allow them to better benefit from its efficiency, simplicity and low toxicity and therefore enjoy a better quality of life. The difficulties we are facing are mainly related to coordination logistic issues during the drug imports and incidentally a lack of awareness and information of the physicians in charge. (author)

  11. Pain and quality of life following palliative radiotherapy of bone metastases

    International Nuclear Information System (INIS)

    Sauer, N.; Wild, B.; Henningsen, P.; Jakobsen, T.; Leising, D.; Treiber, M.

    2006-01-01

    Pain and quality of life following palliative radiotherapy of bone metastases Background and purpose: palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. Patients and methods: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. Results: radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. Conclusion: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects. (orig.)

  12. Palliative radiotherapy for painful bone metastases, single versus multiple fraction treatment: a literature review

    International Nuclear Information System (INIS)

    McKee, L.

    2005-01-01

    Palliative radiotherapy provides pain relief for patients with painful bone metastases. The practice among radiation oncologists as to whether a large single fraction is most effective, or whether multiple smaller fractions are preferable in providing the quickest, most durable pain relief is inconsistent. A literature review was completed to see if there is consensus about whether there is better pain response and control following single versus multiple fraction radiotherapy. The Pub Med search engine was used to find all reported studies comparing single and multiple fraction radiotherapy for painful bone metastases. Each article was reviewed according to specific criteria. A generalized conclusion was ascertained from each study and then compared. Among the studies reviewed, the consensus concluded that single fraction radiotherapy was the better choice for palliation of painful bone metastases. According to the literature reviewed, single fraction radiotherapy provides adequate pain relief with reasonable duration of pain response. (author)

  13. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carrafiello, Gianpaolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: gcarraf@tin.it; Lagana, Domenico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: donlaga@gmail.com; Ianniello, Andrea [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: ianand@libero.it; Nicotera, Paolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: paolonicotera@virgilio.it; Fontana, Federico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: fede.fontana@libero.it; Dizonno, Massimiliano [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: massimilianodizonno@libero.it; Cuffari, Salvatore [Service of Anaesthesiology and Palliative Care, University of Insubria, 21100 Varese (Italy)], E-mail: salvatore.cuffari@libero.it; Fugazzola, Carlo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: carlo.fugazzola@ospedale.varese.it

    2009-08-15

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  14. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Carrafiello, Gianpaolo; Lagana, Domenico; Ianniello, Andrea; Nicotera, Paolo; Fontana, Federico; Dizonno, Massimiliano; Cuffari, Salvatore; Fugazzola, Carlo

    2009-01-01

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  15. Cytogenetic evidence of metastatic myxoid liposarcoma and therapy-related myelodysplastic syndrome in a bone marrow biopsy.

    Science.gov (United States)

    Rossi, Sabrina; Canal, Fabio; Licci, Stefano; Zanatta, Lucia; Laurino, Licia; Gottardi, Michele; Gherlinzoni, Filippo; Dei Tos, Angelo Paolo

    2009-07-01

    Myxoid liposarcoma exhibits a peculiar clinical behavior, with a tendency to spread to serosal membranes, distant soft tissues, and bones, even in the absence of lung metastases. Therapy-related hematological neoplasms are well-known side effects of cytotoxic chemotherapy. We describe an exceptional case of metastatic myxoid liposarcoma of the spine associated with therapy-related refractory anemia with excess of blasts in a 37-year-old woman who underwent multi-agent chemotherapy for a myxoid liposarcoma of the left thigh. Microscopic examination of the bone marrow biopsy revealed dysplastic features, with abnormal localization of immature precursors and micromegakaryocytes, and islands of undifferentiated oval small/medium-size cells, suggestive of acute myeloid leukemia arising in the setting of a myelodysplastic syndrome. Immunohistochemistry was not discriminant. Cytogenetic analyses of bone marrow aspirate disclosed the presence of 2 different rearrangements, subsequently confirmed by fluorescent in situ hybridization and was crucial in making the correct diagnosis.

  16. The role of purinergic receptors in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Heegaard, Anne-Marie

    2012-01-01

    Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular...

  17. Bone and bone marrow scintigraphy in a patient with sickle cell-thalassemia and recurrent pain attacks

    International Nuclear Information System (INIS)

    Mikosch, P.; Gallowitsch, H.-J.; Lind, P.; Jauk, B.; Kaulfersch, W.

    2003-01-01

    The case of an eight years old African boy who suffers from sickle cell-thalassemia is presented. In the course of the disease frequent pain attacks occurred within the abdomen and extremities, recently also within the trunk. Local pain, at some occasions in combination with local swelling and always positive laboratory parameters for inflammation, hindered a solely clinical differentiation between bone infarcts and osteomyelitis. Bone scintigraphy, eventually in combination with bone marrow scintigraphy, can assist the clinician in the differentiation of aseptic bone infarcts versus secondary osteomyelitis. Based on the presented case scintigraphic results for bone infarcts, osteomyelitis and special scintigraphic pattern seen in sickle cell disease are presented. Furthermore, problems regarding the interpretation of the scintigraphies in relation to the delayed time after the beginning of pain attacks are discussed. (author)

  18. Influence of sex differences on the progression of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Appel, Camilla

    2013-01-01

    Background: Pain caused by bone metastases has a severe impact on the quality of life for many patients with cancer. Good translational in vivo models are required to understand the molecular mechanism and develop better treatment. In the current study we evaluated the influence of sex differences...... on the progression of cancer-induced bone pain. Materials and Methods: 4T1-luc2 mammary cancer cells were introduced into the femoral cavity of female and male BALB/cJ mice. Bioluminescence tumor signal, pain-related behavior and bone degradation were monitored for 14 days. Results: Female mice demonstrated...... a significantly greater bioluminescence signal on day 2 compared to male mice and, in addition, a significant earlier onset of pain-related behavior was observed in the females. No sex difference was observed for bone degradation. Finally, a strong correlation between pain-related behavior and bone degradation...

  19. Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment

    Directory of Open Access Journals (Sweden)

    Chelsea R. Amiel

    2016-08-01

    Full Text Available Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery were examined as potential mediators. Women (N = 240 with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01. Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176 and direct effects (β = 0.18, SE = 0.07, t(146 = 2.78, p < 0.01, 95% CI (0.053, 0.311. Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship.

  20. Survey of bone pain in patients of infectious section of Labafinejad hospital using radioisotope scanning

    International Nuclear Information System (INIS)

    Ibrahimie, Farhad

    1996-01-01

    Skeletal scintigraphy is the first or second most frequently performed imaging procedure in most nuclear medicine departments. The uses of bone scan in orthopedic practice are multiple. Bone scans are often used to localize disease, to identify areas of focal increased physiological activity, and to evaluate pain. Bone scans are particularly useful in depicting and localizing small tumors. Bone scans may clarify the significance of radiographic abnormalities. When pain is poorly localized, a bone scan helps focus attention, particularly when it precisely corresponds to the questionable radiographic lesion. In order to do a survey about role of bone scan for the detection and localizing bone pain, a retrospective study was done about 37 patient who from 1373 to 1374 were admitted to the infectious department of Martyr Labafinejad having bone pain. The results of our studies showed that most common case of bone pain of this patients was due to brucellosis (brucella arthritis) with 19%, and other causes were cellulits with 13.15% osteomyelitis and D.J.D with 11%, septic arthritis, bone metastasis, bone abscesses, discopathy, infectious spondylitis, lymphoma, D.V.T. and reactive traumatic arthritis with 2.7%

  1. Pain in castration-resistant prostate cancer with bone metastases: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gater Adam

    2011-10-01

    Full Text Available Abstract Background Bone metastases are a common painful and debilitating consequence of castration-resistant prostate cancer (CPRC. Bone pain may predict patients' prognosis and there is a need to further explore CRPC patients' experiences of bone pain in the overall context of disease pathology. Due to the subjective nature of pain, assessments of pain severity, onset and progression are reliant on patient assessment. Patient reported outcome (PRO measures, therefore, are commonly used as key endpoints for evaluating the efficacy of CRPC treatments. Evidence of the content validity of leading PRO measures of pain severity used in CRPC clinical trials is, however, limited. Methods To document patients' experience of CRPC symptoms including pain, and their impact on health-related quality of life (HRQL, semi-structured in-depth qualitative interviews were conducted with 17 patients with CRPC and bone metastases. The content validity of the Present Pain Intensity (PPI scale from the McGill Pain Questionnaire (MPQ, and the 'Average Pain' and 'Worst Pain' items of the Brief Pain Inventory Short-Form (BPI-SF was also assessed. Results Patients with CRPC and bone metastases present with a constellation of symptoms that can have a profound effect on HRQL. For patients in this study, bone pain was the most prominent and debilitating symptom associated with their condition. Bone pain was chronic and, despite being generally well-managed by analgesic medication, instances of breakthrough cancer pain (BTcP were common. Cognitive debriefing of the selected PRO measures of pain severity highlighted difficulties among patients in understanding the verbal response scale (VRS of the MPQ PPI scale. There were also some inconsistencies in the way in which the BPI-SF 'Average Pain' item was interpreted by patients. In contrast, the BPI-SF 'Worst Pain' item was well understood and interpreted consistently among patients. Conclusions Study findings support the

  2. P2X7 receptor-mediated analgesia in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; D. Schwab, Samantha; Frøsig-Jørgensen, Majbrit

    2015-01-01

    Pain is a common and debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of molecular events, including mechanisms observed in inflammatory and neuropathic pain states, but also changes unique for ca...

  3. Diagnostic value of urinary pyridinoline for determining bone metastasis in patients with non-metastatic breast cancer

    Directory of Open Access Journals (Sweden)

    Fatma Uçar

    2011-12-01

    Full Text Available Objective: In this study, urinary pyridinoline (uPYR, urinary deoxypyridinoline (uDPD and serum alkaline phosphatase (sALP levels were measured in patients without metastatic breast cancer and the role of uPYR and uDPD as biochemical markers of bone metastases were examined during a six years follow-up.Materials and methods: Totally, 34 patients without bone metastasis and 40 healthy individuals as a control group were included in the study.Results: Urinary pyridinoline and uDPD levels were significantly higher in patients without bone metastasis than in normal controls (p<0,05, except sALP levels. As a result of a 6-year follow-up of patients, 20.5% had metastasis. The distribution of metastasis types was as follows: 2.9% of those patients had local, 2.9% had liver, 5.9% had lung and 8.8% had bone metastasis. The cut off value, sensitivity and specifity of uPYR was established as 47,3 pmol/μmol creatinin, 82% and 80% respectively. The cut off value, sensitivity and specifity of uDPD were determined as 9.53 pmol/μmol creatinin, 76%, 72% respectively.Conclusions: This study demonstrated that measurement of urinary collagen cross-links assay may contribute to the early detection of metastatic spread to bone in breast cancer. However further studies with larger scaled groups should be performed. J Clin Exp Invest 2011; 2 (4: 420-424

  4. Behavioral, medical imaging and histopathological features of a new rat model of bone cancer pain.

    Directory of Open Access Journals (Sweden)

    Louis Doré-Savard

    2010-10-01

    Full Text Available Pre-clinical bone cancer pain models mimicking the human condition are required to respond to clinical realities. Breast or prostate cancer patients coping with bone metastases experience intractable pain, which affects their quality of life. Advanced monitoring is thus required to clarify bone cancer pain mechanisms and refine treatments. In our model of rat femoral mammary carcinoma MRMT-1 cell implantation, pain onset and tumor growth were monitored for 21 days. The surgical procedure performed without arthrotomy allowed recording of incidental pain in free-moving rats. Along with the gradual development of mechanical allodynia and hyperalgesia, behavioral signs of ambulatory pain were detected at day 14 by using a dynamic weight-bearing apparatus. Osteopenia was revealed from day 14 concomitantly with disorganization of the trabecular architecture (µCT. Bone metastases were visualized as early as day 8 by MRI (T(1-Gd-DTPA before pain detection. PET (Na(18F co-registration revealed intra-osseous activity, as determined by anatomical superimposition over MRI in accordance with osteoclastic hyperactivity (TRAP staining. Pain and bone destruction were aggravated with time. Bone remodeling was accompanied by c-Fos (spinal and ATF3 (DRG neuronal activation, sustained by astrocyte (GFAP and microglia (Iba1 reactivity in lumbar spinal cord. Our animal model demonstrates the importance of simultaneously recording pain and tumor progression and will allow us to better characterize therapeutic strategies in the future.

  5. Palliation of bone cancer pain by antagonists of platelet-activating factor receptors.

    Directory of Open Access Journals (Sweden)

    Katsuya Morita

    Full Text Available Bone cancer pain is the most severe among cancer pain and is often resistant to current analgesics. Thus, the development of novel analgesics effective at treating bone cancer pain are desired. Platelet-activating factor (PAF receptor antagonists were recently demonstrated to have effective pain relieving effects on neuropathic pain in several animal models. The present study examined the pain relieving effect of PAF receptor antagonists on bone cancer pain using the femur bone cancer (FBC model in mice. Animals were injected with osteolytic NCTC2472 cells into the tibia, and subsequently the effects of PAF receptor antagonists on pain behaviors were evaluated. Chemical structurally different type of antagonists, TCV-309, BN 50739 and WEB 2086 ameliorated the allodynia and improved pain behaviors such as guarding behavior and limb-use abnormalities in FBC model mice. The pain relieving effects of these antagonists were achieved with low doses and were long lasting. Blockade of spinal PAF receptors by intrathecal injection of TCV-309 and WEB 2086 or knockdown of the expression of spinal PAF receptor protein by intrathecal transfer of PAF receptor siRNA also produced a pain relieving effect. The amount of an inducible PAF synthesis enzyme, lysophosphatidylcholine acyltransferase 2 (LPCAT2 protein significantly increased in the spinal cord after transplantation of NCTC 2472 tumor cells into mouse tibia. The combination of morphine with PAF receptor antagonists develops marked enhancement of the analgesic effect against bone cancer pain without affecting morphine-induced constipation. Repeated administration of TCV-309 suppressed the appearance of pain behaviors and prolonged survival of FBC mice. The present results suggest that PAF receptor antagonists in combination with, or without, opioids may represent a new strategy for the treatment of persistent bone cancer pain and improve the quality of life of patients.

  6. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, Rikke Rie; Nielsen, Christian K.; Nasser, Arafat

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... with and without astrocyte activation (BALB/cJ or C3H mice inoculated with 4T1 mammary cancer cells or NCTC 2472 osteosarcoma cells, respectively), suggesting that astrocytic P2X7 receptors play a negligible role in bone cancer pain. The results support the hypothesis that bone cancer pain is a separate pain state...

  7. Bone tumors

    International Nuclear Information System (INIS)

    Unni, K.K.

    1988-01-01

    This book contains the proceedings on bone tumors. Topics covered include: Bone tumor imaging: Contribution of CT and MRI, staging of bone tumors, perind cell tumors of bone, and metastatic bone disease

  8. A dose-response relationship for time to bone pain resolution after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC) bony metastases

    Energy Technology Data Exchange (ETDEWEB)

    Jhaveri, Pavan M. [Dept. of Radiology, Section of Radiation Oncology, Baylor College of Medicine, Houston (United States); Teh, Bin S.; Paulino, Arnold C.; Blanco, Angel I.; Butler, E. Brian [Dept. of Radiation Oncology, The Methodist Hospital/The Methodist Hospital Research Inst., Houston (United States)], email: bteh@tmhs.org; Lo, Simon S. [Dept. of Radiation Oncology, Univ. Hospitals Seidman Cancer Center, Case Western Reserve Univ., Cleveland (United States); Amato, Robert J. [Dept. of Internal Medicine, Div. of Oncology, Univ. of Texas Health Sciences Center, Houston (United States)

    2012-05-15

    Background. To investigate the utility of stereotactic body radiotherapy (SBRT) in the treatment of painful renal cell carcinoma (RCC) bone metastases, and for a possible dose effect on time to symptom relief. Material and methods. Eighteen patients with 24 painful osseous lesions from metastatic RCC were treated with SBRT. The most common treatment regimens were 24 Gy in 3 fractions and 40 Gy in 5 fractions. The times from treatment to first reported pain relief and time to symptom recurrence were evaluated. Median follow-up was 38 weeks (1-156 weeks). Results. Seventy-eight percent of all patients had pain relief. Patients treated with a BED > 85 Gy achieved faster and more durable pain relief compared to those treated with a BED < 85 Gy. There was decrease in time to pain relief after a change in treatment regimen to 8 Gy x 5 fractions (BED = 86). There was only one patient with grade 1 skin toxicity. No neurological or other toxicity was observed. Conclusions. SBRT can safely and effectively treat painful RCC bony metastases. There appears to be a relationship between radiation dose and time to stable pain relief.

  9. Fluorodeoxyglucose Uptake on Positron Emission Tomography Is a Useful Predictor of Long-Term Pain Control After Palliative Radiation Therapy in Patients With Painful Bone Metastases: Results of a Single-Institute Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Takatoshi, E-mail: taka.t-may7@med.Tottori-u.ac.jp [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Fujii, Shinya; Ogawa, Toshihide; Michimoto, Koichi; Fukunaga, Takeru; Tanino, Tomohiko; Uchida, Nobue [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Matsuki, Tsutomu; Sakamoto, Hiroaki [Division of Radiology, Tottori Municipal Hospital, Tottori (Japan)

    2016-02-01

    Purpose: To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) before and after palliative radiation therapy (RT) can predict long-term pain control in patients with painful bone metastases. Methods and Materials: Thirty-one patients with bone metastases who received RT were prospectively included. Forty painful metastatic treatment fields were evaluated. All patients had undergone pre-RT and post-RT PET/CT scanning. We evaluated the relationships between the pre-RT, post-RT, and changes in maximum standardized uptake value (SUV{sub max}) and the pain response, and between SUV{sub max} and pain relapse of the bone metastases in the treatment field. In addition, we compared the SUV{sub max} according to the length of time from the completion of RT to pain relapse of the bone metastases. Results: Regarding the pain response at 4 weeks after the completion of RT, there were 36 lesions of 27 patients in the responder group and 4 lesions of 4 patients in the nonresponder group. Changes in the SUV{sub max} differed significantly between the responder and nonresponder groups in both the early and delayed phases (P=.0292 and P=.0139, respectively), but no relationship was observed between the pre-RT and post-RT SUV{sub max} relative to the pain response. The responder group was evaluated for the rate of relapse. Thirty-five lesions of 26 patients in the responder group were evaluated, because 1 patient died of acute renal failure at 2 months after RT. Twelve lesions (34%) showed pain relapse, and 23 lesions (66%) did not. There were significant differences between the relapse and nonrelapse patients in terms of the pre-RT (early/delayed phases: P<.0001/P<.0001), post-RT (P=.0199/P=.0261), and changes in SUV{sub max} (P=.0004/P=.004). Conclusions: FDG-PET may help predict the outcome of pain control in the treatment field after palliative RT for painful bone metastases.

  10. Metastatic superscan on 99mTc-MDP bone scintigraphy in a case of carcinoma colon: Common finding but rare etiology

    International Nuclear Information System (INIS)

    Chakraborty, Partha Sarathi; Sharma, Punit; Karunanithi, Sellam; Bal, Chandrasekhar; Kumar, Rakesh

    2014-01-01

    Bone scintigraphy in which there is excessive skeletal radioisotope uptake in relation to soft tissues along with absent or faint activity in the genitourinary tract is known as a ‘superscan’. Prostate cancer is the most common malignancy associated with superscan along with others such as lung cancer, breast cancer and haematological malignancies. Here we present the case of a 41 year old woman with carcinoma colon with metastatic superscan on 99m Tc-MDP bone scintigraphy, a very rare cause for metastatic superscan

  11. The role of conventional bone scintigraphy in evaluation of the patients with back pain

    International Nuclear Information System (INIS)

    Khancherly, A.

    2002-01-01

    The aim of study was evaluation of the results of the bone scan in patients suffering back for more than 2 weeks. In 120 patients with back pain for more than 2 w ks who referred for bone scan significant numbers showed inflammatory disease including spondylitis and/ or saltcellar's in bone scintigraphy. Because of low sensitivity of the other imaging modalities in detection of this inflammatory lesions, the bone scan can be used as primary imaging method in evaluation of the patients with back pain in certain geographic regions in which special pathogens endemic ally exist. This study was performed in Hamedan in which Brucella infection and to lesser extent Tuberculosis are endemic

  12. Role of nuclear medicine bone scans in evaluating pain in athletic injuries

    International Nuclear Information System (INIS)

    Martire, J.R.

    1987-01-01

    The utilization of nuclear medicine bone scanning examinations early in the diagnostic process allows physicians to render prompt and correct treatment in urgent or difficult athletic cases. Bone scanning should be performed for athletic injuries whenever (1) x-rays are normal but bone or joint pain persists; (2) x-rays are positive but it cannot be determined if the findings are acute or chronic; (3) soft-tissue injuries present and x-rays are not useful; and (4) bone pain or joint impairment present without a history of trauma.89 references

  13. Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Pomp, Jacqueline [Department of Radiotherapy, Reinier de Graaf Gasthuis, Delft (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands); Marijnen, Corrie A.M.; Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)

    2015-11-01

    Purpose: To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response. Patients and Methods: The prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death as a competing risk, and C-statistics were calculated for discriminative value. Results: In total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56). Conclusions: Responding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.

  14. Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Graeff, Alexander de; Monninkhof, Evelyn M.; Pomp, Jacqueline; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.M.; Linden, Yvette M. van der

    2015-01-01

    Purpose: To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response. Patients and Methods: The prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death as a competing risk, and C-statistics were calculated for discriminative value. Results: In total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56). Conclusions: Responding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.

  15. A meta-analysis of 18F-Fluoride positron emission tomography for assessment of metastatic bone tumor

    International Nuclear Information System (INIS)

    Tateishi, Ukihide; Morita, Satoshi; Taguri, Masataka

    2010-01-01

    The aim of this study was to assess the diagnostic performance of 18 F-Fluoride positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) compared with bone scintigraphy (BS) planar or BS planar and single photon emission computed tomography (SPECT) in evaluating patients with metastatic bone tumor. We performed a meta-analysis of all available studies addressing the diagnostic accuracy of 18 F-Fluoride PET, 18 F-Fluoride PET/CT, BS planar, and BS planar and SPECT for detecting the metastatic bone tumor. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and drew summary receiver operating characteristic curves using hierarchical regression models. We also compared the effective dose and cost-effectiveness estimated by data from the enrolled studies between 18 F-Fluoride PET or PET/CT and BS planar or BS planar and SPECT. When comparing all studies with data on 18 F-Fluoride PET or PET/CT, sensitivity and specificity were 96.2% [95% confidence interval (CI) 93.5-98.9%] and 98.5% (95% CI 97.0-100%), respectively, on a patient basis and 96.9% (95% CI 95.9-98.0%) and 98.0% (95% CI 97.1-98.9%), respectively, on a lesion basis. The Az values of 18 F-Fluoride PET or PET/CT were 0.986 for the patient basis and 0.905 for the lesion basis, whereas those of BS or BS and SPECT were 0.866 for the patient basis and 0.854 for the lesion basis. However, the estimated effective dose and average cost-effective ratio were poorer for 18 F-Fluoride PET or PET/CT than those of BS planar or BS planar and SPECT. 18 F-Fluoride PET or PET/CT has excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and average cost-effective ratio are at a disadvantage compared with BS planar or BS planar and SPECT. (author)

  16. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio; Ballicu, Nicola; Fele, Rosa Maria; Sotgia, Barbara; Melis, Luca [Oncological Hospital ' ' A. Businco' ' , Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Cagliari (Italy); Fancellu, Alessandro [University of Sassari, Department of Clinical and Experimental Medicine, Sassari (Italy)

    2017-04-15

    To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience. (orig.)

  17. Method for palliation of pain in human bone cancer using therapeutic tin-117m compositions

    International Nuclear Information System (INIS)

    Srivastava, S.C.; Meinken, G.E.; Mausner, L.F.; Atkins, H.L.

    1998-01-01

    The invention provides a method for the palliation of bone pain due to cancer by the administration of a unique dosage of a tin-117m (Sn-117m) stannic chelate complex in a pharmaceutically acceptable composition. In addition, the invention provides a method for simultaneous palliation of bone pain and radiotherapy in cancer patients using compositions containing Sn-117m chelates. The invention also provides a method for palliating bone pain in cancer patients using Sn-117m-containing compositions and monitoring patient status by imaging the distribution of the Sn-117m in the patients. Also provided are pharmaceutically acceptable compositions containing Sn-117m chelate complexes for the palliation of bone pain in cancer patients. 5 figs

  18. Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors

    International Nuclear Information System (INIS)

    Waldenstroem, Ann-Charlotte; Olsson, Caroline; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Al-Abany, Massoud; Palm, Asa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

    2011-01-01

    Purpose: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. Methods and Materials: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. Results: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Conclusions: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.

  19. Human brain activity associated with painful mechanical stimulation to muscle and bone

    OpenAIRE

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-01-01

    Purpose The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Methods Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain ac...

  20. Reversible bone pain and symmetric bone scan uptake in a dialysis patient treated with cinacalcet: a case report

    Directory of Open Access Journals (Sweden)

    Bottino Carla

    2010-06-01

    Full Text Available Abstract Introduction The medical management of secondary hyperparathyroidism in patients with end-stage renal disease involves a combination of dietary restrictions, phosphate binders, active vitamin D analogs, and calcimimetics. Case presentation We report the case of a 36-year-old Hispanic dialysis patient, originally from Cuba and now residing in the USA, who developed severe bone pain and muscle twitching after starting low dose cinacalcet, despite normal pre-dialysis ionized calcium and elevated parathyroid hormone. The clinical symptoms correlated with increased symmetrical uptake on bone scan that resolved rapidly upon discontinuation of cinacalcet. Conclusion Cinacalcet may induce severe bone pain and a unique bone scan uptake pattern in hemodialysis patients.

  1. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures

    Energy Technology Data Exchange (ETDEWEB)

    Andresen, R.; Luedtke, C.W.; Kamusella, P.; Wissgott, C. [Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide (Germany). Inst. of Diagnostic and Interventional Radiology/Neuroradiology; Radmer, S. [Center of Orthopedics, Berlin (Germany). Orthopedic Surgery and Traumatology; Schober, H.C. [Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock (Germany). Dept. of Internal Medicine

    2014-09-15

    Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6+/-1.78 (4-10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3+/-0.67 (8-10) pre-operatively to 2.7+/-1.28 (1-5) on the 2nd postoperative day and 2.9+/-0.81 (2-5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain. (orig.)

  2. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures

    International Nuclear Information System (INIS)

    Andresen, R.; Luedtke, C.W.; Kamusella, P.; Wissgott, C.; Radmer, S.; Schober, H.C.

    2014-01-01

    Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6+/-1.78 (4-10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3+/-0.67 (8-10) pre-operatively to 2.7+/-1.28 (1-5) on the 2nd postoperative day and 2.9+/-0.81 (2-5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain. (orig.)

  3. Randall Selitto pressure algometry for assessment of bone-related pain in rats.

    Science.gov (United States)

    Falk, S; Ipsen, D H; Appel, C K; Ugarak, A; Durup, D; Dickenson, A H; Heegaard, A M

    2015-03-01

    Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Randall Selitto pressure algometry over the tibia resulted in reproducible withdrawal thresholds, which were dose-dependently increased by morphine. Cutaneous nociception did not contribute to Randall Selitto measures. In cancer-bearing animals, compared with sham, significant differences in pain-related behaviours were demonstrated by the Randall Selitto test on day 17 and 21 post-surgery. A difference was also demonstrated by von Frey testing, weight-bearing and limb use tests. Our results indicate that pressure applied by the Randall Selitto algometer on a region, where the bone is close to the skin, may offer a way to measure bone-related pain in animal models and could provide a supplement to the traditional behavioural tests and a means to study deep pain. © 2014 European Pain Federation - EFIC®

  4. Patterns of failure following bone marrow transplantation for metastatic breast cancer: the role of consolidative local therapy

    International Nuclear Information System (INIS)

    Shah, Amit B.; Hartsell, William F.; Ghalie, Richard; Kaizer, Herbert

    1995-01-01

    Purpose: The purpose of this analysis is to evaluate the patterns of failure and the role of local therapy in conjunction with bone marrow transplantation (BMT) for metastatic or recurrent breast cancer. Methods and Materials: Between June 1986 and November 1991, 46 patients with hormone unresponsive metastatic or recurrent breast cancer underwent high dose chemotherapy (HDC) with hematopoietic stem cell support. The most commonly used preparative regimen consisted of thiotepa (750 mg/m 2 ), cisplatin (150 mg/m 2 ), and cyclophosphamide (120 mg/kg) followed by autologous BMT. Consolidative surgery or irradiation was considered in patients whose cancer responded to BMT and had localized sites of disease. Results: Six patients (13%) died of BMT-related complications. Of the remaining 40 patients, 22 were candidates for consolidative therapy, and 18 of those patients received consolidative irradiation (17 patients) or surgery (1 patient) to one or more sites. At median follow-up of 27 months (range, 20-78), 12 of 18 (67%) patients have continuous local control at the 22 consolidated sites (1 of 4 controlled at chest wall sites, 7 of 8 at regional nodal sites, 7 of 7 at localized bone sites, and 1 of 3 at lung/mediastinal sites). Toxicity of consolidative irradiation was mainly limited to myelosuppression in 6 of 17 patients. Two patients did not complete the consolidative local therapy, one because of hematologic toxicity and one because of rapid systemic tumor progression during treatment. Conclusion: In patients with localized areas of extravisceral metastases, consolidative irradiation is feasible with acceptable hematologic toxicity. Consolidative irradiation can result in continuous local control, especially in isolated bone metastases and in regional nodal sites; however, the advantage is less clear in patients undergoing consolidative irradiation for chest wall failures. Because distant visceral metastases still remain a major site of failure after this HDC

  5. Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases : a multicenter double-blind placebo-controlled randomized trial

    NARCIS (Netherlands)

    Westhoff, Paulien G.; de Graeff, Alexander; Geerling, Jenske I.; Reyners, Anna K. L.; van der Linden, Yvette M.

    2014-01-01

    Background: Radiotherapy has a good effect in palliation of painful bone metastases, with a pain response rate of more than 60%. However, shortly after treatment, in approximately 40% of patients a temporary pain flare occurs, which is defined as a two-point increase of the worst pain score on an

  6. Dimethyl sulfoxide-sodium bicarbonate infusion for palliative care and pain relief in patients with metastatic prostate cancer.

    Science.gov (United States)

    Hoang, Ba X; Le, Bao T; Tran, Hau D; Hoang, Cuong; Tran, Hung Q; Tran, Dao M; Pham, Cu Q; Pham, Tuan D; Ha, Trung V; Bui, Nga T; Shaw, D Graeme

    2011-01-01

    Prostate cancer (adenocarcinoma of the prostate) is the most widespread cancer in men. It causes significant suffering and mortality due to metastatic disease. The main therapy for metastatic prostate cancer (MPC) includes androgen manipulation, chemotherapy, and radiotherapy and/or radioisotopes. However, these therapeutic approaches are considered palliative at this stage, and their significant side effects can cause further decline in patients' quality of life and increase non-cancer-related morbidity/mortality. In this study, the authors have used the infusion of dimethyl sulfoxide-sodium bicarbonate (DMSO-SB) to treat 18 patients with MPC. The 90-day follow-up of the patients having undergone the proposed therapeutic regimen showed significant improvement in clinical symptoms, blood and biochemistry tests, and quality of life. There were no major side effects from the treatment. In searching for new and better methods for palliative treatment and pain relief, this study strongly suggested therapy with DMSO-SB infusions could provide a rational alternative to conventional treatment for patients with MPC.

  7. Evaluation of Tumor Viability for Primary and Bone Metastases in Metastatic Castration-Resistant Prostate Cancer Using Whole-Body Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Hiromichi Iwamura

    2018-01-01

    Full Text Available In contrast to bone scan and computed tomography (CT, which depend on osteoblastic response to detect bone metastasis, whole-body magnetic resonance imaging (WB-MRI may be able to directly detect viable tumors. A 75-year-old male who had progressive metastatic prostate cancer during primary androgen deprivation therapy was referred to our hospital. Although bone scan and CT showed multiple bone metastases, WB-MRI suggested nonviable bone metastasis and viable tumor of the primary lesion. Prostate needle biopsy demonstrated viable prostate cancer cells from 10 of 12 cores. In contrast, CT-guided needle biopsy from bone metastasis of the lumbar vertebra revealed no malignant cells. Based on these findings, we reasoned that viable tumor cells inducing disease progression may primarily exist in the primary lesions and not in the metastatic lesions, and combined prostate radiotherapy and systemic hormonal therapy resulted in successful clinical response and disease control. The use of WB-MRI to detect viable disease lesions may enable us to design optimal treatment strategies for patients with metastatic castration-resistant prostate cancer.

  8. Orofacial pain and numb chin syndrome as the presenting symptoms of a metastatic prostate cancer.

    Directory of Open Access Journals (Sweden)

    Gaver A

    2002-10-01

    Full Text Available We describe a patient with orofacial pain as the presenting symptom caused by a mandibular metastasis from a previously undiagnosed cancer of the prostate. This possibility should be considered in the differential diagnosis of male patients presenting with orofacial pain.

  9. Biochemical markers of bone turnover in the clinical development of drugs for osteoporosis and metastatic bone disease: potential uses and pitfalls.

    Science.gov (United States)

    Cremers, Serge; Garnero, Patrick

    2006-01-01

    with clinical outcomes may be remarkably different for drugs with alternative mechanisms of action, challenging the use of the markers for the development of new drugs for the treatment of patients with osteoporosis. At present, the pharmacological treatment of cancer that has metastasised to the bone is limited to several bisphosphonates. Recent studies have shown relationships between the normalisation of levels of biochemical markers of bone turnover and clinical outcomes, and prospective studies investigating the application of such relationships are ongoing. The markers may play an important role in the optimisation of registered bisphosphonate treatments. However, their role in the development of new drugs is still limited to dose selection, and potential relationships with clinical outcomes remain to be investigated in instances of new mechanisms of action. Biochemical markers of bone turnover are a valuable asset for drug development, but their rational use is determined by a number of variables. Correctly manipulating these may improve clinical development of drugs for the treatment of patients with metabolic bone diseases such as osteoporosis and cancer metastatic to the bone.

  10. Inter- and intra-observer variability associated with the use of the Mirels' scoring system for metastatic bone lesions.

    LENUS (Irish Health Repository)

    Mac Niocaill, Ruairi F

    2011-01-01

    Metastatic bone disease is increasing in association with ever-improving medical management of osteophylic malignant conditions. The precise timing of surgical intervention for secondary lesions in long bones can be difficult to determine. This paper aims to evaluate a classic scoring system. All radiographs were examined twice by three orthopaedic oncologists and scored according to the Mirels\\' scoring system. The Kappa statistic was used for the purpose of statistical analysis. The results show agreement between observers (κ = 0.35-0.61) for overall scores at the two time intervals. Inter-observer agreement was also seen with subset analysis of size (κ = 0.27-0.60), site (κ = 0.77-1.0) and nature of the lesion (κ = 0.55-0.81). Similarly, low levels of intra-observer variability were noted for each of the three surgeons (κ= 0.34, 0.39, and 0.78, respectively). These results indicate a reliable, repeatable assessment of bony metastases. We continue to advocate its use in the management of patients with long bone metastases.

  11. [Chronic bone pain due to raised FGF23 production? The importance of determining phosphate levels

    NARCIS (Netherlands)

    Jongh, R.T. de; Vervloet, M.G.; Bravenboer, N.; Heijboer, A.C.; Heijer, M. den; Lips, P.

    2013-01-01

    Hypophosphatemia is an important finding in the evaluation of patients with chronic bone pain. Fibroblast-growth factor 23 (FGF23) plays a role in the differential diagnosis of hypophosphatemia. A 34-year-old man had progressive pain in both shoulders and hips due to hypophosphatemic osteomalacia.

  12. Pain and mean absorbed dose to the pubic bone after radiotherapy among gynecological cancer survivors.

    Science.gov (United States)

    Waldenström, Ann-Charlotte; Olsson, Caroline; Wilderäng, Ulrica; Dunberger, Gail; Lind, Helena; al-Abany, Massoud; Palm, Åsa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

    2011-07-15

    To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses beam doses ≥ 52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. 32-Phosphorus for bone pain palliation due to bone metastases, its safety and efficacy in patients with advanced cancer

    International Nuclear Information System (INIS)

    Fettich, J.; Nair, G.; Padky, A.K.; Stare, J.; Nair, N.; Moralles, R.; Riccabona, G.; Tanumihardia, M.

    2001-01-01

    Bone pain due to bony metastases can seriously affect a patient's quality of life. External irradiation, narcotic drugs and polyphosphates may cause important side effects or are expensive, therefore in many patients radionuclide treatment using a single dose of beta emitting bone seeking radiopharmaceuticals has become widely accepted. Except 32-Phosphorus (32-P) all of them are expensive and difficult to obtain in certain countries. The aim of the study was to evaluate safety and efficacy of 32-P for palliation of bone pain due to bony metastases by comparing it to 89-Strontium (89-Sr), the most commonly used radiopharmaceutical for bone pain palliation in the framework of a prospective IAEA co-ordinated multicenter study. A very strict protocol for unified patient inclusion and follow up was used. 93 cancer patients with osteoblastic bony metastases were included into the study, 48 were treated by 89-Sr (150 MBq) and 45 by 32-P (450 MBq). Pain score, analgesic consumption, quality of life, and indices of bone marrow depression were monitored 2 weeks pre- and up to 4 months post treatment. Favourable response to treatment was recorded in 75% of the patients treated with 89-Sr and in 60% of those treated with 32-P (p=0,122). There was no significant difference between the duration of favourable effect for both radiopharmaceuticals. Moderate decrease of white blood cell (WBC) and platelet counts, and haemoglobin (Hb) levels was detected more often in the 32-P treated group. Although 32-P appears to be more toxic, no toxic effects requiring specific treatment were seen in either group. Due to its comparable efficacy and safety, general availability and low cost its more widespread use should be encouraged to increase quality of life and reduce cost of medical care of patients with intractable bone pain due to cancer metastases. (author)

  14. The impact of bone marrow micrometastases on metastatic disease-free survival in patients with colorectal carcinoma.

    LENUS (Irish Health Repository)

    O'Connor, O J

    2012-02-03

    AIMS: The biological relevance of bone marrow micrometastases (BMM) in colorectal cancer remains unknown. Here, we investigate their nature by examining the impact of the presence of BMM on metastatic disease-free survival in a cohort of patients with this disease. METHODS: Sixty-three consecutive patients undergoing surgery for colorectal cancer of any stage were studied after approval of the study protocol by the local ethics committee and with full individual informed consent. All had bilateral iliac crest bone marrow aspirates prior to operation. Aspirates were then examined for the presence of aberrant cytokeratin-18-positive cells by a blinded observer using both flow cytometric and APAAP immunohistochemical techniques. RESULTS: Mean follow-up after surgery was 4.6 years (range 1.9-6.9) for those without hepatic metastases at diagnosis. Seven of 34 patients with Dukes\\' stage A or B developed metastatic disease after a mean interval of 4.7 years (range 3.8-6.8). However, only 2 of these patients demonstrated BMM at the time of surgery. Nine of 15 patients with Dukes\\' C carcinoma at the time of surgery subsequently developed metastases after a mean interval of 4.4 years (range 1.9-6.9). Again, only two of these patients had BMM detectable initially. In only three of the 14 patients known to have metastases at the time of operation (i.e. Dukes\\'\\'D\\' disease) were BMM found. CONCLUSION: The presence of BMM as detected by this methodology was not predictive of tumour recurrence or metastasis. This study does not support the consideration of adjuvant therapy based on the presence of BMM at a single pre-operative time point in patients with colorectal cancer.

  15. Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N. [University Hospital Muenster (Germany). Dept. of Radiotherapy and Radiooncology

    2002-05-01

    Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

  16. Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

    International Nuclear Information System (INIS)

    Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N.

    2002-01-01

    Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

  17. Increased circulating rather than spinal cytokines accompany chronic pain behaviors in experimental bone cancer and arthritis

    Directory of Open Access Journals (Sweden)

    Line Pourtau

    2014-12-01

    Full Text Available Aim: Peripheral cytokines contribute to arthritis and bone cancer pain through sensory nerve actions. However, increased spinal cytokine and glial filament expression, coined neuroinflammation, has also been proposed to play a part in chronic pain. Therefore, spinal cord, dorsal root ganglia and circulating cytokines were compared in murine arthritis and bone cancer models in relationship to behavioral signs of pain. Methods: Exploratory behaviors were studied after intra-articular complete Freund's adjuvant or bone intramedullary sarcoma cell injection. Nervous tissue and blood cytokine expression were determined by real-time polymerase chain reaction (PCR and multiplex immunoassays, respectively. Results: PCR analysis did not reveal any hallmark of spinal neuroinflammation in spontaneously-behaving mice with cartilage or bone lesions. However, imposed paw stimulation during joint inflammation increased spinal interleukin-1β (IL-1β expression. Spontaneous paw guarding during rearing was displayed by animals with joint inflammation and bone destruction and was accompanied by increased circulating IL-6 and monocyte chemoattractant protein-1, respectively. In addition, dorsal root ganglia were found to constitutively express receptors for this chemotactic cytokine. Conclusion: Our findings indicate that spinal neuroinflammation is not a necessary condition for chronic pain and suggest that circulating cytokine action in dorsal root ganglia may contribute to experimental joint inflammation and bone cancer pain.

  18. Human brain activity associated with painful mechanical stimulation to muscle and bone.

    Science.gov (United States)

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-08-01

    The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain activation in response to mechanical nociceptive stimulation targeting muscle and bone were measured by fMRI and analyzed. Painful mechanical stimulation targeting muscle and bone activated the common areas including bilateral insula, anterior cingulate cortex, posterior cingulate cortex, secondary somatosensory cortex (S2), inferior parietal lobe, and basal ganglia. The contralateral S2 was more activated by strong stimulation than by weak stimulation. Some areas in the basal ganglia (bilateral putamen and caudate nucleus) were more activated by muscle stimulation than by bone stimulation. The putamen and caudate nucleus may have a more significant role in brain processing of muscle pain compared with bone pain.

  19. Analgesic effects of lappaconitine in leukemia bone pain in a mouse model

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    Xiao-Cui Zhu

    2015-05-01

    Full Text Available Bone pain is a common and severe symptom in cancer patients. The present study employed a mouse model of leukemia bone pain by injection K562 cells into tibia of mouse to evaluate the analgesic effects of lappacontine. Our results showed that the lappaconitine treatment at day 15, 17 and 19 could effectively reduce the spontaneous pain scoring values, restore reduced degree in the inclined-plate test induced by injection of K562 cells, as well as restore paw mechanical withdrawal threshold and paw withdrawal thermal latency induced by injection of K562 cells to the normal levels. Additionally, the molecular mechanisms of lappaconitine’s analgesic effects may be related to affect the expression levels of endogenous opioid system genes (POMC, PENK and MOR, as well as apoptosis-related genes (Xiap, Smac, Bim, NF-κB and p53. Our present results indicated that lappaconitine may become a new analgesic agent for leukemia bone pain management.

  20. Measurement of 24-hr whole-body retention of Tc-99mMDP with a thyroid uptake probe: quantitative assessment of metabolic and metastatic bone diseases

    International Nuclear Information System (INIS)

    Seto, H.; Futatsuya, R.; Kamei, T.; Furumoto, N.; Ishizaki, Y.; Hada, M.; Kakishita, M.

    1983-01-01

    A new method for measurement of 24-hr whole body retention (WBR) of Tc-99mMDP, using a thyroid uptake probe was established and its clinical significance was evaluated in 102 patients with various bone disorders, including metabolic and metastatic bone diseases, aged above 20 years old. Reproducibility of 24-hr WBR in 10 patients was very good (r=0.996). The 24-hr WBR of Tc-99mMDP in the normal subjects was 30.4 +- 4.6%. The WBR values of chronic renal failure, metastatic bone disease and hyperthyroidism groups were 98.4 +- 3.0, 44.0 +- 8.0, 40,6 +- 6.3% respectively, which were significantly higher (p < 0.001). However the WBR of steroid-induced osteoporotic group was significantly lower (17.3 +- 5.4%) as compared with the normal group (p < 0.001). Based on these results the method is simple, reproducible and accurate to measure 24-hr WBR of Tc-99mMDP. Quantification of WBR is of great clinical value to diagnose metabolic bone disease and to follow-up metabolic and metastatic bone disease after treatment

  1. Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain.

    Science.gov (United States)

    Bennett, Michael I; Johnson, Mark I; Brown, Sarah R; Radford, Helen; Brown, Julia M; Searle, Robert D

    2010-04-01

    This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain. Cancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. The diagnostic value of bone scintigraphy in patients with low back pain

    International Nuclear Information System (INIS)

    Schuette, H.E.; Park, W.M.

    1983-01-01

    Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering ''non-specific'' back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings. (orig.)

  3. Diagnostic value of bone scintigraphy in patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Schuette, H.E.; Park, W.M.

    1983-06-01

    Bone scintigraphy has been studied in two groups of patients with low back pain. In one group of 38 patients suffering ''non-specific'' back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings.

  4. Alpha Particle Therapy in Metastatic Prostate Cancer

    International Nuclear Information System (INIS)

    O’Sullivan, Joe

    2013-01-01

    Metastatic castrate resistant prostate cancer (CRPC) is a leading cause of cancer mortality among men in western countries. Although nearly 85% of patients present with localised disease, up to 40% will eventually develop metastatic disease during the course of illness. Of men dying from prostate cancer, more than 90% have bone metastases many with no other significant metastatic sites. Symptoms related to bone metastases and skeletal related events (SREs) account for the major cause of morbidity in these patients. Bone-seeking radionuclides have been used in the treatment of prostate cancer bone metastases for many years. The first bone seeking radionuclide drug approved by the FDA was Strontium-89. Other agents have also been used including Samarium-153 EDTMP, Rhenium-186 (-188)-HEDP. These radionuclides are all emit shortrange therapeutic beta radiation with bone marrow as the dose limiting toxicity. There is strong clinical trial evidence of benefit for these radionuclides in reducing pain in advanced prostate cancer; however, none of the drugs has been shown to improve survival, albeit none of the clinical trials were powered to detect differences in survival

  5. Topical Treatment with Xiaozheng Zhitong Paste (XZP Alleviates Bone Destruction and Bone Cancer Pain in a Rat Model of Prostate Cancer-Induced Bone Pain by Modulating the RANKL/RANK/OPG Signaling

    Directory of Open Access Journals (Sweden)

    Yanju Bao

    2015-01-01

    Full Text Available To explore the effects and mechanisms of Xiaozheng Zhitong Paste (XZP on bone cancer pain, Wistar rats were inoculated with vehicle or prostate cancer PC-3 into the tibia bone and treated topically with inert paste, XZP at 15.75, 31.5, or 63 g/kg twice per day for 21 days. Their bone structural damage, nociceptive behaviors, bone osteoclast and osteoblast activity, and the levels of OPG, RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were examined. In comparison with that in the placebo group, significantly reduced numbers of invaded cancer cells, decreased levels of bone damage and mechanical threshold and paw withdrawal latency, lower levels of serum TRACP5b, ICTP, PINP, and BAP, and less levels of bone osteoblast and osteoclast activity were detected in the XZP-treated rats (P<0.05. Moreover, significantly increased levels of bone OPG but significantly decreased levels of RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were detected in the XZP-treated rats (P<0.05 for all. Together, XZP treatment significantly mitigated the cancer-induced bone damage and bone osteoclast and osteoblast activity and alleviated prostate cancer-induced bone pain by modulating the RANKL/RANK/OPG pathway and bone cancer-related inflammation in rats.

  6. Therapeutic efficacy and dosimetric aspects of Rhenium-188-HEDP in bone pain palliation

    International Nuclear Information System (INIS)

    Liepe, Knut

    2005-01-01

    Full text: Bone metastases are a frequent complication of cancer, occurring in up 70% of patients suffering from advanced breast or prostate cancer and often present with severe bone pain. In this purpose the radionuclide therapy is a useful option for cancer patients. Different radionuclides are described, such as 89 Sr, 32 P, 153 Sm-EDTMP, 186 Re-HEDP, 131 I-BDP3, 90 Y, 117mSn-DTPA, 188 Re-HEDP and 188 Re-DMSA. The most experiences are available for 89 Sr. An indication for the treatment are patients with osteoblastic metastases, bone pain, sufficient bone marrow function and at least of three bone metastases visualized in bone scan. A bisphosphonate therapy, a chemotherapy with lower bone marrow toxicity or a local field external beam radiotherapy represent no contraindications, especially because the reported synergistic effects to the systemic radionuclide therapy. In 33 treated patients (breast and prostate cancer) we investigated the effect of 188 Re-HEDP on pain relief, analgesic intake and impairment of bone marrow function. There were an improvement on the Karnofsky performance scale from 74 7% to 85 9% 12 weeks after therapy (p= 0.001). The pain score showed a maximum decrease from 44 ± 18% to 27 ± 20% in the 3rd to the 8th week after therapy (p = .009) and 76% had a pain relief (20% were pain free). The maximal differences between the values of platelets and leukocytes before and after therapy were not statistically significant (p = 0.021 and p = 0.094). In 105 investigated patients treated with different radionuclides ( 89 Sr, 153 Sm-EDTMP, 186 Re-HEDP, 188 Re-HEDP and 89 Sr in combination with chemotherapy) no different therapeutic efficacy of the treatments were observed. In dose calculation of 188 Re-HEDP a radiation dose of 3.83 ± 2.01 mGy/MBq (12.6 Gy for 3300 MBq) for bone metastases and 0.61 ± 0.21 mGy/MBq (2 Gy for 3300 MBq) were found. With the introducing of radionuclide treatments with chemotherapy and repeated treatments, the

  7. Bone scan: A useful test for evaluating patients with low back pain

    International Nuclear Information System (INIS)

    Collier, B.D.; Kir, K.M.; Mills, B.J.A.; Patel, N.C.; Pochis, W.T.; Onsel, C.; Liu, Y.; Turoglu, H.T.

    1990-01-01

    For many years it has been known that the sensitivity of bone scanning to the presence of destructive bony lesions favors its use in screning for bone metastases and osteomyelitis. More recently bone scanning has been routinely employed in evaluating benign skeletal pathology that may be the cause of low back pain. Bone scanning can play an important part identifying the cause of pain, clarifying the significance of radiographic findings, and evaluating the results of spinal surgery. This expansion of the role of nuclear medicine in diagnosing and managing low back pain is based in part upon novel diagnostic applications of 99m Tc-methylene diphosphonate, a radiopharmaceutical that has been available for over 15 years. Equally important for this development, however, has been the recent availability of SPECT, a tomographic imaging technique that can be used to display the spine in a series of 6- to 8-mm thick sections. Slightly more than one-half of newly purchased gamma cameras are rotating systems suitable for bone SPECT studies. Thus, many community hospitals can now perform state-of-the-art bone scans for low back pain. (orig.)

  8. Levo-Tetrahydropalmatine Attenuates Bone Cancer Pain by Inhibiting Microglial Cells Activation

    Directory of Open Access Journals (Sweden)

    Mao-yin Zhang

    2015-01-01

    Full Text Available Objective. The present study is to investigate the analgesic roles of L-THP in rats with bone cancer pain caused by tumor cell implantation (TCI. Methods. Thermal hyperalgesia and mechanical allodynia were measured at different time points before and after operation. L-THP (20, 40, and 60 mg/kg were administrated intragastrically at early phase of postoperation (before pain appearance and later phase of postoperation (after pain appearance, respectively. The concentrations of TNF-α, IL-1β, and IL-18 in spinal cord were measured by enzyme-linked immunosorbent assay. Western blot was used to test the activation of astrocytes and microglial cells in spinal cord after TCI treatment. Results. TCI treatment induced significant thermal hyperalgesia and mechanical allodynia. Administration of L-THP at high doses significantly prevented and/or reversed bone cancer-related pain behaviors. Besides, TCI-induced activation of microglial cells and the increased levels of TNF-α and IL-18 were inhibited by L-THP administration. However, L-THP failed to affect TCI-induced astrocytes activation and IL-1β increase. Conclusion. This study suggests the possible clinical utility of L-THP in the treatment of bone cancer pain. The analgesic effects of L-THP on bone cancer pain maybe underlying the inhibition of microglial cells activation and proinflammatory cytokines increase.

  9. In-vitro studies with 188Re-HEDP, a clinically used bone pain palliating agent, on bone cancer cells

    International Nuclear Information System (INIS)

    Sharma, Rohit; Kumar, Chandan; Mallia, Madhava B.; Banerjee, Sharmila; Kameswaran, Mythili

    2017-01-01

    Rhenium-188 is an attractive radioisotope for a wide variety of radiotherapy applications. 188 Re-HEDP (HEDPhydroxyethylidene- 1,1-diphosphonic acid) is one such, clinically useful, radiopharmaceutical for palliation of bone pain due to osseous metastasis. Herein, our aim was to study the uptake and retention of 188 Re-HEDP in mineralized bone and to assess its cellular toxicity, along with its underlying mechanism in human osteocarcinoma (MG-63 and Soas-2) cell lines. 188 Re-HEDP uptake was found to be significantly higher in mineralized bone. The 188 Re-HEDP complex also induces G2-M cell cycle arrest and thus contributing to apoptosis and cellular toxicity in bone cancer cells. (author)

  10. Bisphosphonates Inhibit Pain, Bone Loss, and Inflammation in a Rat Tibia Fracture Model of Complex Regional Pain Syndrome.

    Science.gov (United States)

    Wang, Liping; Guo, Tian-Zhi; Hou, Saiyun; Wei, Tzuping; Li, Wen-Wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-10-01

    Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenesis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that antiresorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously, we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS, and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, postfracture cutaneous cytokine upregulation, and adaptive immune responses in this CRPS model. Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by microcomputed tomography, and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed, and skin cytokine (tumor necrosis factor, interleukin [IL]-1, IL-6) and nerve growth factor (NGF) levels were determined by enzyme immunoassay. Skin and sciatic nerve immunoglobulin levels were determined by enzyme immunoassay. Rats with tibia fractures developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression and trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by microcomputed tomography, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression, and elevated immunocomplex deposition in skin and nerve

  11. Clinical relevance of the apparent diffusion coefficient value of metastatic bone tumours on diffusion-weighted MRI images: differences according to the types of primary tumour, the affected bones, and clinical factors.

    Science.gov (United States)

    Cha, M J; Yoon, Y C

    2015-10-01

    To evaluate whether the apparent diffusion coefficient (ADC) of metastatic bone tumours on diffusion-weighted magnetic resonance imaging (MRI) images differs according to the type of primary cancer, the affected bone, and clinical factors. For this retrospective study, two radiologists reviewed MRI images, including ADC maps, of 67 patients (M:F=38:29; median age, 48 years) who were diagnosed with bone metastasis by means of histological or clinical confirmation. The primary tumours included 29 lung adenocarcinomas, 15 invasive ductal adenocarcinomas of the breast, 13 hepatocellular carcinomas, six prostatic carcinomas, and four renal cell carcinomas. ADC values of the metastatic tumour were compared according to the type of primary malignancy, the affected bone, and the age and sex of the patient using Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction. In addition, pre-contrast CT images were available in 38 of 67 patients; a subanalysis of the CT radiodensity and ADC values were performed with Spearman correlation. The mean, standard deviation, and minimum and maximum values of the ADC of metastatic bone tumours did not differ significantly according to type of primary malignancy, the affected bone, or clinical variables (p>0.1). The ADC value was not significantly correlated with CT radiodensity (p=0.24). Intra- and interobserver agreements for the mean ADC values were excellent (intra-observer: p=0.98; interobserver: p=0.98). Assessment of the ADC value of metastatic bone tumours is not reliable for differentiation of the type of primary cancer. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Radiation-induced relief of pain in an animal model with bone invasion from cancer

    International Nuclear Information System (INIS)

    Seong, J.; Kim, J.; Kim, K.H.; Kim, U.J.; Lee, B.W.

    2003-01-01

    In clinic, local radiation is effective for relief of pain from cancer invasion into the bones. This effect is usually observed before the regression of tumor occurs, which implies radiation-induced pain relief by mechanisms other than tumor irradication. In this study, possible mechanisms were explored in animal model system. To establish an animal model, syngeneic hepatocarcinoma, HCa-I was transplanted on femoral periosteum of C3H/HeJ male mice and bone-invasive tumor growth was identified through the histological analysis. Development of tumor-induced pain was assessed by von Frey filament test, acetone test, and radiant heat test. Animals were also irradiated for their tumors. Any change in pain was analyzed by above tests for the quantitative change and by immunohistochemical stain for the expression of molecules such as c-fos, substance P, and calcitonin gene-related peptide (CGRP) in lumbar spinal cord. Cancer invasion into the bone was started from 7th day after transplantation and became evident at day 14. Objective increase of pain in the ipsilateral thigh was observed at day 14 on von Frey filament test and acetone test, while there was no remarkable regression of the tumors. In this model system, local radiation of tumor resulted in decrease in objective pain on von Frey filament test and acetone test. In the immunohistochemical stain for lumbar spinal cord, the expression of substance P and CGRP but not c-fos increased in tumor-bearing animal compared to the control. The expression of these molecules decreased in animals given local radiation. In summary, an animal model system was established for objective pain from cancer invasion into the bones. Local radiation of tumor induced objective pain relief and this effect seems to be mediated not by tumor regression but through altered production of pain-related molecules

  13. Radiation-induced relief of pain in an animal model with bone invasion from cancer

    Energy Technology Data Exchange (ETDEWEB)

    Seong, J; Kim, J; Kim, K H; Kim, U J; Lee, B W [Yonsei University Medical College, (Korea, Republic of)

    2003-07-01

    In clinic, local radiation is effective for relief of pain from cancer invasion into the bones. This effect is usually observed before the regression of tumor occurs, which implies radiation-induced pain relief by mechanisms other than tumor irradication. In this study, possible mechanisms were explored in animal model system. To establish an animal model, syngeneic hepatocarcinoma, HCa-I was transplanted on femoral periosteum of C3H/HeJ male mice and bone-invasive tumor growth was identified through the histological analysis. Development of tumor-induced pain was assessed by von Frey filament test, acetone test, and radiant heat test. Animals were also irradiated for their tumors. Any change in pain was analyzed by above tests for the quantitative change and by immunohistochemical stain for the expression of molecules such as c-fos, substance P, and calcitonin gene-related peptide (CGRP) in lumbar spinal cord. Cancer invasion into the bone was started from 7th day after transplantation and became evident at day 14. Objective increase of pain in the ipsilateral thigh was observed at day 14 on von Frey filament test and acetone test, while there was no remarkable regression of the tumors. In this model system, local radiation of tumor resulted in decrease in objective pain on von Frey filament test and acetone test. In the immunohistochemical stain for lumbar spinal cord, the expression of substance P and CGRP but not c-fos increased in tumor-bearing animal compared to the control. The expression of these molecules decreased in animals given local radiation. In summary, an animal model system was established for objective pain from cancer invasion into the bones. Local radiation of tumor induced objective pain relief and this effect seems to be mediated not by tumor regression but through altered production of pain-related molecules.

  14. Association of bone scintigraphic abnormalities with knee malalignment and pain.

    Science.gov (United States)

    Kraus, V B; McDaniel, G; Worrell, T W; Feng, S; Vail, T P; Varju, G; Coleman, R E

    2009-11-01

    The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms. A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase (99m)Technetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data. The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001). To the authors' knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

  15. The physiology of bone pain. How much do we really know?

    Directory of Open Access Journals (Sweden)

    Sara eNencini

    2016-04-01

    Full Text Available Pain is associated with most bony pathologies. Clinical and experimental observations suggest that bone pain can be derived from noxious stimulation of the periosteum or bone marrow. Sensory neurons are known to innervate the periosteum and marrow cavity, and most of these have a morphology and molecular phenotype consistent with a role in nociception. However, little is known about the physiology of these neurons, and therefore information about mechanisms that generate and maintain bone pain is lacking. The periosteum has received greater attention relative to the bone marrow, reflecting the easier access of the periosteum for experimental assessment. With the electrophysiological preparations used, investigators have been able to record from single periosteal units in isolation, and there is a lot of information available about how they respond to different stimuli, including those that are noxious. In contrast, preparations used to study sensory neurons that innervate the bone marrow have been limited to recording multi-unit activity in whole nerves, and whilst they clearly report responses to noxious stimulation, it is not possible to define responses for single sensory neurons that innervate the bone marrow. There is only limited evidence that peripheral sensory neurons that innervate bone can be sensitized or that they can be activated by multiple stimulus types, and at present this only exists in part for periosteal units. In the central nervous system, it is clear that spinal dorsal horn neurons can be activated by noxious stimuli applied to bone. Some can be sensitized under pathological conditions and may contribute in part to secondary or refered pain associated with bony pathology. Activity related to stimulation of sensory nerves that innervate bone has also been reported in neurons of the spinoparabrachial pathway and the somatosensory cortices, both known for roles in coding information about pain. Whilst these provide some clues

  16. [Effects of pamidronate disodium (Bonin) combined with chemotherapy on bone pain in multiple myeloma].

    Science.gov (United States)

    Leng, Yun; Chen, Shi-lun; Shi, Hong-zhi

    2002-10-01

    Objective. To evaluate the therapeutic effects of Disodium Pamidronate (Bonin) on bone pain in multiple myeloma. Method. 18 patients received only chemotherapy and 16 patients with addition of Bonin were compared. Result. The bone pain was significantly relieved both in chemotherapy alone group and in the combination group of Bonin with chemotherapy after treatment (P<0.01, as compared with before therapy). However, the effects of combination group were more dramatical than that of the other group (P<0.05). No obvious side-effects were observed except mild fever in one patient in the combination group. Conclusion. Bonin, as a safe and effective Bisphosphonates preparation, could relieve bone pain in multiple myeloma more effectively when combined with chemotherapy.

  17. 188Rhenium-HEDP in the Treatment of Pain in Bone Metastases

    International Nuclear Information System (INIS)

    Gaudiano, J.; Savio, E.; Robles, A.; Muniz, S.; Leon, A.; Verdera, S.; Martinez, G.; Hermida, J.C.; Knapp, F.F. Jr.

    1999-01-01

    Systemic use of radiopharmaceuticals is a recognized alternative method for the treatment of pain in patients with multiple bone metastasis. A new option, 188 Re-HEDP is proposed, using generator-obtained 188 Rhenium (β energy = 2.1 MeV, γ energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastasis from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities

  18. Curcumin deteriorates trabecular and cortical bone in mice bearing metastatic Lewis lung carcinoma

    Science.gov (United States)

    Bone is a major target of metastasis for many malignancies; curcumin has been studied for its role in cancer prevention including early phase clinical trials for its efficacy and safe use with cancer patients. The present study investigated the effects of dietary supplementation with curcumin (2% a...

  19. Labelling of Re-ABP with 188Re for bone pain palliation

    International Nuclear Information System (INIS)

    Arteaga de Murphy, Consuelo; Ferro-Flores, Guillermina; Pedraza-Lopez, Martha; Melendez-Alafort, Laura; Croft, B.Y.Barbara Y.; Ramirez, Flor de Maria; Padilla, Juan

    2001-01-01

    Etidronate and medronate have been labelled with technetium-99m ( 99m Tc-HEDP, 99m Tc-MDP) for bone scanning and, with rhenium-188 ( 188 Re-HEDP) to palliate the pain resulting from bone metastases. The objective of this study was to label alendronate, ABP, a new bisphosphonate, with SnF 2 -reduced- 188 Re. The reagents for the 5 mg ABP kit were SnF 2 , KReO 4 and gentisic acid at acid pH. The chemical, spectroscopic and microscopic characteristics, quality control, rat bone uptake of [ 188 Re]Re-ABP and similarities with 99m Tc-ABP are presented. We conclude that this is a promising new radiopharmaceutical for bone metastases pain palliation

  20. Schnitzler's syndrome: an unusual cause of bone pain with suggestive nuclear imaging features

    International Nuclear Information System (INIS)

    Raedt, N. de; Mortelmans, L.

    2009-01-01

    Schnitzler's syndrome is a rare inflammatory disorder characterised by chronic urticarial rash and monoclonal IgM gammopathy accompanied by at least two of the following features: fever, arthralgia or arthritis, bone pain, lymphadenopathy, hepato- or splenomegaly, leucocytosis and elevated sedimentation. The association of these clinical and biological features with radiographic and bone scan findings are suggestive of the disease. The case of a 37-year-old man presenting with Schnitzler's syndrome, emphasizing nuclear imaging features is reported here. (N.C.)

  1. Bone hyperalgesia after mechanical impact stimulation: a human experimental pain model.

    Science.gov (United States)

    Finocchietti, Sara; Graven-Nielsen, Thomas; Arendt-Nielsen, Lars

    2014-12-01

    Hyperalgesia in different musculoskeletal structures including bones is a major clinical problem. An experimental bone hyperalgesia model was developed in the present study. Hyperalgesia was induced by three different weights impacted on the shinbone in 16 healthy male and female subjects. The mechanical impact pain threshold (IPT) was measured as the height from which three weights (165, 330, and 660 g) should be dropped to elicit pain at the shinbone. Temporal summation of pain to repeated impact stimuli was assessed. All these stimuli caused bone hyperalgesia. The pressure pain threshold (PPT) was assessed by a computerized pressure algometer using two different probes (1.0 and 0.5 cm(2)). All parameters were recorded before (0), 24, 72, and 96 h after the initial stimulations. The IPTs were lowest 24 h after hyperalgesia induction for all three weights and the effect lasted up to 72 h (p pain and hyperalgesia model may provide the basis for studying this fundamental mechanism of bone-related hyperalgesia and be used for profiling compounds developed for this target.

  2. Malignant bone tumors

    International Nuclear Information System (INIS)

    Zedgenidze, G.A.; Kishkovskij, A.N.; Elashov, Yu.G.

    1984-01-01

    Clinicoroentgenologic semiotics of malignant bone tumors as well as metastatic bone tumors are presented. Diagnosis of malignant and metastatic bone tumors should be always complex, representing a result of cooperation of a physician, roentgenologist, pathoanatomist

  3. Knee joint pain potentially due to bone alterations in a knee osteoarthritis patient.

    Science.gov (United States)

    Komatsu, Masatoshi; Nakamura, Yukio; Kamimura, Mikio; Uchiyama, Shigeharu; Mukaiyama, Keijiro; Ikegami, Shota; Kato, Hiroyuki

    2014-12-01

    Osteoarthritis (OA) is the leading cause of musculoskeletal pain and functional disability worldwide. However, the etiology of this condition is still largely unknown. We report the clinical course of an elderly man with knee OA. Plain radiographs and MRI examinations performed during follow-up suggested that the pathophysiology of the patient's knee OA and joint pain may have been primarily due to bone alterations.

  4. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease

    DEFF Research Database (Denmark)

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann

    2016-01-01

    describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery......, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality....

  5. The Role of Osteoblast-Derived Cytokines in Bone Metastatic Breast Cancer

    Science.gov (United States)

    2009-01-01

    transform infrared microspectroscopy [34]. The MC3T3-E1 cultures, however, contained material of an unknown origin that represented dystrophic...x- ray densitometer (GE Medical Systems, Fitchburg, WI) and scanned via a Dual Energy X- ray Absorptiometry (DEXA) scan. Company-provided software...including osteoporosis, rheumatoid arthritis , and skeletal metastases, resulting in osteoclast activity in excess of bone deposition by osteoblasts with

  6. Differential effects of repeated low dose treatment with the cannabinoid agonist WIN 55,212-2 in experimental models of bone cancer pain and neuropathic pain

    DEFF Research Database (Denmark)

    Hald, Andreas; Ding, Ming; Egerod, Kristoffer Lihme

    2008-01-01

    Pain due to bone malignancies is one of the most difficult types of cancer pain to fully control and may further decrease the patients' quality of life. Animal models of chronic pain conditions resulting from peripheral inflammatory reactions or nerve injuries are responsive to treatment with can......Pain due to bone malignancies is one of the most difficult types of cancer pain to fully control and may further decrease the patients' quality of life. Animal models of chronic pain conditions resulting from peripheral inflammatory reactions or nerve injuries are responsive to treatment...... with cannabinoid agonists. However, the use of cannabinoid agonists in humans may be hampered by CNS related side effects and development of tolerance. In the present study, we investigated the effect of repeated low dose administration of the synthetic cannabinoid agonist WIN 55,212-2 on bone cancer pain...... and neuropathic pain in mice. In addition, we investigated the development of CNS related side effects and tolerance. We found that 0.5 mg/kg/day for 18 days reduced pain related behavior and expression of spinal glial fibrillary acidic protein in the bone cancer pain model but not in the neuropathic pain model...

  7. Most efficient questionnaires to measure quality of life, physical function, and pain in patients with metastatic spine disease: a cross-sectional prospective survey study.

    Science.gov (United States)

    Paulino Pereira, Nuno Rui; Janssen, Stein J; Raskin, Kevin A; Hornicek, Francis J; Ferrone, Marco L; Shin, John H; Bramer, Jos A M; van Dijk, Cornelis Nicolaas; Schwab, Joseph H

    2017-07-01

    Assessing quality of life, functional outcome, and pain has become important in assessing the effectiveness of treatment for metastatic spine disease. Many questionnaires are able to measure these outcomes; few are validated in patients with metastatic spine disease. As a result, there is no consensus on the ideal questionnaire to use in these patients. Our study aim was to assess whether certain questionnaires measuring quality of life, functional outcome, and pain (1) correlated with each other, (2) measured the construct they claim to measure, (3) had good coverage-floor and ceiling effects, (4) were reliable, and (5) whether there were differences in completion time between them. This is a prospective cross-sectional survey study from three outpatient clinics (two orthopedic oncology clinics and one neurosurgery clinic) from two affiliated tertiary hospital care centers. We included 100 consecutive patients with metastatic spine disease between July 2014 and February 2016. We excluded non-English-speaking patients. The following questionnaires were given in random order: Oswestry Disability Index (ODI) or Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Intensity, EuroQol-5 Dimensions (EQ-5D), and the Spine Oncology Study Group Outcome Questionnaire (SOSG-OQ). We used exploratory factor analysis-correlating questionnaires with an underlying mathematically derived trait-to assess if questionnaires measured the same concept. Coverage was assessed by floor and ceiling effects, and reliability was assessed by standard error of measurement as a function of ability. Differences in completion times were tested using the Friedman test. Questionnaires measured the construct they were developed for, as demonstrated with high correlations (>0.7) with the underlying trait. A floor effect was present in the PROMIS Pain Intensity (7.0%), ODI or NDI (4.0%), and the PROMIS Physical Function (1

  8. Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy.

    Science.gov (United States)

    Talamo, Giampaolo; Liao, Jason; Bayerl, Michael G; Claxton, David F; Zangari, Maurizio

    2010-03-01

    Medical literature provides only scarce data about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB), and little is known about the factors that can modify the perception of pain. In this study, we evaluated the effectiveness of a combination of analgesia and anxiolysis in reducing the pain score of patients undergoing BMAB. Eighty-four consecutive adult patients underwent BMAB after local anesthesia with 5 mL of lidocaine hydrochloride 1% aqueous solution in the left posterior superior iliac crest. Analgesia was obtained with acetaminophen 650 mg and oxycodone 10 mg, and anxiolysis was obtained with lorazepam 2 mg, all drugs given once orally 30 min before the procedure. We assessed the pain level with the Wong-Baker Faces Pain Rating Scale, which distinguishes six levels of pain, from 0 to 5. The 34 patients who received an oral administration of analgesia and anxiolysis reported pain at lower levels, i.e., in the range of 0-2, more frequently than the 50 patients who underwent BMAB without analgesia/anxiolysis (78% vs 64%, respectively). Among several predictors analyzed using a multivariate regression model, three were found to be associated with decreased pain level: the use of analgesia/anxiolysis, male sex, and increase in age (all with p values <0.05). Length of the extracted bone specimen, body mass index, and need of a spinal needle for anesthesia in obese patients did not predict for pain level. An oral administration of prophylactic regimen of analgesia and anxiolysis, at the above-mentioned doses, produced a statistically significant reduction of the perception of pain in patients undergoing BMAB, but its effect did not seem to provide a major and clinically significant reduction of pain level.

  9. Rate of Clinical Complete Response for 1 Year or More in Bone-Metastatic Breast Cancer after Comprehensive Treatments including Autologous Formalin-Fixed Tumor Vaccine.

    Science.gov (United States)

    Kuranishi, Fumito; Imaoka, Yuki; Sumi, Yuusuke; Uemae, Yoji; Yasuda-Kurihara, Hiroko; Ishihara, Takeshi; Miyazaki, Tsubasa; Ohno, Tadao

    2018-01-01

    No effective treatment has been developed for bone-metastatic breast cancer. We found 3 cases with clinical complete response (cCR) of the bone metastasis and longer overall survival of the retrospectively examined cohort treated comprehensively including autologous formalin-fixed tumor vaccine (AFTV). AFTV was prepared individually for each patient from their own formalin-fixed and paraffin-embedded breast cancer tissues. Three patients maintained cCR status of the bone metastasis for 17 months or more. Rate of cCR for 1 year or more appeared to be 15% (3/20) after comprehensive treatments including AFTV. The median overall survival time (60.0 months) and the 3- to 8-year survival rates after diagnosis of bone metastasis were greater than those of historical control cohorts in Japan (1988-2002) and in the nationwide population-based cohort study of Denmark (1999-2007). Bone-metastatic breast cancer may be curable after comprehensive treatments including AFTV, although larger scale clinical trial is required.

  10. Rate of Clinical Complete Response for 1 Year or More in Bone-Metastatic Breast Cancer after Comprehensive Treatments including Autologous Formalin-Fixed Tumor Vaccine

    Directory of Open Access Journals (Sweden)

    Fumito Kuranishi

    2018-01-01

    Full Text Available Introduction. No effective treatment has been developed for bone-metastatic breast cancer. We found 3 cases with clinical complete response (cCR of the bone metastasis and longer overall survival of the retrospectively examined cohort treated comprehensively including autologous formalin-fixed tumor vaccine (AFTV. Patients and Methods. AFTV was prepared individually for each patient from their own formalin-fixed and paraffin-embedded breast cancer tissues. Results. Three patients maintained cCR status of the bone metastasis for 17 months or more. Rate of cCR for 1 year or more appeared to be 15% (3/20 after comprehensive treatments including AFTV. The median overall survival time (60.0 months and the 3- to 8-year survival rates after diagnosis of bone metastasis were greater than those of historical control cohorts in Japan (1988–2002 and in the nationwide population-based cohort study of Denmark (1999–2007. Conclusion. Bone-metastatic breast cancer may be curable after comprehensive treatments including AFTV, although larger scale clinical trial is required.

  11. The value of SPECT bone scans in diagnosis of patients with zygapophseal joint pain

    International Nuclear Information System (INIS)

    Hu Jiajia; Liang Yu; Li Biao; Zhu Chengmo; Chen Gang; Wang Chao; Tian Weijia; Qu Liumin

    2008-01-01

    Objective: Bone scintigraphy with SPECT of the lumbar spine allows identification of lesions not seen with planar imaging, in patients with chronic low back pain. The aim of this study was to investigate the value of SPECT bone scans in diagnosis of patients with zygapophyseal joint pain. Methods: Thirty-five consecutive patients in Ruijin hospital from July 2006 to March 2007 with low back pain were en- rolled. All patients underwent bone scintigraphy with SPECT. According to the results of SPECT, patients with isotope-uptake joints received injections at the levels where abnormalities were identified on the scan. Patients with negative scans received other treatment (conservative treatment or surgery) but not facet joint injection. Clinical records were collected at 1-, 3-, and 6-month in SPECT-positive group after their initial treatment. And the SPECT-negative group were followed up at 6-month after therapy. Statistical analysis was performed with SPSS 10.0. Patients with SPECT-positive and -negative results were performed with the grouped t-test. Visual analog scales (VAS) were with the paired t-test used in patients with positive scans at before and after treatment. Results: Fifteen cases had facetal uptake of isotope on SPECT bone scans. After facet joint injection, 85.7% patients (12/14, 1 patient was excluded for operation) had improvement in pain score at 1-month, 78.6% (11/14) at 3-month, and 50.0% (7/14) at 6-month. Of 20 negative cases, 3 were treated by surgery and 17 by conservative treatment. All 20 cases were followed up for 6 months and 70.0% (14/20) had long time pain relief. Conclusion: SPECT bone scans are helpful to identify patients with low back pain who would benefit from facet joint injections. (authors)

  12. Bone SPECT-CT: An additional diagnostic tool for undiagnosed wrist pain.

    Science.gov (United States)

    Shirley, R A; Dhawan, R T; Rodrigues, J N; Evans, D M

    2016-10-01

    Diagnosis of wrist pain can be difficult to determine with clinical examination and conventional imaging techniques alone. Bone SPECT-CT (single-photon emission tomography with computerized tomography) is a hybrid imaging technique that overlays functional bone scintigraphy in tomographic/3D mode with conventional CT. Data from the two modalities are complementary; areas of abnormal bone metabolism can be localized with anatomical precision, hitherto lacking in conventional bone scans, while structural information from the CT scan further embellishes the diagnostic information. Over the last 6 years, one surgeon (David Evans) has used bone SPECT and later bone SPECT-CT as an additional line of investigation. This is a series of 21 consecutive patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT-CT. Clinical and imaging findings, management, and outcomes of these cases are discussed to explore the potential role of this hybrid functional modality in hand and wrist surgical practice. Copyright © 2016. Published by Elsevier Ltd.

  13. The hypoxic cancer secretome induces pre-metastatic bone lesions through lysyl oxidase

    DEFF Research Database (Denmark)

    Cox, Thomas R; Rumney, Robin M H; Schoof, Erwin M

    2015-01-01

    Tumour metastasis is a complex process involving reciprocal interplay between cancer cells and host stroma at both primary and secondary sites, and is strongly influenced by microenvironmental factors such as hypoxia. Tumour-secreted proteins play a crucial role in these interactions and present...... morbidity and mortality. The molecular interactions governing the early events of osteolytic lesion formation are currently unclear. Here we show hypoxia to be specifically associated with bone relapse in patients with oestrogen-receptor negative breast cancer. Global quantitative analysis of the hypoxic...

  14. Strontium-89 in palliative treatment of widespread painful bone metastases: Response rate and duration

    International Nuclear Information System (INIS)

    Haddad, Peiman; Ghadiri, Farhad

    2005-01-01

    Full text: Intravenous injection of Strontium-89 (Sr-89) is an accepted palliative treatment for bone metastases. We evaluated the pain relief achieved with this radiopharmaceutical in patients with widespread painful bone metastases from prostate and breast cancers. Pain intensity on a 9-grade scale and use of narcotics was recorded before and after Sr-89 injection, and the ensuing palliative effect was divided into complete, partial and no response. The duration of response was also recorded. Thirty-five patients with widespread painful bone metastases were treated with Sr-89, of whom 22 had prostate and 13 breast cancers. Mean follow-up was 227 days, during which death was recorded for 32 patients. Fourteen patients (40%) had a complete response, 9 (26%) partial and 12 (34%) no response. In the 23 responding patients, mean duration of response was 6 months. In 17 patients the response was present until death. There was no significant relationship between pain response and patients' age or type of primary cancer. No side effects were recorded other than mild and temporary drop in white blood cell and platelet counts. Three patients with a complete response had a second injection of Sr-89 after progression of pain. One of these patients had a second partial response; the other 2 did not show a response to the second injection. The use of Sr-89 for treatment of widespread painful bone metastases from prostate and breast cancers in our department showed a 66% rate of response and a mean response duration of 6 months, with no significant side effects. (author)

  15. Initial experience of single fraction radiotherapy (8 Gy x 1) in the treatment of painful bone metastases

    International Nuclear Information System (INIS)

    Amano, Kosuke; Ikeda, Hiroko; Chigusa, Satoshi; Tanaka, Masahiro; Katayama, Hirofumi; Takeda, Koji

    2014-01-01

    Sixteen patients with painful bone metastases received single fraction radiotherapy of 8 Gy. Single fraction radiotherapy was effective in providing pain relief with response rate of 88.8%. There were no severe acute side effects. The therapeutic regimen was also safe and effective in patients with poor performance status and poor prognosis. Therefore single fraction radiotherapy should be considered to treat pain arising from bone metastases. (author)

  16. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    International Nuclear Information System (INIS)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji

    1998-01-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  17. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji [Juntendo Univ., Tokyo (Japan). School of Medicine

    1998-02-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  18. Bone scanning in patients with low back pain following minimal trauma

    International Nuclear Information System (INIS)

    Weidinger, W.; Hatzl-Griesenhofer, M.; Pichler, R.; Huber, H.; Maschek, W.

    2002-01-01

    Full text: Low back pain following minimal trauma may be caused by insufficiency fracture of the sacrum, which is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analyzed retrospectively. Bone scintigraphy was done on 228 patients treated by the departments of orthopedics at the General Hospital Linz. Predominantly after (minor) trauma, they suffered from lower back pain and their conventional radiographic findings were negative. During a 24 month period, a sacral insufficiency fracture was diagnosed in 68 patients (29,8 %). H-shaped hyperfixation of the tracer - described as typical - was present in only 12 % of the gases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (39 % / 9 %), horizontal (31 %) and half H-shaped (9 %). In the majority of the gases bone scan detected farther fractures with main localization in the pubic bones, in the spine and the ribs. The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (author)

  19. Radiotherapy for bone metastases from cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Monzen, Yoshio; Nakanishi, Kazue; Ajimu, Akira; Morikawa, Minoru; Hayashi, Kuniaki

    1989-03-01

    The authors have investigated 6 cases of bone metastases from cervical cancer out of a total of 90 cases of metastatic bone tumors that were irradiated for relief of associated pain at the Department of Radiology, Nagasaki University Hospital from April 1977 to March 1987. In 2 of the 6 cases, a rare, delayed recurrence with paraaortic lymph node metastases was seen. An invasion to the proasmajor muscle, iliomajor muscle was demonstrated by Computed Tomography after the initiation of therapy, so that the size of the field was modified. Computed Tomography was found useful to determine the exact field size for radiotherapy of metastatic bone tumor.

  20. Evaluation of radiation therapy for bone metastases: pain relief and quality of life

    International Nuclear Information System (INIS)

    Gilbert, H.A.; Kagan, A.R.; Nussbaum, H.; Rao, A.R.; Satzman, J.; Chan, P.; Allen, B.; Forsythe, A.

    1977-01-01

    The records of 158 patients irradiated for bone metastases were reviewed to evaluate the effectiveness of pain relief and to judge the effect of treatment on overall quality of life. Within 3 months 73% of the sites treated had pain relief, with 55 to 65% having sustained relief up to 1 year or death. Of patients surviving more than 3 months, 63% maintained a satisfactory quality of life and were able to take care of most personal needs. The median survival of all patients was 1 year from initial treatment for bone metastasis. Radiation dose and the primary tumor site do not seem to be significant prognostic factors for initial pain relief or quality of life

  1. CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes for the treatment of intractable carcinomatous abdominal pain

    International Nuclear Information System (INIS)

    Xi Qian; Wang Peijun; Shang Mingyi; Ma Jun; Lu Ying; Huang Zongliang; Tang Junjun; Gao Xiaolong

    2010-01-01

    Objective: To evaluate CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes in treating intractable carcinomatous abdominal pain. Methods: A total of 104 patients with late stage cancers were enrolled in this study. All patients suffered from serious carcinomatous pain at upper abdomen and their retroperitoneal lymph nodes were extensively enlarged and fused, together with the involved celiac plexus, into a hard crumb. As the patients failed to respond to narcotic analgesics CT-guided ethanol nerve block therapy of celiac plexus was carried out by pushing the puncture needle through the fused lymphatic mass to celiac plexus site. The analgesic effects and complications were observed and the therapeutic results were evaluated. Results: The analgesic effective rate of ethanol nerve block therapy immediately after the procedure was 100%, and at 2 weeks, 1, 2, 3 and 4 months after the treatment it was 100%, 100%, 98.0%, 96.9% and 92.6%, respectively. No serious complications occurred during perioperative period. The living quality was markedly improved in all patients. Conclusion: For the treatment of intractable carcinomatous abdominal pain in patients with their celiac plexus being embedded in mass-like metastatic retroperitoneal lymph nodes CT-guided percutaneous ethanol nerve block therapy by pushing the puncture needle through the fused lymphatic mass to celiac plexus site is of great clinical value in relieving carcinomatous abdominal pain. (authors)

  2. Efficacy of Magnetic Resonance-guided Focused Ultrasound Surgery for Bone Metastases Pain Palliation

    Science.gov (United States)

    Kawasaki, Motohiro; Nanba, Hirofumi; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro

    2011-09-01

    Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a novel treatment method that achieves non-invasive thermal ablation by focusing many ultrasound waves on a target tissue with real-time monitoring of the location and temperature of the target during the procedure. We investigated the palliative effect on pain and safety of MRgFUS in painful bone metastases. Six patients (mean age, 65.8 years) who met eligibility criteria for the clinical study approved by our Institutional Ethics Committee based on the cooperative protocol were treated with MRgFUS. Targeted sites included the sacrum (n = 1), ilium (n = 2), scapula (n = 2), and femur (n = 1). The mean follow-up period was 9.2 months. All procedures were performed as a single-session treatment using the treatment system that is integrated into the patient table of a magnetic resonance image (MRI) scanner. Endpoints were change in the intensity of pain due to bone metastases from before to after the treatment, as measured on a numerical rating scale, pain interference with daily activities as determined by the Brief pain inventory (BPI), change in images, and safety. Pain relief was obtained in all patients early after treatment, with a reduction in the mean pain score from 6.0±1.3 at baseline to 1.2±1.0 at the end of follow-up as well as in pain interference with daily activities. The mean time required for a single-session treatment was 83.7±37.0 min, with a mean number of sonications required of 13.3±3.7 and mean energy applied of 846.4±273.5 J. No significant growth of tumors was observed, nor were there treatment-related adverse events. These results suggest that MRgFUS has a non-invasive palliative effect on the localized pain in patients with bone metastasis. MRgFUS could become an option in treatment strategies for painful bone metastases in the future.

  3. Zoledronic Acid improves clinical outcomes when administered before onset of bone pain in patients with prostate cancer.

    Science.gov (United States)

    Saad, Fred; Eastham, James

    2010-11-01

    To evaluate, in an exploratory analysis, the effect of zoledronic acid (ZOL) on skeletal-related event (SRE) incidence as determined by the bone pain levels at study entry. Bone metastases can undermine skeletal integrity long before the onset of symptoms. Treating patients before symptom onset might be more effective in preventing SREs and improving patients' quality of life. ZOL has shown significant reductions in SREs and pain compared with placebo in patients with bone metastases from advanced prostate cancer in a randomized placebo-controlled trial. Patients from a placebo-controlled, Phase III trial of men with castration-resistant prostate cancer, randomized to receive ZOL 4 mg (n = 214) or placebo (n = 208) for ≤ 24 months, were stratified by pain or no pain at baseline. Bone pain was assessed at baseline, week 3, and week 6 and at 6-week intervals thereafter. The primary endpoint was the proportion of patients with ≥ 1 SRE. ZOL significantly reduced the mean pain scores compared with placebo at 3, 9, 21, and 24 months (P ≤ .03 for each point) and reduced the annual incidence of SREs. Among patients without baseline pain, ZOL decreased the percentage of patients with ≥ 1 SRE by 39% and reduced the annual incidence of SREs by 49% compared with placebo. ZOL delayed the onset of bone pain in those patients without pain at baseline compared with placebo. ZOL reduced bone pain and SREs compared with placebo in patients with bone metastases from castration-resistant prostate cancer, irrespective of the baseline pain status, and appeared more efficacious when initiated before the onset of pain. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Lutetium-177-EDTMP for pain palliation in bone metastases

    International Nuclear Information System (INIS)

    Rutty Sola, Gisela A.; Arguelles, Maria G.; Bottazzini, Debora L.; Furnari, Juan C.; Vera Ruiz, H.

    1999-01-01

    Experiences with the new palliative agent Lu-177 EDTMP are summarized. The production of primary 177 Lu by the 176 Lu(n,γ) 177 Lu reaction and the synthesis of the radioactive complex are described as well as the procedures used for the control of the radionuclidic and the radiochemical purity. The stability of the compound has been also studied. The in vivo essays with rats and the use of the radiopharmaceutical, after a careful dose evaluation, in a patient with bone metastases from a breast cancer, show that the behaviour of Lu-177 EDTMP is similar to that of the analogue Sm-153 EDTMP. (author)

  5. RANK ligand inhibition in bone metastatic cancer and risk of osteonecrosis of the jaw (ONJ): non bis in idem?

    Science.gov (United States)

    Van den Wyngaert, Tim; Wouters, Kristien; Huizing, Manon T; Vermorken, Jan B

    2011-12-01

    The purpose of this study was to assess the necessity of post-marketing safety monitoring focused on osteonecrosis of the jaw (ONJ) in patients with bone metastatic cancer treated with denosumab (AMG162). The ONJ safety data from three randomized phase III trials were pooled, and risk ratios and power were computed using traditional methods and simulation. A total of 89 ONJ cases (1.57%; 95% CI, 1.26-1.92) were reported with 52 (1.83%; 95% CI, 1.37-2.39) occurring in the denosumab group (n = 2,841) and 37 (1.30%; 95% CI, 0.92-1.79) in the zoledronic acid group (n = 2,836). Overall, the pooled risk ratio (RR) for ONJ was 1.40 (95% CI, 0.92-2.13; p = 0.11). In the trials reporting superior therapeutic efficacy of denosumab, the RR for ONJ was 1.61 (95% CI, 0.99-2.62; p = 0.052). However, neither separately nor pooled had any trial adequate power (>80%) to detect excess relative risks of ONJ of up to 76%, assuming fixed ONJ rates in the control arms. The joint power of the trials to detect the observed excess relative risk of 40% was only 36%. The rate of mucosal healing in patients with ONJ appeared similar in both groups (RR, 1.28; 95% CI, 0.66-2.45; p = 0.5). Although the overall frequency of ONJ was low, post-marketing risk-benefit studies with this novel compound appear warranted focusing specifically on this rare toxicity, which can potentially have a high impact on quality of life.

  6. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

    International Nuclear Information System (INIS)

    Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung; Kang, Heung Sik

    2004-01-01

    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients

  7. Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging

    International Nuclear Information System (INIS)

    Buck, Florian M.; Hoffmann, Alexander; Hofer, Bernhard; Allgayer, Bernhard; Pfirrmann, Christian W.A.

    2009-01-01

    The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI). Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed. At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm 3 ; range, 1,200-39,200 mm 3 ). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p=0.004; MCL signal changes p=0.002). Only MCL signal changes predicted pain during exercise significantly (p=0.001). In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL. (orig.)

  8. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes)

    DEFF Research Database (Denmark)

    Albert, H. B.; Sørensen, Joan S.; Berit Schiott, Christensen

    2013-01-01

    PURPOSE: Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6...... months) and Modic type 1 changes (bone edema). METHODS: The study was a double-blind RCT with 162 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type 1 changes...

  9. Studying on process for labeling of EDTMP with 90Y using for bone pain palliation

    International Nuclear Information System (INIS)

    Pham Ngoc Dien; Duong Van Dong; Dang Ho Hong Quang; Nguyen Thanh Binh; Bui Van Cuong; Nguyen Dang Khoa; Nguyen Thi Thu; Mai Phuoc Tho; Vo Cam Hoa

    2013-01-01

    This Study describes the method for preparation of labelling compound Ethylene diamine tetramethylene phosphonic acid (EDTMP) with 90 Y. Malignant cancer is one of the most important resulting in human death. Bone metastases in nearly 25% of all cancer patients; so it is useful to develop radiopharmaceuticals for the treatment of bone cancer. Yttrium-90 is high energy (2.3 MeV) beta emitter required with a physical haft life of 2.7 days which has limited bone-seeking properties. Its physical properties make it ideal for therapeutic application, the most energetic beta emission being able to penetrate to 1 cm from the site of deposition in soft tissue with an average range of approximately 4 mm. Theoretically, therefore, it can penetrate all marrow spaces in normal trabecular bone and conceivably even to the centre of large tumours where bone destruction may be extensive. Specific deposition of 90 Y into the skeleton demands its delivery in a chemical form with affinity for bone mineral alone. Compounds with these properties are the phosphonate analogues of polyaminocarboxylic acids, and one in particular EDTMP (ethylen diamine tetra methylene phosphonate) has already been used to target 153 Sm to bone mineral with success. Because of chemical similarities between 90 Y and the rare earths, EDTMP should form stable complexes with 90 Y and carry it specifically to the bone with comparable efficiency. Skeletal uptake of β - emitting radionuclides may be used for bone pain palliation or myeloablation. The physical characteristics of the β - particles required for the two conditions are, however, different, that is, higher energies are favorable for destruction of bone marrow. (author)

  10. New aspects of radionuclide therapy of bone and joint diseases

    International Nuclear Information System (INIS)

    Fischer, M.

    2001-01-01

    Whereas in developing countries P-32 is widely used for radionuclide therapy of painful bone metastases, in Europe three radionuclides or radiopharmaceutical agents are available for pain palliation: Sr-89, Sm-153-EDTMP, and Re-186-HEDP. Radionuclide therapy for pain palliation is indicated for bone pain due to metastatic malignancy that has involved multiple skeletal sites and has evoked an osteoblastic response on bone scintigraphy. Response rates of about 70-80% in patients with breast or prostate cancer is reported in the literature, less in metastatic lesions of other primary malignancies. Sm-153-EDTMP may also be used for curative treatment of primary bone tumours or their metastases. Radiosynovectomy as therapeutic procedure or rheumatoid arthritis, other inflammatory joint diseases, persistent synovial perfusion, and other joint diseases is widely used. Using Y-90 for the knee joint, Re-186 for middle sized joints, and Er-169 for small joints an improvement of symptoms may be observed in about 70-80%. (author)

  11. A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain

    Directory of Open Access Journals (Sweden)

    Resham Bahadur Rana

    2010-04-01

    Full Text Available Background: Despite advances in the knowledge of pathophysiology of pain and its management, patients continue to suffer from pain in many terminal stage cancer. Tramadol hydrochloride is a weak opioid with analgesic properties, and can be tried for cancer pain management. Objectives: This study was performed to find out the efficacy of the analgesic property of Tramadol through epidural route in cancer patients as an combination with low dose(.125% Bupivacaine and to compare with Fentanyl, a μ opioid agonist. Methods: 50 Cancer patients with or without previous pain management were randomly allocated to one of the two study regime- Group-A (tramadol 50 mg and Group-B (Fentanyl 50 mgm in combination with .125% Bupivacaine. Drugs were administered epidurally 6 hourly, 8 hourly and 12 hourly respectively for the 1st, 2nd and 3rd day. Low dose bupivacaine was added to both groups to enhance quality. Pain scores, blood pressure, respiratory rate, heart rate, side effects and patients' satisfaction score was recorded 6 hourly for 72 hrs. The data yielded from this study were compiled and analyzed by unpaired and paired ‘t' test with 95% confidence limit. A value of P< 0.05 was considered to be significant. ÷ square test was done for some of the data. Results: Pain scores were significantly decreased in both the groups but were not significantly different. The incidence of side effects including nausea and vomiting was found in both the groups and was not significantly different between the two groups. Conclusion: The use of epidural Tramadol in selected cancer pain patients (especially pain in lower abdomen and lower back may be very useful and is comparable to opioid in certain situations. Key words: Metastatic cancer pain; Epidural tramadol. DOI: 10.3329/bsmmuj.v2i2.4760 BSMMU J 2009; 2(2: 66-72

  12. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    International Nuclear Information System (INIS)

    Brill, D.R.

    1983-01-01

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes

  13. Reoperative surgical stabilization of a painful nonunited rib fracture using bone grafting and a metal plate.

    Science.gov (United States)

    Cho, Yang Hyun; Kim, Hyun Koo; Kang, Du-Young; Choi, Young Ho

    2009-09-01

    We report a case of a nonunited sixth rib in a patient with multiple rib fractures who underwent internal fixation using a wire and Judet strut 3 times. During the following 3 years, the patient continued to complain of pain and instability. At surgery, a pseudarthrosis between the ends of the sixth rib was excised. A longitudinal gutter crossing the fracture site was fashioned and splinted with an inlay block of cancellous bone grafted from the iliac crest; stabilization was accomplished with a reconstruction plate and screws. The following 2 years of follow-up demonstrated no instability or pain.

  14. Assessment of diagnosing metastatic bone tumor on T2*-weighted images. Comparison between turbo spin echo (TSE) method and gradient echo (GE) method

    International Nuclear Information System (INIS)

    Hayashi, Takahiko; Sugiyama, Akira; Katayama, Motoyuki

    1996-01-01

    We examined the usefulness of T2 * weighted gradient field echo images for diagnosis for metastatic bone tumors in comparison with T2 weighted turbo spin echo (fast spin echo) images. In T2 * weighted gradient field echo sequence to obtain maximum contrast-to-noise ratio (CNR), we experimentally manipulated flip angle (FA) (5deg-90deg), repetition time (TR) (400, 700 msec), and echo time (TE) (10-50 msec). The best CNR was 16.4 in fast low angle shot (FLASH) (TE: 24 msec, TR: 700 msec, FA: 40deg). Magnetic resonance imaging was carried out in 28 patients with metastatic bone tumors. In addition to conventional T1 weighted spin echo images, T2 weighted turbo spin echo (fast spin echo images) and T2 * weighted gradient field echo images were obtained. T2 * weighted gradient field echo images were superior to T2 weighted turbo spin echo (fast spin echo) images in delineating the tumors, adjacent fat tissues, and bone marrow. (author)

  15. A preliminary study of pamidronic acid downregulation of angiogenic factors IGF-1/PECAM-1 expression in circulating level in bone metastatic breast cancer patients

    Directory of Open Access Journals (Sweden)

    Wang Z

    2016-05-01

    Full Text Available Zeng Wang,1,2 Lei Lei,2,3 Xin-jun Cai,4 Ling Ya Chen,1,2 Meiqin Yuan,2,3 Guonong Yang,1,2 Ping Huang,1,2 Xiaojia Wang2,3 1Department of Pharmacy, 2Zhejiang Key Lab of Diagnosis & Treatment Technology on Thoracic Oncology, 3Department of Chemotherapy Center, Zhejiang Cancer Hospital, 4Department of Pharmacy, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China Objective: To evaluate the expressions of circulating angiogenic factors affected by pamidronic acid (PA intravenous infusion in bone metastatic breast cancer patients and the impact on their prognosis.Methods: Peripheral blood of ten bone metastatic breast cancer patients was collected for serum insulin-like growth factor-1 (IGF-1 and platelet endothelial cell adhesion molecule-1 expression detection just before and 2 days after PA infusion.Results: Both IGF-1 and platelet endothelial cell adhesion molecule-1 concentrations decreased after PA treatment for 48 hours (P<0.05. Modification was defined as >20% decrease recorded 2 days after PA administration. The decrease of IGF-1 was more significant in breast cancer patients who had received previous hormonotherapy. Moreover, the progression-free survival of first-line chemotherapy treatment of IGF-1 modified patients was longer than that of IGF-1 unmodified patients (P=0.009.Conclusion: PA treatment could suppress circulating serum IGF-1 and platelet endothelial cell adhesion molecule-1 concentrations; moreover, the prognosis of patients in IGF-1 unmodified group was relatively poor. Keywords: pamidronic acid, insulin-like growth factor-1, platelet endothelial cell adhesion molecule-1, bone metastatic breast cancer, prognosis

  16. Radiation therapy for painful bone metastases. Aiming at optimal treatment schedules

    International Nuclear Information System (INIS)

    Murakami, Ryuji; Saito, Ryuichi; Miyazaki, Toshiyuki; Takahashi, Mutsumasa

    2001-01-01

    The purpose of this study is to evaluate the pain relief obtained by radiation therapy for painful bone metastases, with a special regard to general condition. Between June 1998 and May 2000, 54 patients with 86 painful bone metastases were treated with radiation therapy whose effects could be evaluated for a minimum period of 6 months or until death. Treatment schedules were 3 Gy/fraction/day (30-36 Gy/10-12 fractions) in usual cases (61 lesions), 4-8 Gy/fraction/day (8-20 Gy/1-5 fractions) in patients with a poor general condition (9 lesions), and 2 Gy/fraction/day (40-50 Gy/20-25 fractions) in lesions with a large radiation field (16 lesions). Complete pain relief without medication (CR) was achieved in 40 lesions (47%). Significant predictors for CR were primary site (p=0.0003), performance status (p=0.0060), pain score (p=00190), narcotic score (p<0.0001), and prognosis (p<0.0001), but no difference was found in CR among treatment schedules. No evidence of severe radiation-induced complication was seen. General condition (performance status and prognosis) has an influence on pain relief. Compared with the daily 2 Gy protocol, the daily 3 Gy protocol has the advantage of shorter treatment time. The treatment schedule should be assessed in patients with a large radiation field and/or poor general condition. Especially for the patients with poor general condition, combined pain medication should be considered. (author)

  17. Bilateral Knee Pain Associated with Bone Infarction in a Patient with Behcet's Disease

    Directory of Open Access Journals (Sweden)

    Pelin Oktayoglu

    2012-01-01

    Full Text Available We describe a 31-years-old female patient with severe pain in both knees who had been diagnosed as Behcet’s disease (BD for 12 years. She had had a history of complications due to BD including superior vena cava thrombosis, pulmonary thromboembolism, uveitis, and erythema nodosum and has reported the administration of corticosteroid therapy irregularly. After radiologic evaluation, she has been diagnosed with bone infarction of both left and right knee with the existance of lupus anticoagulants (LA positivity. Severe joint pain without the evidence of arthritis must alert the clinician to the possibility of bone necrosis of the extremity, although those may rarely occur bilateral in BD.

  18. Recurrent Upper Quadrant Pain: A Fish Bone Secondary to Gastric Perforation and Liver Abscess

    Directory of Open Access Journals (Sweden)

    Hui Liang

    2011-12-01

    Full Text Available A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.

  19. Chronic Osteoporotic Pain in Mice: Cutaneous and Deep Musculoskeletal Pain Are Partially Independent of Bone Resorption and Differentially Sensitive to Pharmacological Interventions

    Directory of Open Access Journals (Sweden)

    Miyako Suzuki

    2017-01-01

    Full Text Available Although the pathological changes in osteoporotic bones are well established, the characterization of the osteoporotic pain and its appropriate treatment are not fully elucidated. We investigated the behavioral signs of cutaneous and deep musculoskeletal pain and physical function; time-dependent changes in bone mineral density (BMD and the emergence of the behavioral phenotype; and the effects of pharmacological interventions having different mechanisms of action (chronic intraperitoneal administration of pamidronate [0.25 mg/kg, 5x/week for 5 weeks] versus acute treatment with intraperitoneal morphine [10 mg/kg] and pregabalin [100 mg/kg] in a mouse model of ovariectomized or sham-operated mice 6 months following surgery. We observed reduced BMD associated with weight gain, referred cutaneous hypersensitivity, and deep musculoskeletal pain that persisted for 6 months. Chronic bisphosphonate treatment, 6 months after ovariectomy, reversed bone loss and hypersensitivity to cold, but other behavioral indices of osteoporotic pain were unchanged. While the efficacy of acute morphine on cutaneous pain was weak, pregabalin was highly effective; deep musculoskeletal pain was intractable. In conclusion, the reversal of bone loss alone is insufficient to manage pain in chronic osteoporosis. Additional treatments, both pharmacological and nonpharmacological, should be implemented to improve quality of life for osteoporosis patients.

  20. A randomized controlled trial to compare the efficacy of bisphosphonates in the management of painful bone metastasis

    Directory of Open Access Journals (Sweden)

    Krishnangshu Bhanja Choudhury

    2011-01-01

    Conclusion: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

  1. Proteinase-activated receptor 2 modulates OA-related pain, cartilage and bone pathology.

    Science.gov (United States)

    Huesa, Carmen; Ortiz, Ana C; Dunning, Lynette; McGavin, Laura; Bennett, Louise; McIntosh, Kathryn; Crilly, Anne; Kurowska-Stolarska, Mariola; Plevin, Robin; van 't Hof, Rob J; Rowan, Andrew D; McInnes, Iain B; Goodyear, Carl S; Lockhart, John C; Ferrell, William R

    2016-11-01

    Proteinase-activated receptor 2 (PAR2) deficiency protects against cartilage degradation in experimental osteoarthritis (OA). The wider impact of this pathway upon OA-associated pathologies such as osteophyte formation and pain is unknown. Herein, we investigated early temporal bone and cartilage changes in experimental OA in order to further elucidate the role of PAR2 in OA pathogenesis. OA was induced in wild-type (WT) and PAR2-deficient (PAR2 -/- ) mice by destabilisation of the medial meniscus (DMM). Inflammation, cartilage degradation and bone changes were monitored using histology and microCT. In gene rescue experiments, PAR2 -/- mice were intra-articularly injected with human PAR2 (hPAR2)-expressing adenovirus. Dynamic weight bearing was used as a surrogate of OA-related pain. Osteophytes formed within 7 days post-DMM in WT mice but osteosclerosis was only evident from 14 days post induction. Importantly, PAR2 was expressed in the proliferative/hypertrophic chondrocytes present within osteophytes. In PAR2 -/- mice, osteophytes developed significantly less frequently but, when present, were smaller and of greater density; no osteosclerosis was observed in these mice up to day 28. The pattern of weight bearing was altered in PAR2 -/- mice, suggesting reduced pain perception. The expression of hPAR2 in PAR2 -/- mice recapitulated osteophyte formation and cartilage damage similar to that observed in WT mice. However, osteosclerosis was absent, consistent with lack of hPAR2 expression in subchondral bone. This study clearly demonstrates PAR2 plays a critical role, via chondrocytes, in osteophyte development and subchondral bone changes, which occur prior to PAR2-mediated cartilage damage. The latter likely occurs independently of OA-related bone changes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Proteinase-activated receptor 2 modulates OA-related pain, cartilage and bone pathology

    Science.gov (United States)

    Huesa, Carmen; Ortiz, Ana C; Dunning, Lynette; McGavin, Laura; Bennett, Louise; McIntosh, Kathryn; Crilly, Anne; Kurowska-Stolarska, Mariola; Plevin, Robin; van ‘t Hof, Rob J; Rowan, Andrew D; McInnes, Iain B; Goodyear, Carl S; Lockhart, John C; Ferrell, William R

    2016-01-01

    Objective Proteinase-activated receptor 2 (PAR2) deficiency protects against cartilage degradation in experimental osteoarthritis (OA). The wider impact of this pathway upon OA-associated pathologies such as osteophyte formation and pain is unknown. Herein, we investigated early temporal bone and cartilage changes in experimental OA in order to further elucidate the role of PAR2 in OA pathogenesis. Methods OA was induced in wild-type (WT) and PAR2-deficient (PAR2−/−) mice by destabilisation of the medial meniscus (DMM). Inflammation, cartilage degradation and bone changes were monitored using histology and microCT. In gene rescue experiments, PAR2−/− mice were intra-articularly injected with human PAR2 (hPAR2)-expressing adenovirus. Dynamic weight bearing was used as a surrogate of OA-related pain. Results Osteophytes formed within 7 days post-DMM in WT mice but osteosclerosis was only evident from 14 days post induction. Importantly, PAR2 was expressed in the proliferative/hypertrophic chondrocytes present within osteophytes. In PAR2−/− mice, osteophytes developed significantly less frequently but, when present, were smaller and of greater density; no osteosclerosis was observed in these mice up to day 28. The pattern of weight bearing was altered in PAR2−/− mice, suggesting reduced pain perception. The expression of hPAR2 in PAR2−/− mice recapitulated osteophyte formation and cartilage damage similar to that observed in WT mice. However, osteosclerosis was absent, consistent with lack of hPAR2 expression in subchondral bone. Conclusions This study clearly demonstrates PAR2 plays a critical role, via chondrocytes, in osteophyte development and subchondral bone changes, which occur prior to PAR2-mediated cartilage damage. The latter likely occurs independently of OA-related bone changes. PMID:26698846

  3. Effectiveness of traditional bone setting in chronic neck pain: randomized clinical trial.

    Science.gov (United States)

    Zaproudina, Nina; Hänninen, Osmo O P; Airaksinen, Olavi

    2007-01-01

    This study evaluates the effectiveness of traditional bone setting (TBS) in chronic neck pain (cNP) compared with conventional physiotherapy (PT) and massage (M). This was a randomized clinical trial. Working-aged employed subjects with cNP (n = 105; 37 men and 68 women; mean age, 41.5 years) were randomized into TBS, PT, and M groups. Follow-up times were 1, 6, and 12 months after the treatments. Neck pain intensity (visual analog scale), perceived disability (Neck Disability Index [NDI]), and neck spine mobility measurements were used as outcomes. Global assessment was evaluated by the subjects (scale from -1 to +10). Data were analyzed using time (pre and post) by group (TBS, PT and M), 2- way analysis of variance for repeated measures. Neck pain decreased and NDI scores improved in all groups 1 month after the treatment (P better after TBS. Neck spine mobility in rotation movements tended to improve significantly better and the frons-knee distance improved more after TBS. One year later, both NDI and neck pain were significantly better after TBS than in reference groups. A significant improvement was reported by 40% to 45.5% of subjects in the PT and M groups and by 68.6% in the TBS group. Bone setters' ability to communicate and to interact with patients was evaluated significantly higher. In the TBS group, the number of sick days was minimal as was the use of painkillers during 1-year follow-up compared to that in the reference groups. Traditional bone setting, which is a soft manual mobilization technique focusing on the muscles, joints, and ligaments, appears to be effective in cNP. Two thirds of subjects experienced it as beneficial, and it seems to be able to improve disability and pain in patients with cNP. Subjective and partially objective benefits of TBS were found in those patients more than after other interventions, and the effects lasted at least for 1 year.

  4. 188Rhenium-HEDP in the treatment of pain in bone metastases

    International Nuclear Information System (INIS)

    Gaudiano, J.; Martinez, G.; Hermida, J.C.; Savio, E.; Verdera, S.; Robles, A.; Muniz, S.; Leon, A.; Knapp, F.F.

    2001-01-01

    Systemic use of radiopharmaceuticals is a recognised alternative method for the treatment of pain in patients with multiple bone metastases. A new option, 188 Re-HEDP is proposed, using generator-obtained 188 Rhenium (β energy = 2.1 MeV, γ energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastases from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities. (author)

  5. Mice with cancer-induced bone pain show a marked decline in day/night activity.

    Science.gov (United States)

    Majuta, Lisa A; Guedon, Jean-Marc G; Mitchell, Stefanie A T; Kuskowski, Michael A; Mantyh, Patrick W

    2017-09-01

    Cancer-induced bone pain (CIBP) is the most common type of pain with cancer. In humans, this pain can be difficult to control and highly disabling. A major problem with CIBP in humans is that it increases on weight-bearing and/or movement of a tumor-bearing bone limiting the activity and functional status of the patient. Currently, there is less data concerning whether similar negative changes in activity occur in rodent models of CIBP. To determine whether there are marked changes in activity in a rodent model of CIBP and compare this to changes in skin hypersensitivity. Osteosarcoma cells were injected and confined to 1 femur of the adult male mouse. Every 7 days, spontaneous horizontal and vertical activities were assessed over a 20-hour day and night period using automated activity boxes. Mechanical hypersensitivity of the hind paw skin was assessed using von Frey testing. As the tumor cells grew within the femur, there was a significant decline in horizontal and vertical activity during the times of the day/night when the mice are normally most active. Mice also developed significant hypersensitivity in the skin of the hind paw in the tumor-bearing limb. Even when the tumor is confined to a single load-bearing bone, CIBP drives a significant loss of activity, which increases with disease progression. Understanding the mechanisms that drive this reduction in activity may allow the development of therapies that allow CIBP patients to better maintain their activity and functional status.

  6. {sup 188}Rhenium-HEDP in the Treatment of Pain in Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Gaudiano, J.; Savio, E.; Robles, A.; Muniz, S.; Leon, A.; Verdera, S.; Martinez, G.; Hermida, J.C.; Knapp, F.F., Jr.

    1999-01-18

    Systemic use of radiopharmaceuticals is a recognized alternative method for the treatment of pain in patients with multiple bone metastasis. A new option, {sup 188}Re-HEDP is proposed, using generator-obtained {sup 188}Rhenium ({beta} energy = 2.1 MeV, {gamma} energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastasis from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities.

  7. The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain

    International Nuclear Information System (INIS)

    Sande, Tonje A.; Scott, Angela C.; Laird, Barry J.A.; Wan, Hong I.; Fleetwood-Walker, Susan M.; Kaasa, Stein; Klepstad, Pål; Mitchell, Rory; Murray, Gordon D.; Colvin, Lesley A.; Fallon, Marie T.

    2014-01-01

    Background and purpose: An objective measure of pain relief may add important information to patients’ self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. Materials and methods: Patients were assessed before (baseline) and 6–8 weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann–Whitney and Pearson statistical analyses were done. Results: Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p < 0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r = 0.469, p = 0.002) and gait (cadence r = 0.341, p = 0.03). The activPAL and GAITRite parameters did not change following XRT (p > 0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p > 0.05). Conclusion: Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT

  8. Contribution of the bone scintigraphy in unexplained pains of the thigh

    International Nuclear Information System (INIS)

    Oufroukhi, Y.; Ech Charraq, I.; Ben Rais, N.

    2006-01-01

    Mr. R.N. 32 year's old, high level sportsman, without particular pathological antecedents, consults for pains of the area above the knee of the left thigh, of mechanical pace being exacerbated with the effort. The clinical examination notes pains induced by the deep of the left thigh. The biological assessment, in particular blood cell formula and CRP were normal. The standard radiography of the femurs did not find an anomaly of the osseous structure. Because of the persistence of the pains, an osseous scintiscan was carried out and orientated towards pathology of soft tissues. The doppler and the TDM made it possible to pose the diagnosis of intra-tissues muscular hemangioma. The early times of the bone scintigraphy appears important in the approach diagnosis of many osseous disease of the sportsman. (author)

  9. Antinociceptive effect of intrathecal microencapsulated human pheochromocytoma cell in a rat model of bone cancer pain.

    Science.gov (United States)

    Li, Xiao; Li, Guoqi; Wu, Shaoling; Zhang, Baiyu; Wan, Qing; Yu, Ding; Zhou, Ruijun; Ma, Chao

    2014-07-08

    Human pheochromocytoma cells, which are demonstrated to contain and release met-enkephalin and norepinephrine, may be a promising resource for cell therapy in cancer-induced intractable pain. Intrathecal injection of alginate-poly (l) lysine-alginate (APA) microencapsulated human pheochromocytoma cells leads to antinociceptive effect in a rat model of bone cancer pain, and this effect was blocked by opioid antagonist naloxone and alpha 2-adrenergic antagonist rauwolscine. Neurochemical changes of cerebrospinal fluid are in accordance with the analgesic responses. Taken together, these data support that human pheochromocytoma cell implant-induced antinociception was mediated by met-enkephalin and norepinephrine secreted from the cell implants and acting at spinal receptors. Spinal implantation of microencapsulated human pheochromocytoma cells may provide an alternative approach for the therapy of chronic intractable pain.

  10. Antinociceptive Effect of Intrathecal Microencapsulated Human Pheochromocytoma Cell in a Rat Model of Bone Cancer Pain

    Directory of Open Access Journals (Sweden)

    Xiao Li

    2014-07-01

    Full Text Available Human pheochromocytoma cells, which are demonstrated to contain and release met-enkephalin and norepinephrine, may be a promising resource for cell therapy in cancer-induced intractable pain. Intrathecal injection of alginate-poly (l lysine-alginate (APA microencapsulated human pheochromocytoma cells leads to antinociceptive effect in a rat model of bone cancer pain, and this effect was blocked by opioid antagonist naloxone and alpha 2-adrenergic antagonist rauwolscine. Neurochemical changes of cerebrospinal fluid are in accordance with the analgesic responses. Taken together, these data support that human pheochromocytoma cell implant-induced antinociception was mediated by met-enkephalin and norepinephrine secreted from the cell implants and acting at spinal receptors. Spinal implantation of microencapsulated human pheochromocytoma cells may provide an alternative approach for the therapy of chronic intractable pain.

  11. Cancer stemness and metastatic potential of the novel tumor cell line K3: an inner mutated cell of bone marrow-derived mesenchymal stem cells.

    Science.gov (United States)

    Qian, Hui; Ding, Xiaoqing; Zhang, Jiao; Mao, Fei; Sun, Zixuan; Jia, Haoyuan; Yin, Lei; Wang, Mei; Zhang, Xu; Zhang, Bin; Yan, Yongmin; Zhu, Wei; Xu, Wenrong

    2017-06-13

    Mesenchymal stem cells (MSCs) transplantation has been used for therapeutic applications in various diseases. Here we report MSCs can malignantly transform in vivo. The novel neoplasm was found on the tail of female rat after injection with male rat bone marrow-derived MSCs (rBM-MSCs) and the new tumor cell line, K3, was isolated from the neoplasm. The K3 cells expressed surface antigens and pluripotent genes similar to those of rBM-MSCs and presented tumor cell features. Moreover, the K3 cells contained side population cells (SP) like cancer stem cells (CSCs), which might contribute to K3 heterogeneity and tumorigenic capacity. To investigate the metastatic potential of K3 cells, we established the nude mouse models of liver and lung metastases and isolated the corresponding metastatic cell lines K3-F4 and K3-B6. Both K3-F4 and K3-B6 cell lines with higher metastatic potential acquired more mesenchymal and stemness-related features. Epithelial-mesenchymal transition is a potential mechanism of K3-F4 and K3-B6 formation.

  12. Bone pain caused by swelling of mouse ear capsule static xylene and effects on rat models of cervical spondylosis

    Science.gov (United States)

    Zhang, Xuhui; Xia, Lei; Hao, Shaojun; Chen, Weiliang; Guo, Junyi; Ma, Zhenzhen; Wang, Huamin; Kong, Xuejun; Wang, Hongyu; Zhang, Zhengchen

    2018-04-01

    To observe the effect of intravenous bone pain Capsule on the ear of mice induced by xylene, swelling of rat models of cervical spondylosis. Weighing 18 ˜ 21g 50 mice, male, were randomly divided into for five groups, which were fed with service for bone pain static capsule suspension, Jingfukang granule suspension 0.5%CMC liquid and the same volume of. Respectively to the mice ear drop of xylene 0.05 ml, 4h after cervical dislocation, the mice were sacrificed and the cut two ear, rapid analytical balance weighing, and calculate the ear swelling degree and the other to take the weight of 200 - 60 250g male SD rats, were randomly divided into for 6 groups, 10 rats in each group, of which 5 groups made cervical spondylosis model. Results: with the blank group than bone pain static capsule group and Jingfukang granule group can significantly reduce mouse auricular dimethylbenzene swelling, significantly reduce ear swelling degree (P cervical spondylosis. With the model group ratio, large, medium and small dose of bone pain static capsule group, Jingfukang granule group (P pain static capsule group, Jingfukang granule group can significantly reduce the rat X-ray scores (P pain static capsule can significantly reduce mouse auricular dimethylbenzene swelling. The bone pain capsule has a good effect on the rat model of cervical spondylosis.

  13. An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Bollen, Laurens; Dijkstra, Sander P. [Department of Orthopedic Surgery, Leiden University Medical Center (Netherlands); Steen-Banasik, Elzbieta M. van der [ARTI Institute for Radiation Oncology Arnhem, Arnhem (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands); Marijnen, Corrie A.; Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)

    2014-11-15

    Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS and primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is

  14. Is 32P option in the treatment of bone metastases pain?

    International Nuclear Information System (INIS)

    Morín, José; Alberti, Alejandro; Cruz, Jorge; Taylor, Tamara; García, Enrique

    2016-01-01

    This paper deals with the international experience of using sodium orthophosphate labeled with 32 P as a first radiopharmaceutical for the treatment of metastatic bone disease (EOM). It examines the decline in use when introducing other products considered best features is exposed and its rebirth from the comparable efficacy, possibility for oral use, lower cost and absence of incontrovertible evidence about their side effects inadmissible. It is also aware of the user experience in Cuba and concludes that the radiopharmaceutical should be part of the arsenal of resources to be used in the EOM, given the prevalence of this and the economic burden of handling. Non-clinical and clinical data on promissory features of 90 Y-EDTMP are also discussed. (author)

  15. Specific bone region localization of osteolytic versus osteoblastic lesions in a patient-derived xenograft model of bone metastatic prostate cancer

    Directory of Open Access Journals (Sweden)

    Takeshi Hirata

    2016-10-01

    Conclusion: PCSD1 cells reproducibly induced bone loss leading to osteolytic lesions at the ends of the femur, and, in contrast, induced aberrant bone formation leading to osteoblastic lesions along the femur shaft. Therefore, the interaction of PCSD1 cells with different bone region-specific microenvironments specified the type of bone lesion. Our approach can be used to determine if different bone regions support more therapy resistant tumor growth, thus, requiring novel treatments.

  16. A phase 2 study of high-activity {sup 186}Re-HEDP with autologous peripheral blood stem cell transplant in progressive hormone-refractory prostate cancer metastatic to bone

    Energy Technology Data Exchange (ETDEWEB)

    O' Sullivan, J.M. [Queen' s University Belfast/Belfast City Hospital, Department of Oncology, Belfast (United Kingdom); Norman, A.R. [Royal Marsden Foundation NHS Trust, Department of Computing, Sutton, Surrey (United Kingdom); McCready, V.R.; Flux, G.; Buffa, F.M. [Royal Marsden Foundation NHS Trust, Department of Physics, Sutton, Surrey (United Kingdom); Johnson, B. [Royal Marsden Foundation NHS Trust, Bob Champion Unit, Sutton, Surrey (United Kingdom); Coffey, J.; Horwich, A.; Huddart, R.A.; Parker, C.C.; Dearnaley, D.P. [Royal Marsden Foundation NHS Trust, Academic Unit of Urology, Sutton, Surrey (United Kingdom); Cook, G. [Royal Marsden Foundation NHS Trust, Department of Nuclear Medicine, Sutton, Surrey (United Kingdom); Treleaven, J. [Royal Marsden Foundation NHS Trust, Department of Haematology, Sutton, Surrey (United Kingdom)

    2006-09-15

    We investigated the potential for improvement in disease control by use of autologous peripheral blood stem cell transplant (PBSCT) to permit administration of high activities of {sup 186}Re-hydroxyethylidene diphosphonate (HEDP) in patients with progressive hormone-refractory prostate cancer (HRPC). Eligible patients had progressive HRPC metastatic to bone, good performance status and minimal soft tissue disease. Patients received 5,000 MBq of {sup 186}Re-HEDP i.v., followed 14 days later by PBSCT. Response was assessed using PSA, survival, pain scores and quality of life. Thirty-eight patients with a median age of 67 years (range 50-77) and a median PSA of 57 ng/ml (range 4-3,628) received a median activity of 4,978 MBq {sup 186}Re-HEDP (range 4,770-5,100 MBq). The most serious toxicity was short-lived grade 3 thrombocytopenia in 8 (21%) patients. The median survival of the group is 21 months (95%CI 18-24 months) with Kaplan-Meier estimated 1- and 2-year survival rates of 83% and 40% respectively. Thirty-one patients (81%, 95% CI 66-90%) had stable or reduced PSA levels 3 months post therapy while 11 (29%, 95% CI 15-49%) had PSA reductions of >50% lasting >4 weeks. Quality of life measures were stable or improved in 27 (66%) at 3 months. We have shown that it is feasible and safe to deliver high-activity radioisotope therapy with PBSCT to men with metastatic HRPC. Response rates and survival data are encouraging; however, further research is needed to define optimal role of this treatment approach. (orig.)

  17. Imaging findings in a child with calcineurin inhibitor-induced pain syndrome after bone marrow transplant for beta thalassemia major

    International Nuclear Information System (INIS)

    Ayyala, Rama S.; Arnold, Staci D.; Bhatia, Monica; Dastgir, Jahannaz

    2016-01-01

    Calcineurin inhibitor-induced pain syndrome is an entity recognized in patients on immunosuppressive therapy after transplantation. Diagnosis is characterized by onset of pain beginning in the setting of an elevated calcineurin-inhibitor trough level. Reducing the medication dose relieves symptoms. Imaging findings can be nonspecific, including bone marrow edema and periosteal reaction. We present the unique case of calcineurin inhibitor-induced pain syndrome in a child and review the imaging findings. (orig.)

  18. Imaging findings in a child with calcineurin inhibitor-induced pain syndrome after bone marrow transplant for beta thalassemia major

    Energy Technology Data Exchange (ETDEWEB)

    Ayyala, Rama S.; Arnold, Staci D.; Bhatia, Monica; Dastgir, Jahannaz [Columbia University Medical Center, Morgan Stanley Children' s Hospital, Department of Radiology, New York, NY (United States)

    2016-10-15

    Calcineurin inhibitor-induced pain syndrome is an entity recognized in patients on immunosuppressive therapy after transplantation. Diagnosis is characterized by onset of pain beginning in the setting of an elevated calcineurin-inhibitor trough level. Reducing the medication dose relieves symptoms. Imaging findings can be nonspecific, including bone marrow edema and periosteal reaction. We present the unique case of calcineurin inhibitor-induced pain syndrome in a child and review the imaging findings. (orig.)

  19. Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

    OpenAIRE

    Yi, Yu Ri; Lee, Na Rea; Kwon, Young Suk; Jang, Ji Su; Lim, So Young

    2016-01-01

    Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-yea...

  20. Osteoporosis in patients with low back pain - a study with DEXA bone densitometer

    International Nuclear Information System (INIS)

    Hussain, R.; Momtaz, S.; Khan, ASM H.; Jehan, A.H.

    2001-01-01

    Osteoporosis has frequently been called the 'silent epidemic' because most patients do not present until they fracture or alternatively in some cases of spinal disease develop back pain, significant loss of height, or a kyphosis. In a longitudinal study of one year period a total of 96 patients were evaluated for bone densitometric measurements. Among them 48 patients (40 F, 8 M) complained of persistent low back pain. The age group was 35-80 years (Mean 59 years). They were referred for their first Dual Energy X-ray Absorptiometry (DEXA) studies. None of the patients received estrogen, biphosphonates or steroid therapy. Bone density of the hip and lumbar spine were measured. The T- score, which measures the difference between patient's BMD and young normal was computed and Z-score, were calculated. X-ray correlation was also done in most of the cases. Out of 48 patients, 18 (39.6%) showed osteoporosis, 16 (33.3%) showed osteopenia and 12 (25%) were normal. In the osteoporosis group, 14 were female and 4 were male. All were above 50 years of age except a 35 -year old man with Cushing's disease. This study demonstrates the importance of DEXA studies in diagnosing osteoporosis in patients suffering from low back pain. (author) 19 refs

  1. {sup 177}Lu-EDTMP for palliation of pain from bone metastases in patients with prostate and breast cancer: a phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Krishan Kant; Singla, Suhas; Arora, Geetanjali; Bal, Chandrasekhar [All India Institute of Medical Sciences, Department of Nuclear Medicine, Ansari Nagar, New Delhi (India)

    2015-01-15

    The purpose of this study was to evaluate the efficacy and safety of {sup 177}Lu-EDTMP for pain palliation in patients with bone metastases from castration-resistant prostate and breast cancer. The secondary objective was to compare low-dose and high-dose {sup 177}Lu-EDTMP in bone pain palliation. Included in the study were 44 patients with documented breast carcinoma (12 patients; age 47 ± 13 years) or castration-resistant prostate carcinoma (32 patients; age 66 ± 9 years) and skeletal metastases. Patients were randomized into two equal groups treated with {sup 177}Lu-EDTMP intravenously at a dose of 1,295 MBq (group A) or 2,590 MBq (group B). Pain palliation was evaluated using a visual analogue score (VAS), analgesic score (AS) and Karnofsky performance score (KPS) up to 16 weeks. Toxicity was assessed in terms of haematological and renal parameters. The overall response rate (in all 44 patients) was 86 %. Complete, partial and minimal responses were seen in 6 patients (13 %), 21 patients (48 %) and 11 patients (25 %), respectively. A favourable response was seen in 27 patients (84 %) with prostate cancer and in 11 patients (92 %) with breast cancer. There was a progressive decrease in the VAS from baseline up to 4 weeks (p < 0.05). Also, AS decreased significantly from 1.8 ± 0.7 to 1.2 ± 0.9 (p < 0.0001). There was an improvement in quality of life of the patients as reflected by an increase in mean KPS from 56 ± 5 to 75 ± 7 (p < 0.0001). The overall response rate in group A was 77 % compared to 95 % in group B (p = 0.188). There was a significant decrease in VAS and AS accompanied by an increase in KPS in both groups. Nonserious haematological toxicity (grade I/II) was observed in 15 patients (34 %) and serious toxicity (grade III/IV) occurred in 10 patients (23 %). There was no statistically significant difference in haematological toxicity between the groups. {sup 177}Lu-EDTMP was found to be a safe and effective radiopharmaceutical for bone pain

  2. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer.

    Science.gov (United States)

    Çelebioğlu, Ayda; Gürol, Ayşe; Yildirim, Zuhal Keskin; Büyükavci, Mustafa

    2015-12-01

    Cancer and its treatment are stressful and reduce the quality of life in children. The aim of this study was to investigate the effect of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. We conducted a controlled pretest/posttest quasi-experimental study at a paediatric oncology unit in Turkey. Twenty-five children were enrolled in this study. Their pain and anxiety were determined using a visual analogue scale. When the pretest and posttest pain and anxiety levels of the groups were compared, no statistically significant difference was found (P > 0.05). It was determined that pain and anxiety levels in the experimental group decreased significantly. This study provides preliminary evidence for the effectiveness in children of massage in reducing pain and anxiety arising from intrathecal therapy or bone marrow aspiration. © 2014 Wiley Publishing Asia Pty Ltd.

  3. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations.

    Science.gov (United States)

    Liossi, C; Hatira, P

    1999-04-01

    A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.

  4. Cancer-induced bone loss and associated pain-related behavior is reduced by risedronate but not its phosphonocarboxylate analog NE-10790

    DEFF Research Database (Denmark)

    Hald, Andreas; Hansen, Rikke Rie; Thomsen, Mette W

    2009-01-01

    Prostate, breast and lung cancers readily develop bone metastases which lead to fractures, hypercalcemia and pain. Malignant growth in the bones depends on osteoclast-mediated bone resorption and in this regard bisphosphonate compounds, which have high-bone affinity and inhibit osteoclast activit...

  5. The semiquantitative three-phase bone scintigraphy on hemiplegic patients with earlier complex regional pain syndrome

    International Nuclear Information System (INIS)

    Li Fang; Liu Xingdang; Lu Zhihui; Liu Congjin

    2010-01-01

    Objective: To investigate the difference between the early phases and delay phase of three-phase bone scintigraphy on hemiplegic patients with earlier complex regional pain syndrome (CRPS). Methods: Twenty-nine stroke patients with hemiplegia complicating CRPS received three-phase bone scintigraphy after intravenous injection of 99 Tc m -methylene diphosphonate (MDP). The region of interest (ROI) technique was used to obtain the radioactive counts of involved joints and contralateral sites on wrists, metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. The total counts of these four sites in each patient were then obtained and the total uptake ratios of involved joints/contralateral joints for each phase were calculated to compare the difference among the three phases. Wilcoxon test and ANOVA were used in data analyses. Results: The involved joints of hemiplegic side displayed higher tracer uptake. There were significant differences of the radioactive counts between involved joints and uninvolved ones in the perfusion, pool and delay phase (Wilcoxon test, Z: -4.73 to -2.10, P<0.05). There was no significant difference of total uptake ratios of involved joints/contralateral joints among the three phases (ANOVA, F = 0. 807, P < 0.05). Conclusions: Due to higher bone seeking agent accumulation on three-phase bone scintigraphy, both early phases and delay phase imaging showed similar value in stroke patients with hemiplegia complicating earlier CRPS. (authors)

  6. Magnetic resonance guided focused ultrasound surgery (MRgFUS) of bone metastases: From primary pain palliation to local tumor control

    Science.gov (United States)

    Napoli, A.; Leonardi, A.; Andrani, F.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    Purpose: To evaluate the clinical performance of MRgFUS in primary pain palliation of painful bone metastases and in local tumor control. Materials and Methods: We enrolled 26 consecutive patients (female/male 12/14; age: 64.7±7.5yrs) with painful bone metastases. Before and 3 months after MRgFUS treatment pain severity and pain interference scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria and patients underwent both CT and MRI. Local tumor control was evaluated according to lesion size, density and perfusion at CT, dynamic contrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and metabolic activity at PET or scintigraphy. Patients were classified as responders or non-responders. Results: No treatment-related adverse events were recorded during the study. As statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (p<0.05). Increased bone density was observed in 9/26 (34.6%) patients. Non-Perfused Volume values ranged between 20% and 92%. There was no difference in NPV values between responders and non-responders (46.7±24.2% [25 - 90 %] vs. 45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary cancer) there was nearly absence of metabolic activity after treatment (mean SUV=1.2). Conclusion: MRgFUS can be safely and effectively used as the primary treatment for pain palliation in patients with painful bone metastases; moreover our experience demonstrated also a potential role for the MRgFUS in local tumor control.

  7. 99mTc-MDP bone scanning of patients with diffuse metastatic carcinoma of the axial skeleton

    International Nuclear Information System (INIS)

    Morita, Seiichiro; Ishibashi, Masatoshi; Takahashi, Kazuyuki; Funatsu, Kazuhiro; Yoshii, Toshiaki; Shirabe, Ichiju; Nomura, Yasushi; Ohtake, Hisashi

    1990-01-01

    Fifteen bone scintigrams in patients with diffuse bone metastases were reviewed because of the diffuse radionuclide accumulation in the axial skeleton. Diagnoses were gastric cancer in 6 patients, prostatic cancer in 5, breast cancer in 3, and renal pelvic tumor in one. In 5 patients with gastric cancer, one with prostatic cancer, and one with renal pelvic tumor, initial bone scintigraphy showed diffuse accumulation. In one gastric cancer patient and two breast cancer patients, the multiple bone metastases had altered the diffuse bone metastasis. All patients had no lung or liver metastasis morphologically at the course of diagnosed diffuse bone metastasis. Overall, the diffuse bone metastases were classified into two groups: diffuse symmetrical accumulation in proportion to bone marrow demonstrated in the gastric cancer, and diffuse accumulation centering the axial skeleton with asymmetrical accumulation in the rib and extremities demonstrated in cancer of the prostate. The finding of X ray films were consistent to common bone metastases in proportion to the primary tumor. Diffuse bone metastases did not show the characteristic finding. During the period from the diagnosed time to the death of patients, the patients with gastric cancer died extremely earlier in comparison to the patients with breast cancer and with prostatic cancer. (author)

  8. 99m technetium-MDP bone scintigraphy in evaluation of painful joint prosthesis

    International Nuclear Information System (INIS)

    Milosevic, D.; Jaukovic, M.; Jaukovic, Lj.; Ajdinovic, B.

    2004-01-01

    In addition of clinical evaluation and x-ray radiography, the diagnosis of a loose joint prosthesis is often made by nuclear medicine imaging techniques. Differentiation between loosening and infected prosthesis is important for better treatment of those patients. Aim: The aim of this study was to reevaluate the scintigraphic patterns in patients with painful hip of knee arthroplasty. Material and Method: From 1996. to 2003. forty patients aged 49-78 years were referred for evaluation of possible loosening/infection joint prosthesis: 36 pts with 39 total/ partial hip prosthesis, 1 pt with knee prosthesis and 3 pts with history of previously extracted hip prosthesis due to infection. Whole body acquisition had been performed with a single head gamma camera three hours after the injection of 740 MBq 99m Tc-MDP. Scans were classified as: positive for loosening if abnormal uptake was shown at the tip of the prosthesis; positive for infection if diffuse abnormal uptake was shown around the implant; negative and indeterminate scans. Scintigraphic findings were compared to clinical follow up, histology or cultures. Results: Positive findings were found in 17 bone scans strongly suggesting loosening in 10 cases, infection of prosthesis in 4 cases and both loosening/infection in 3 cases. Bone scintigraphy was normal in 11pts. Scans of three pts with previously extracted hip prosthesis and scheduled for reimplatation, showed inhomogeneously and mildly increased uptake in femur. Most of scans classified as indeterminate (n=12) showed slightly increased tracer uptake in region of acetabular roof, greater or lesser tho chanter, suggesting bone remodeling due to the presence of implant, rather than loosening. Conclusion: 99m Tc-MDP bone scintigraphy had a significant role in assessing the painful joint prosthesis. Complementary diagnostic procedures should be considered in indeterminate scintiscans. (authors)

  9. Perceived levels of pain associated with bone marrow aspirates and biopsies.

    Science.gov (United States)

    Talamo, Giampaolo; Liao, Jason; Joudeh, Jamal; Lamparella, Nicholas E; Dinh, Hoang; Malysz, Jozef; Ehmann, W Christopher

    2012-01-01

    Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB). To evaluate the effectiveness of several strategies aimed at reducing the pain score. We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner. On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels. Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. The Effect of Classical Turkish Music on Pain Severity and Anxiety Levels in Patients Undergoing Bone Marrow Aspiration and Biopsy.

    Science.gov (United States)

    Özdemir, Ülkü; Taşcı, Sultan; Yıldızhan, Esra; Aslan, Süheyla; Eser, Bülent

    2018-05-18

    Bone marrow aspiration is a painful procedure. In addition, the anxiety experienced during the procedure can affect the pain felt during the procedure. This study was conducted as a randomized controlled study to determine the effect of classical Turkish music on pain severity and anxiety levels in patients undergoing bone marrow aspiration and biopsy. The study was performed in an oncology hospital with a total of 30 patients, of whom 14 were in the intervention group and 16 were in the control group. All underwent bone marrow aspiration and biopsy for the first time. Ethics committee approval, institutional permission, and the study participants' written informed consent were obtained. Data were collected using patient information forms and follow-up charts, the Visual Analog Scale, and the State Anxiety Inventory. It was determined that the scores gathered from the State Anxiety Inventory during the first follow-up increased in the second follow-up in both the intervention and control groups, and this increase was statistically significant in the intervention group (p < .05). The mean pain severity scores of the patients undergoing the procedure were significantly lower in the intervention group than in the control group (p < .05). This study found that classical Turkish music reduced the severity of pain but increased the levels of anxiety in patients undergoing bone marrow aspiration and biopsy. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  11. A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.

    Science.gov (United States)

    Barr, Andrew J; Campbell, T Mark; Hopkinson, Devan; Kingsbury, Sarah R; Bowes, Mike A; Conaghan, Philip G

    2015-08-25

    Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA. A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring. In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively. Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target. PROSPERO registration number: CRD 42013005009.

  12. Altering the Microenvironment to Promote Dormancy of Metastatic Breast Cancer Cell in a 3D Bone Culture System

    Science.gov (United States)

    2015-12-01

    of the collagen -rich extracellular matrix . Further addition of metastatic breast cancer cells to the co-culture mimicked the vicious cycle; there was...biodegradable polymers to type I collagen or matrix derived from native extracellular matrix following decellularization. Papadimitropoulos et al., presents a...metastasis, 3D model, osteoblasts, cytokines, extracellular matrix 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a

  13. Role of technetium-99m planar bone scanning in the evaluation of low back pain

    International Nuclear Information System (INIS)

    Valdez, D.C.; Johnson, R.G.

    1994-01-01

    The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scannings as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudoarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decision-making in many conditions. (orig.)

  14. Minocycline attenuates bone cancer pain in rats by inhibiting NF-κB in spinal astrocytes.

    Science.gov (United States)

    Song, Zhen-Peng; Xiong, Bing-Rui; Guan, Xue-Hai; Cao, Fei; Manyande, Anne; Zhou, Ya-Qun; Zheng, Hua; Tian, Yu-Ke

    2016-06-01

    To investigate the mechanisms underlying the anti-nociceptive effect of minocycline on bone cancer pain (BCP) in rats. A rat model of BCP was established by inoculating Walker 256 mammary carcinoma cells into tibial medullary canal. Two weeks later, the rats were injected with minocycline (50, 100 μg, intrathecally; or 40, 80 mg/kg, ip) twice daily for 3 consecutive days. Mechanical paw withdrawal threshold (PWT) was used to assess pain behavior. After the rats were euthanized, spinal cords were harvested for immunoblotting analyses. The effects of minocycline on NF-κB activation were also examined in primary rat astrocytes stimulated with IL-1β in vitro. BCP rats had marked bone destruction, and showed mechanical tactile allodynia on d 7 and d 14 after the operation. Intrathecal injection of minocycline (100 μg) or intraperitoneal injection of minocycline (80 mg/kg) reversed BCP-induced mechanical tactile allodynia. Furthermore, intraperitoneal injection of minocycline (80 mg/kg) reversed BCP-induced upregulation of GFAP (astrocyte marker) and PSD95 in spinal cord. Moreover, intraperitoneal injection of minocycline (80 mg/kg) reversed BCP-induced upregulation of NF-κB, p-IKKα and IκBα in spinal cord. In IL-1β-stimulated primary rat astrocytes, pretreatment with minocycline (75, 100 μmol/L) significantly inhibited the translocation of NF-κB to nucleus. Minocycline effectively alleviates BCP by inhibiting the NF-κB signaling pathway in spinal astrocytes.

  15. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    International Nuclear Information System (INIS)

    Nakamura, Naoki; Shikama, Naoto; Wada, Hitoshi; Harada, Hideyuki; Nozaki, Miwako; Nagakura, Hisayasu; Tago, Masao; Oguchi, Masahiko; Uchida, Nobue

    2012-01-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: “time until first increase in pain” (85%), “incidence of spinal cord compression” (50%), and “incidence of pathologic fractures” (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  16. Study on the serum levels of relevant cytokines IL-β, IL-6, IL-8 and tumor markers CEA, CA15-3, PRL in breast cancer patients with bone metastatic lesions shown on SPECT radio-nuclide bone scan

    International Nuclear Information System (INIS)

    Zhu Bao

    2009-01-01

    Objective: To explore the correlationship between SPECT radionuclide bone scan and serum levels of three tumor markers as well as three cytokines in patients with breast cancer. Methods: Serum levels of IL-1β, IL-6, IL-8, CEA, CA15-3(with RIA) and PRL(with CLIA) were determined in 1)20 breast cancer patients with definite bone metastatic lesions shown on radio-nuclide bone scan 2) 20 breast cancer patients without bone metastasis 3) 30 patients with benign breast disorders and 4) 35 controls. Results: The serum tumor markers levels in patients osseous metastasis were significantly higher than those in the other three groups (P 0.05). The serum levels of IL-6, IL-8, IL-1β in patients with osseous metastasis were also significantly higher than those in other groups(P<0.05). Conclusion: Over expression of CEA, CA15-3 and PRL as well as IL-6, IL-8, IL-1β were related with osseous metastasis from breast cancer. Determination of the levels of these six parameters would be helpful for dynamic monitoring of the extent of metastasis. (authors)

  17. The role of bone scintigraphy in determining the etiology of heel pain

    International Nuclear Information System (INIS)

    Ozdemir, H.; Soyuncu, Y.; Urguden, M.

    2002-01-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. Sixty-seven heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging

  18. The role of bone scintigraphy in determining the etiology of heel pain

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, H.; Soyuncu, Y.; Urguden, M. [Akdeniz Univ., Antalya (Turkey). Medical School; Ozdemir, A. [General State Hospital, Antalya (Turkey)

    2002-09-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. Sixty-seven heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging

  19. High levels of circulating VEGFR2+ Bone marrow-derived progenitor cells correlate with metastatic disease in patients with pediatric solid malignancies.

    Science.gov (United States)

    Taylor, Melissa; Rössler, Jochen; Geoerger, Birgit; Laplanche, Agnès; Hartmann, Olivier; Vassal, Gilles; Farace, Françoise

    2009-07-15

    Pediatric solid malignancies display important angiogenic potential, and blocking tumor angiogenesis represents a new therapeutic approach for these patients. Recent studies have evidenced rare circulating cells with endothelial features contributing to tumor neovascularization and have shown the pivotal role of bone marrow-derived (BMD) progenitor cells in metastatic disease progression. We measured these cells in patients with pediatric solid malignancies as a prerequisite to clinical trials with antiangiogenic therapy. Peripheral blood was drawn from 45 patients with localized (n = 23) or metastatic (n = 22) disease, and 20 healthy subjects. Subsets of circulating vascular endothelial growth factor receptor (VEGFR)2+-BMD progenitor cells, defined as CD45-CD34+VEGFR2(KDR)+7AAD- and CD45(dim)CD34+VEGFR2+7AAD- events, were measured in progenitor-enriched fractions by flow cytometry. Mature circulating endothelial cells (CEC) were measured in whole blood as CD31+CD146+CD45-7AAD- viable events. Data were correlated with VEGF and sVEGFR2 plasma levels. The CD45-CD34+VEGFR2(KDR)+7AAD- subset represented <0.003% of circulating BMD progenitor cells (< or =0.05 cells/mL). However, the median level (range) of the CD45(dim)CD34+VEGFR2+7AAD- subset was higher in patients compared with healthy subjects, 1.5% (0%-10.3%) versus 0.3% (0%-1.6%) of circulating BMD progenitors (P < 0.0001), and differed significantly between patients with localized and metastatic disease, 0.7% (0%-8.6%) versus 2.9% (0.6%-10.3%) of circulating BMD progenitors (P < 0.001). Median CEC value was 7 cells/mL (0-152 cells/mL) and similar in all groups. Unlike VEGFR2+-BMD progenitors, neither CECs, VEGF, or sVEGFR2 plasma levels correlated with disease status. High levels of circulating VEGFR2+-BMD progenitor cells correlated with metastatic disease. Our study provides novel insights for angiogenesis mechanisms in pediatric solid malignancies for which antiangiogenic targeting of VEGFR2+-BMD progenitors

  20. Eligibility audits for the randomized neuropathic bone pain trial (TROG 96.05)

    International Nuclear Information System (INIS)

    Roos, D.E.; Turner, S.L.

    2000-01-01

    In February 1996 the Trans-Tasman Radiation Oncology Group (TROG) initiated a two-arm, multicentre, prospective randomized trial on radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). This trial compares the response to a single 8-Gy fraction with 20 Gy in five fractions. The accrual target is 270 patients. In order to evaluate compliance with eligibility criteria after approximately 1 year of accrual, an independent audit of the first 42 randomized patients was commissioned. This found that only one of these patients did not have genuine neuropathic pain, but that this patient and seven others (19%) had infringements of other eligibility/exclusion criteria for the trial. Accordingly it was decided to continue the full audit up to 90 patients. This detected no further patients without genuine neuropathic pain, and found only one other eligibility infringement (1/48; 2%). It is concluded that this quality assurance (QA) measure undertaken early in the trial led to significantly improved clinician awareness of, and compliance with, eligibility/exclusion criteria. It also enabled an accurate comparison of outcome data for all randomized versus all eligible patients at the time of the preplanned first interim analysis at 90 patients. In view of the excellent compliance demonstrated in the second audit, a one-in-five sampling is proposed for future audits from centres that have already accrued at least five consecutive eligible patients. This is consistent with TROG QA guidelines now operational. Copyright (2000) Blackwell Science Pty Ltd

  1. US Food and Drug Administration Pooled Analysis to Assess the Impact of Bone-Only Metastatic Breast Cancer on Clinical Trial Outcomes and Radiographic Assessments.

    Science.gov (United States)

    Wedam, Suparna B; Beaver, Julia A; Amiri-Kordestani, Laleh; Bloomquist, Erik; Tang, Shenghui; Goldberg, Kirsten B; Sridhara, Rajeshwari; Ibrahim, Amna; Kim, Geoffrey; Kluetz, Paul; McKee, Amy; Pazdur, Richard

    2018-04-20

    Purpose The outcome and proportion of patients with bone-only (BO) metastatic breast cancer (MBC) has not been well described. We sought to describe the differential outcomes of patients with BO MBC in clinical trials and explore whether there was a discrepancy in radiographic reads between investigator and blinded independent central review. Methods We pooled and analyzed data on 10,521 patients from 13 prospective trials submitted for MBC treatment in initial or supplemental New Drug or Biologics License Applications from 2005. Three subsets were evaluated: BO, bone with other metastases (BWO), and no bone metastases (NBM). Early discordance rate and late discordance rate were calculated from 3,733 and 2,813 patients subject to a blinded independent central review, respectively. Results Bone metastases were identified in 49% (range: 42% to 73%) of patients across trials. BO disease was present in 12.5% (range: 4% to 26%), dependent on subtype. Investigator-assessed progression-free survival (PFS) and overall survival (OS) for the pooled trials demonstrated improved outcomes for the BO subgroup compared with other subgroups (BO v BWO PFS hazard ratio [HR], 0.64; 95% CI, 0.591 to 0.696; BO v NBM PFS HR, 0.70; 95% CI, 0.65 to 0.76; BO v BWO OS HR, 0.56; 95% CI, 0.50 to 0.61; BO v NBM OS HR, 0.68; 95% CI, 0.61 to 0.76). The BO subgroup has a higher early discordance rate and lower late discordance rate than the BWO and NBM subgroups. Conclusion To our knowledge, this review is the largest analysis to date of the BO subgroup of MBC and suggests this subgroup may have a distinct natural history. There also seems to be a difference in how the local investigators assessed progression events in the BO subgroup when compared with the other two groups.

  2. Pain and quality of life following palliative radiotherapy of bone metastases; Der Einfluss palliativer Strahlentherapie auf Schmerz und Lebensqualitaet bei Patienten mit Knochenmetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Sauer, N.; Wild, B.; Henningsen, P.; Jakobsen, T. [Klinik fuer Psychosomatische und Allgemeine Klinische Medizin, Univ. Heidelberg (Germany); Leising, D. [Inst. fuer Psychologie, Univ. Wuerzburg (Germany); Treiber, M. [Radiologische Universitaetsklinik, Heidelberg (Germany)

    2006-09-15

    Pain and quality of life following palliative radiotherapy of bone metastases Background and purpose: palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. Patients and methods: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. Results: radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. Conclusion: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects. (orig.)

  3. Bone SPECT in low back pain: Results of an IAEA co-ordinated research project

    International Nuclear Information System (INIS)

    Buscombe, J.; Cwikla, J.B.; Kolasinska, A.D.; Xing-Dang, L.; Dave, P.K.; Dougall, P.; Fettich, J.; Fettich-Seliger, M.; Frangos, S.; Van Heerden, B.B.; Kanmaz, B.; Lele, V.; Szilvasi, I.; Soricelli, A.; Padhy, A.K.

    2003-01-01

    The aim of this study was to determine if it would be possible to use spinal bone single photon emission computed tomography (SPECT) in patients with unexplained back pain in varied clinical backgrounds and to determine if a positive or negative study had any prognostic value. The study was co-ordinated by the International Atomic Energy Agency (IAEA) and involved 8 centres in 7 countries. A total of 174 patients (mean age 42 years, range 15-80 years) were screened and found to have no obvious cause for their back pain at the time of the SPECT scan. All patients had a CT, and planar radiology. There was clinical follow-up data for 6 months without active treatment (such as surgery) in 147 patients. A panel of 9 specialists in nuclear medicine, radiology and orthopaedics reviewed all images and histories. Final assessment determined that 141 patients had skeletal causes for their back pain. SPECT was abnormal in 64% of these patients as compared to 58% with CT and 18% with planar radiology. CT was most likely to be diagnostic in disc degeneration (sensitivity 92%). SPECT was most diagnostic in facet joint disease (sensitivity 96%). In the 43 patients without any skeletal disease the specificity of SPECT was 79%, compared to 65% for CT. Follow-up of patients at 6 months showed that on average 71% had improvement of symptoms, suggesting a benign course for their back pain, with the exception of patients with pure facet joint disease, identified on SPECT but with no treatment. Spinal skeletal SPECT can be applied in a wide range of social and clinical settings. Results compare well with CT, providing additional information in 30% of patients, especially in facet joint disease where a positive SPECT study, suggests a worse clinical outcome at 6 months. (author)

  4. Imaging of Spinal Metastatic Disease

    Directory of Open Access Journals (Sweden)

    Lubdha M. Shah

    2011-01-01

    Full Text Available Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver. Approximately 60–70% of patients with systemic cancer will have spinal metastasis. Materials/Methods. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease. Conclusions. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease.

  5. The Histone Deacetylase Inhibitor, Vorinostat, Reduces Tumor Growth at the Metastatic Bone Site and Associated Osteolysis, but Promotes Normal Bone Loss

    OpenAIRE

    Pratap, Jitesh; Akech, Jacqueline; Wixted, John J.; Szabo, Gabriela; Hussain, Sadiq; McGee-Lawrence, Meghan E.; Li, Xiaodong; Bedard, Krystin; Dhillon, Robinder J.; van Wijnen, Andre J.; Stein, Janet L.; Stein, Gary S.; Westendorf, Jennifer J.; Lian, Jane B.

    2010-01-01

    Vorinostat, an oral histone deacetylase inhibitor with anti-tumor activity, is in clinical trials for hematological and solid tumors that metastasize and compromise bone structure. Consequently, there is a requirement to establish the effects of vorinostat on tumor growth within bone. Breast (MDA-231) and prostate (PC3) cancer cells were injected into tibias of SCID/NCr mice and the effects of vorinostat on tumor growth and osteolytic disease were assessed by radiography, μCT, histological an...

  6. The Palliative Radiotherapy in Bone Metastases

    International Nuclear Information System (INIS)

    Choi, Young Min; Lee, Hyung Sik; Hur, Won Joo

    1994-01-01

    To objectively compare the response of the palliative radiotherapy in bone metastatic patients which decreases pain and prevents pathologic fractures, we introduced and applied the RTOG pain and narcotic measure system. From Oct in 1991 to July in 1993, thirty-two patients with painful bone metastases, 17 of them were solitary lesions and others were multiple lesions, were treated with mainly 6 MV photon otherwise 15 MV photon. Radiation doses to bone metastatic sites ranged about from 2000 to 4600cGy. Responses of radiation therapy were compared with days of pre-RT, RT finish, 3, 6, 9 months after the start of RT and solitary versus multiple lesions and follow up scores according to the RTOG measure system. Survival analysis was done. Pain and narcotic score of the entire patients were 7.3, 7.8 at the pre-RT period and 2.6, 3.9 at the immediate or 2 weeks after RT, which was 64%, 50% decrement compared with the pre-RT score. Pain scores of 3, 6 and 9 months after the beginning of irradiation were 3.6, 3.7 and 3.3. The best response found in the breast and prostate primaries was 84%, 78% decrement of pain score as compared with pre-RT score (statistically insignificant). Median survival was 5.5 months and mean survival was 5 months. We conclude that the RTOG pain and narcotic measure system in relatively effective scale in the comparison of before and after palliative irradiation to the painful bone metastatic sites but more detailed parameters will be required in the narcotic scoring system. More aggressive but less or similar toxic radiotherapy is needed in the patients having relatively long life expected time

  7. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Naoki, E-mail: naokinak@luke.or.jp [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka (Japan); Wada, Hitoshi [Department of Radiation Oncology, Miyagi Cancer Center, Natori (Japan); Harada, Hideyuki [Division of Radiation Oncology, Shizuoka Cancer Center, Mishima (Japan); Nozaki, Miwako [Department of Radiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya (Japan); Nagakura, Hisayasu [Department of Radiology, KKR Sapporo Medical Center, Sapporo (Japan); Tago, Masao [Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Uchida, Nobue [Department of Radiation Oncology, Shimane University Hospital, Izumo (Japan)

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  8. A randomised, phase II study of repeated rhenium-188-HEDP combined with docetaxel and prednisone versus docetaxel and prednisone alone in castration-resistant prostate cancer (CRPC) metastatic to bone; the Taxium II trial

    Energy Technology Data Exchange (ETDEWEB)

    Dodewaard-de Jong, Joyce M. van [VU University Medical Centre, Department of Medical Oncology, Amsterdam (Netherlands); Meander Medical Centre, Department of Medical Oncology, Amersfoort (Netherlands); Klerk, John M.H. de [Meander Medical Centre, Department of Nuclear Medicine, Amersfoort (Netherlands); Bloemendal, Haiko J. [Meander Medical Centre, Department of Medical Oncology, Amersfoort (Netherlands); University Medical Centre Utrecht, Department of Medical Oncology, Utrecht (Netherlands); Oprea-Lager, Daniela E.; Hoekstra, Otto S. [VU University Medical Centre, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands); Berg, H.P. van den [Tergooi Medical Hospital, Department of Medical Oncology, Hilversum (Netherlands); Los, Maartje [St Antonius Hospital Utrecht, Department of Medical Oncology, Utrecht (Netherlands); Beeker, Aart [Spaarne Gasthuis, Department of Medical Oncology, Hoofddorp (Netherlands); Jonker, Marianne A. [VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam (Netherlands); O' Sullivan, Joe M. [Queen' s University Belfast, Centre for Cancer Research and Cell Biology, Belfast, Northern Ireland (United Kingdom); Verheul, Henk M.W.; Eertwegh, Alfons J.M. van den [VU University Medical Centre, Department of Medical Oncology, Amsterdam (Netherlands)

    2017-08-15

    Rhenium-188-HEDP is a beta-emitting radiopharmaceutical used for palliation of metastatic bone pain. We investigated whether the addition of rhenium-188-HEDP to docetaxel/prednisone improved efficacy of chemotherapy in patients with CRPC. Patients with progressive CRPC and osteoblastic bone metastases were randomised for first-line docetaxel 75 mg/m{sup 2} 3-weekly plus prednisone with or without 2 injections of rhenium-188-HEDP after the third (40 MBq/kg) and after the sixth (20 MBq/kg) cycle of docetaxel. Primary endpoint was progression-free survival (PFS), defined as either PSA, radiographic or clinical progression. Patients were stratified by extent of bone metastases and hospital. Forty-two patients were randomised for standard treatment and 46 patients for combination therapy. Median number of cycles of docetaxel was 9 in the control group and 8 in the experimental group. Median follow-up was 18.4 months. Two patients from the experimental group did not start treatment after randomisation. In the intention to treat analysis no differences in PFS, survival and PSA became apparent between the two groups. In an exploratory per-protocol analysis median overall survival was significantly longer in the experimental group (33.8 months (95%CI 31.75-35.85)) than in the control group (21.0 months (95%CI 13.61-28.39); p 0.012). Also median PFS in patients with a baseline phosphatase >220U/L was significantly better with combination treatment (9.0 months (95%CI 3.92-14.08) versus 6.2 months (95%CI 3.08-9.32); log rank p 0.005). As expected, thrombocytopenia (grade I/II) was reported more frequently in the experimental group (25% versus 0%). Combined treatment with rhenium-188-HEDP and docetaxel did not prolong PFS in patients with CRPC. The observed survival benefit in the per-protocol analysis warrants further studies in the combined treatment of chemotherapy and radiopharmaceuticals. (orig.)

  9. [Stress fractures of the ribs with acute thoracic pain in a young woman, diagnosed by the bone scan].

    Science.gov (United States)

    Georgitzikis, Athanasios; Siopi, Dimitra; Doumas, Argyrios; Mitka, Ekaterini; Antoniadis, Antonios

    2010-01-01

    We report the unusual case of a 29 -year old woman with emotional instability who presented with acute onset chest pain after severe chronic cough. The chest X-ray and the serological tests were normal but the CT scanning, and the bone scanning revealed multiple bilateral rib stress fractures, caused by severe coughing and physical activity and worsened by the patient's emotional instability.

  10. Metastatic Neuroendocrine Tumor with Extensive Bone Marrow Involvement at Diagnosis: Evaluation of Response and Hematological Toxicity Profile of PRRT with 177Lu-DOTATATE

    International Nuclear Information System (INIS)

    Basu, Sandip; Ranade, Rohit; Thapa, Pradeep

    2016-01-01

    The aim of this study was to evaluate the response and hematological toxicity in peptide receptor radionuclide therapy (PRRT) with lutetium ( 177 Lu)-DOTA-octreotate (DOTATATE) in metastatic neuroendocrine tumor (NET) with extensive bone marrow metastasis at the initial diagnosis. A retrospective evaluation was undertaken for this purpose: Patients with NET with extensive diffuse bone marrow involvement at diagnosis who had received at least three cycles of PRRT with 177 Lu-DOTATATE were considered for the analysis. The selected patients were analyzed for the following: (i) Patient and lesional characteristics, (ii) associated metastatic burden, (iii) hematological parameters at diagnosis and during the course of therapy, (iv) response to PRRT (using a 3-parameter assessment: Symptomatic including Karnofsky/Lansky performance score, biochemical finding, and scan finding), (v) dual tracer imaging features [with somatostatin receptor imaging (SRI) and fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT)]. Based on the visual grading, tracer uptake in somatostatin receptor (SSTR)-positive bone marrow lesions were graded by a 4-point scale into four categories (0-III) in comparison with the hepatic uptake on the scan: 0 - no uptake; I - clear focus but less than liver uptake; II - equal to liver uptake; and III - higher than liver uptake]. Hematological toxicity was evaluated using National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 score. A total of five patients (age range: 26-62 years; three males and two females) with diffuse bone marrow involvement at the diagnosis was encountered following analysis of the entire patient population of 250 patients. Based on the site of the primary, three had thoracic NET (two patients bronchial carcinoid and one pulmonary NET) and two gastroenteropancreatic NET (one in the duodenum and one patient of unknown primary with liver metastasis). Associated sites

  11. Assessment of treatment response by total tumor volume and global apparent diffusion coefficient using diffusion-weighted MRI in patients with metastatic bone disease: a feasibility study.

    Directory of Open Access Journals (Sweden)

    Matthew D Blackledge

    Full Text Available We describe our semi-automatic segmentation of whole-body diffusion-weighted MRI (WBDWI using a Markov random field (MRF model to derive tumor total diffusion volume (tDV and associated global apparent diffusion coefficient (gADC; and demonstrate the feasibility of using these indices for assessing tumor burden and response to treatment in patients with bone metastases. WBDWI was performed on eleven patients diagnosed with bone metastases from breast and prostate cancers before and after anti-cancer therapies. Semi-automatic segmentation incorporating a MRF model was performed in all patients below the C4 vertebra by an experienced radiologist with over eight years of clinical experience in body DWI. Changes in tDV and gADC distributions were compared with overall response determined by all imaging, tumor markers and clinical findings at serial follow up. The segmentation technique was possible in all patients although erroneous volumes of interest were generated in one patient because of poor fat suppression in the pelvis, requiring manual correction. Responding patients showed a larger increase in gADC (median change = +0.18, range = -0.07 to +0.78 × 10(-3 mm2/s after treatment compared to non-responding patients (median change = -0.02, range = -0.10 to +0.05 × 10(-3 mm2/s, p = 0.05, Mann-Whitney test, whereas non-responding patients showed a significantly larger increase in tDV (median change = +26%, range = +3 to +284% compared to responding patients (median change = -50%, range = -85 to +27%, p = 0.02, Mann-Whitney test. Semi-automatic segmentation of WBDWI is feasible for metastatic bone disease in this pilot cohort of 11 patients, and could be used to quantify tumor total diffusion volume and median global ADC for assessing response to treatment.

  12. Alteration of cancer pain-related signals by radiation: Proteomic analysis in an animal model with cancer bone invasion

    International Nuclear Information System (INIS)

    Park, Hee Chul; Seong, Jinsil; An, Jung Hee; Kim, Jiyoung; Kim, Un Jung; Lee, Bae Whan

    2005-01-01

    Purpose: Although radiotherapy is highly effective in relieving bone pain due to cancer invasion, its mechanism remains unclear. The aim of this study was to explore this mechanism in an animal model system. Methods and Materials: A hind paw model of cancer pain was developed by transplanting a murine hepatocarcinoma, HCa-1, into the periosteal membrane of the foot dorsum of C3H/HeJ mice. Bone invasion from HCa-1 was histopathologically confirmed from sequential tumor sampling. For three experimental groups, a control (N), tumor without radiation (T), and tumor with radiation (TR), the development and level of pain were objectively examined in mice with a growing tumor by assessing pain-associated behavior. The differential expression of pain-related signals in the spinal cord was analyzed by proteomic analysis using high-resolution two-dimensional gel electrophoresis (2-DE) and mass spectrometry, and those of proteins by Western blotting. The pain-mediating neurotransmitters in the spinal cord were also examined by immunohistochemical staining for calcitonin gene-related peptide (CGRP) and substance P. Results: In the histopathologic examinations, bone invasion from HCa-1 was seen from Day 7 and was evident at Day 14 after transplantation, and measurable pain-associated behaviors were developed from Day 7. After 25 Gy of radiation to the tumors, the objective level of pain in the TR group decreased, with higher thresholds to mechanical and thermal stimulation than in the T group. From the 2-DE of spinal cord, 107 spots were identified; 12 proteins were changed more than fivefold because of tumor formation but then reversed after radiation in the tumor-bearing mice. The proteins involved included secretagogin, syntenin, P2X purinoreceptor 6 (P2X6), and Ca 2+ /Calmodulin-dependent protein kinase 1 (CaM kinase 1), the functions of which have been known to be involved in the Ca 2+ -signaling cascade, ATP-mediated fast synaptic transmission, or control of vesicular

  13. Alteration of cancer pain-related signals by radiation: Proteomic analysis in an animal model with cancer bone invasion

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hee Chul [Department of Radiation Oncology, Hallym University, Chuncheon (Korea, Republic of); Seong, Jinsil [Department of Radiation Oncology, Brain Korea 21 Project for Medicine, Yonsei University, Seoul (Korea, Republic of); An, Jung Hee [Department of Radiation Oncology, Brain Korea 21 Project for Medicine, Yonsei University, Seoul (Korea, Republic of); Kim, Jiyoung [Department of Radiation Oncology, Brain Korea 21 Project for Medicine, Yonsei University, Seoul (Korea, Republic of); Kim, Un Jung [Yonsei Medical Research Center, Brain Korea 21 Project for Medicine, Yonsei University, Seoul (Korea, Republic of); Lee, Bae Whan [Yonsei Medical Research Center, Brain Korea 21 Project for Medicine, Yonsei University, Seoul (Korea, Republic of)

    2005-04-01

    Purpose: Although radiotherapy is highly effective in relieving bone pain due to cancer invasion, its mechanism remains unclear. The aim of this study was to explore this mechanism in an animal model system. Methods and Materials: A hind paw model of cancer pain was developed by transplanting a murine hepatocarcinoma, HCa-1, into the periosteal membrane of the foot dorsum of C3H/HeJ mice. Bone invasion from HCa-1 was histopathologically confirmed from sequential tumor sampling. For three experimental groups, a control (N), tumor without radiation (T), and tumor with radiation (TR), the development and level of pain were objectively examined in mice with a growing tumor by assessing pain-associated behavior. The differential expression of pain-related signals in the spinal cord was analyzed by proteomic analysis using high-resolution two-dimensional gel electrophoresis (2-DE) and mass spectrometry, and those of proteins by Western blotting. The pain-mediating neurotransmitters in the spinal cord were also examined by immunohistochemical staining for calcitonin gene-related peptide (CGRP) and substance P. Results: In the histopathologic examinations, bone invasion from HCa-1 was seen from Day 7 and was evident at Day 14 after transplantation, and measurable pain-associated behaviors were developed from Day 7. After 25 Gy of radiation to the tumors, the objective level of pain in the TR group decreased, with higher thresholds to mechanical and thermal stimulation than in the T group. From the 2-DE of spinal cord, 107 spots were identified; 12 proteins were changed more than fivefold because of tumor formation but then reversed after radiation in the tumor-bearing mice. The proteins involved included secretagogin, syntenin, P2X purinoreceptor 6 (P2X6), and Ca{sup 2+}/Calmodulin-dependent protein kinase 1 (CaM kinase 1), the functions of which have been known to be involved in the Ca{sup 2+}-signaling cascade, ATP-mediated fast synaptic transmission, or control of

  14. Non-metastatic Ewing's sarcoma family of tumors of bone in adolescents and adults: prognostic factors and clinical outcome-single institution results.

    Science.gov (United States)

    Oksüz, Didem Colpan; Tural, Deniz; Dincbas, Fazilet Öner; Dervisoglu, Sergülen; Turna, Hande; Hiz, Murat; Kantarci, Fatih; Ceylaner, Beyhan; Koca, Sedat; Mandel, Nil Molinas

    2014-01-01

    There is limited data regarding outcomes of Ewing's sarcoma family of tumors in adolescents and adults compared with the same tumors in childhood. The aim of the study was to analyze prognostic factors and treatment results in a cohort of adolescents and adults with non-metastatic skeletal Ewing's sarcoma family of tumors. From 1992-2008, 90 adolescents and adults with Ewing's sarcoma family of tumors of the bone were referred to our institution. Sixty-five (72%) non-metastatic patients with analyzable data and treated in our institution were retrospectively evaluated. All patients were treated with alternated chemotherapy regimens administered every 3 weeks. The local treatment modality was selected according to tumor and patient characteristics. The median age was 21 years (range, 13-50). Most patients (74%) were >17 years of age. Forty-six percent of the tumors were located in the extremities. Local therapy was surgery in 45 patients and radiotherapy alone in 19 patients. Twenty-one patients received preoperative and 13 patients postoperative radiotherapy. Median follow-up was 43 months (range, 7-167). The 5-year event-free and overall survival rates for all patients were 44% and 49%, respectively. On univariate survival analysis, event-free and overall survival were worse for patients >17 years of age, tumor size >8 cm in diameter, an axial location, positive surgical margins, and poor histopathological response (<90% necrosis). Age, tumor site and tumor size on event-free and overall survival remained significant on multivariate analysis. We identified age, tumor size, and tumor site as independent prognostic factors, in accord with the Western literature. These patients require novel treatment modalities.

  15.  Oncogenic osteomalacia and its symptoms: hypophosphatemia, bone pain and pathological fractures

    Directory of Open Access Journals (Sweden)

    Sonia Kaniuka-Jakubowska

    2012-08-01

    Full Text Available  Oncogenic osteomalacia (OOM is a rare paraneoplastic syndrome induced by tumor produced phosphaturic factors, i.e. phosphatonins. The disorder is characterized by renal tubular phosphate loss, secondary to this process hypophosphatemia and defective production of active form of vitamin D. The clinical course of oncogenic osteomalacia is characterized by bone pain, pathological fractures, muscle weakness and general fatigue. Osteomalacia-associated tumors are usually located in the upper and lower limbs, with half of the lesions primarily situated in the bones. Most of them are small, slow-growing tumors. Their insignificant size and various location coupled with rare occurrence of the disease and non-specificity of clinical symptoms lead to difficulties in reaching a diagnosis, which is often time-consuming and requires a number of additional tests. The average time between the appearance of the first symptoms and the establishment of an accurate diagnosis and the beginning of treatment is over 2.5 years. The aim of this study is to discuss the pathophysiology of disease symptoms, pathomorphology of tumors, diagnostic methods and treatment of oncogenic osteomalacia.

  16. Spinal high-mobility group box 1 contributes to mechanical allodynia in a rat model of bone cancer pain

    International Nuclear Information System (INIS)

    Tong, Wei; Wang, Wei; Huang, Jing; Ren, Ning; Wu, Sheng-Xi; Li, Yong-Qi

    2010-01-01

    Mechanisms underlying bone cancer-induced pain are largely unknown. Previous studies indicate that neuroinflammation in the spinal dorsal horn is especially involved. Being first reported as a nonhistone chromosomal protein, high-mobility group box 1 (HMGB1) is now implicated as a mediator of inflammation. We hypothesized that HMGB1 could trigger the release of cytokines in the spinal dorsal horn and contribute to bone cancer pain. To test this hypothesis, we first built a bone cancer pain model induced by intratibal injection of Walker 256 mammary gland carcinoma cells. The structural damage to the tibia was monitored by radiological analysis. The mechanical allodynia was measured and the expression of spinal HMGB1 and IL-1β was evaluated. We observed that inoculation of cancer cells, but not heat-killed cells, induced progressive bone destruction from 9 d to 21 d post inoculation. Behavioral tests demonstrated that the significant nociceptive response in the cancer cells-injected rats emerged on day 9 and this kind of mechanical allodynia lasted at least 21 d following inoculation. Tumor cells inoculation significantly increased HMGB1 expression in the spinal dorsal horn, while intrathecal injecting a neutralizing antibody against HMGB1 showed an effective and reliable anti-allodynia effect with a dose-dependent manner. IL-1β was significantly increased in caner pain rats while intrathecally administration of anti-HMGB1 could decrease IL-1β. Together with previous reports, we predict that bone cancer induces HMGB1 production, enhancing spinal IL-1β expression and thus modulating spinal excitatory synaptic transmission and pain response.

  17. Effects of Electroacupuncture Treatment on Bone Cancer Pain Model with Morphine Tolerance

    Directory of Open Access Journals (Sweden)

    Lei Sima

    2016-01-01

    Full Text Available Objective. To explore the efficacy of electroacupuncture treatment in cancer induced bone pain (CIBP rat model with morphine tolerance and explore changes of calcitonin-gene related peptide (CGRP expression in dorsal root ganglion (DRG. Methods. Forty SD rats were divided into five groups: sham, CIBP (B, CIBP + morphine (BM, CIBP + electroacupuncture (BE, and CIBP + morphine + electroacupuncture (BME. B, BM, BE, and BME groups were prepared CIBP model. The latter three groups then accepted morphine, electroacupuncture, and morphine combined electroacupuncture, separately, nine days consecutively (M1 to M9. Mechanical withdraw threshold (MWT was evaluated. Results. BE group only had differences in M1, M2, and M3 compared to B group (P<0.01. From M5, BM group showed significantly decreased MWT. Electroacupuncture could obtain analgesic effects only at early stage (M1 to M5. From M5 to M9, BME had the differences with BM group (P<0.01. IOD value of CGRP in BM and BME was substantially less than in B group. CGRP in BME was significantly lower than that in BM group (P<0.01. Conclusion. When used in combination with electroacupuncture, morphine could result in improving analgesic effects and reducing tolerance. CGRP may be associated with pain behaviors.

  18. Cutaneous metastatic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Joshi Arun

    2001-01-01

    Full Text Available A 5.5-year-old male presented with asymptomatic nodules and plaques on his scalp and pubic region of 2 months′ duration. He was having productive cough, haemoptysis, chest pain, anorexia and weight loss and receiving antitubercular treatment for these symptoms for last 3 months. Clinical diagnosis of cutaneous metastatic disease was made. Chest x-ray revealed multiple coin shaped shadows on both sides with pleural effusion. Routine investigations were normal except for anemia and hyperuricemia. Biopsy of skin nodules showed features of metastatic adenocarcinoma. Features and significance of cutaneous metastases are discussed.

  19. New bisphosphonate labeled with Iodine-131 for the palliative therapy for bone metastases pain

    International Nuclear Information System (INIS)

    Prats Capote, Anaís; Perera Pintado, Alejandro; León, Mariela; Hernández González, Ignacio; Leyva Montaña, René; Mocelo Castell, Raúl; O'Reilly, Beatriz; Calderón, Osmar; Griffith Pérez, Yoel; García Batle, Marisé; Rodríguez Tanty, Chryslaine

    2016-01-01

    The aim of this work was to obtain new bisphosphonate marked with 131I suitable for palliative treatment of bone metastases pain characteristics. Materials and Methods: It started with aromatic amino acids and the synthesis consisted of three stages: 1) Protection of amino groups by acetylation; 2) phosphonation protected amino acids with a mixture of phosphorous acid and phosphorus pentachloride; 3) Lack of protection of the amino groups by basic hydrolysis. The compounds obtained were characterized by IR, 1H NMR, RMN13-C mass. Los spectrometry bisphosphonic acids obtained were labeled with 131I using chloramine T and iodogen as oxidants. Stability of labeled compounds in aqueous solution was studied serum. 3 mg of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid labeled of 131I were administered to male wistar rats (170-190 g) through a lateral tail vein. The scintigraphic study was conducted at 2, 6 and 12 hours. Results: The yield of the reactions of the amino group protection four compounds ranged from 75 to 80%, while the phosphonation was between 50 and 60%. The radiochemical purity of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1- bisphosphonic acid labeled with 131I was (91.5 ± 1.4)% and its stability was satisfactory for 72h. Scintigraphic images suggest excretion by the kidneys of the compound and from 12 h post-administration begin to visualize bone structures of the animal, suggesting that the compound exhibits affinity for these tissues. Conclusions: A novel synthesis method with modifications that yielded the sodium salts of bisphosphonic acids starting from the respective aromatic amino acids was developed. 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid 131I labeled was stable up to 72h and showed affinity for bone tissue. (author)

  20. Use of Strontium Chloride (89Sr) in evaluation of painful bone metastases arising from carcinoma of prostate gland

    International Nuclear Information System (INIS)

    Mahapatra, G.N.; Shetty, Jayarama K.; More, M.

    2004-01-01

    Full text: Bone metastases that develop in patients with advanced prostatic cancer often cause deep, unremitting pain adversely affecting quality of life, pathologic fracture, immobility, anxiety and depression. Currently, a number of therapies specifically targeted for the treatment of pain from bone metastases are available. These include analgesics, chemotherapy, hormonal therapy, surgery, external beam radiation and systemically administered radiopharmaceuticals. Strontium Chloride (89Sr - Metastron) injection has been used as systemically administered radio therapeutic agent for the palliation of osteoblastic skeletal metastases. It imitates the biodistribution of calcium invivo and is avidly taken up by bony metastases. Twenty-five known prostatic cancer patients with painful bone metastases were assessed following a single injection of 89Sr (2.0 MBq / Kg body weight). Six patients (24%) showed dramatic improvement, 9 patients (36%) have substantial improvement, 5 patients (20%) have some improvements while 5 patients (20%) did not have any improvement. These improvements were assessed in various scoring rates such as improvement in the intensity of pain, fall in the total and free PSA titre, regression in the demonstrated area of metastases in bone scan. The last group of 5 patients who do not show any improvement were also tried with second injection of 89Sr. These patients were followed-up with measurement of total platelets count, differential cell count (DC) and total leucocyte count. Two patients have moderate improvement in the pain relief and rest three patients were refractory to the multiple schedules of injection. We conclude that 89Sr has a significant effect in improving palliation of the distressing symptoms associated with prostate cancer as against the major drawback of external beam radiotherapy limits to the number of sites that can be treated at a time or recurrence at the treated site or new areas of bony pain requiring several hospital

  1. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin.

    Directory of Open Access Journals (Sweden)

    Yulia Kundel

    Full Text Available Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m(2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial at 12 weeks was 86%. Side effects were of mild intensity (grade I or II and included nausea (38% of patients, weakness (24%, diarrhea (24%, mucositis (10%, and hand and foot syndrome (7%.External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.ClinicalTrials.gov NCT01784393NCT01784393.

  2. The Role of Extracellular Vesicles in Bone Metastasis

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    Michela Rossi

    2018-04-01

    Full Text Available Multiple types of cancer have the specific ability to home to the bone microenvironment and cause metastatic lesions. Despite being the focus of intense investigation, the molecular and cellular mechanisms that regulate the metastasis of disseminated tumor cells still remain largely unknown. Bone metastases severely impact quality of life since they are associated with pain, fractures, and bone marrow aplasia. In this review, we will summarize the recent discoveries on the role of extracellular vesicles (EV in the regulation of bone remodeling activity and bone metastasis occurrence. Indeed, it was shown that extracellular vesicles, including exosomes and microvesicles, released from tumor cells can modify the bone microenvironment, allowing the formation of osteolytic, osteosclerotic, and mixed mestastases. In turn, bone-derived EV can stimulate the proliferation of tumor cells. The inhibition of EV-mediated crosstalk between cancer and bone cells could represent a new therapeutic target for bone metastasis.

  3. Bone scintigraphy in bone stress. A technical consideration and correlation of the findings to clinical symptoms especially to the pain

    International Nuclear Information System (INIS)

    Kuusela, T.; Vorne, M.; Vahatalo, S.

    1983-01-01

    The purpose of this investigation was to find out a reliable scintigraphic method to investigate different fatigue phenomena in bone and to correlate the scintigraphic findings to the development of clinical symptoms. The gamma-imaging after the injection of bone seeking tracers is recommended to be performed after a period of 1-3 hours. The experiments indicate that in active bone tissue, might it be a healing fracture or a remodeling bone, the tracer uptake still increases after 1-3 hours. The delayed gamma-imaging can therefore be useful, especially if it is important to investigate faint physiological changes in bone tissue. It seems, that the capacity of emission energy in the diagnosis of bone affections is superior to the radiology because of its excellent histo-functional resolution especially in detecting and localizing bone affections

  4. Preliminary Results for the Treatment of a Pain-Causing Osteoporotic Vertebral Compression Fracture with a Sky Bone Expander

    International Nuclear Information System (INIS)

    Liu, Jin Bo; Tang, Xue Ming; Xu, Nan Wei; Bao, Hong Tao

    2008-01-01

    Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 ± 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 ± 5.0 mL) was injected per vertebra. The average anterior height was 18.4 ± 5.1 mm preoperatively and 20.5 ± 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 ± 5.2 mm preoperatively and 18.9 ± 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 ± 8.2 degrees preoperatively to 9.2 ± 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 ± 1.8 points preoperatively to 3.1 ± 2.0, 2.9 ± 1.7, 2.6 ± 1.5 and 2.9 ± 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally

  5. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Wei; Hao, Bing; Chen, Hao-jun; Zhao, Long; Luo, Zuo-ming; Wu, Hua; Sun, Long [The First Affiliated Hospital of Xiamen University, Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, Xiamen (China)

    2017-01-15

    {sup 18}F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of {sup 18}F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and {sup 18}F-FDG-avid bone lesions after whole-body {sup 18}F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated. A total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin's lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min. PET/CT-guided percutaneous biopsy of {sup 18}F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer. (orig.)

  6. Zoledronic acid in metastatic chondrosarcoma and advanced sacrum chordoma: two case reports

    Directory of Open Access Journals (Sweden)

    Capasso Elena

    2009-01-01

    Full Text Available Abstract Introduction Chondrosarcomas and chordomas are usually chemoresistant bone tumors and may have a poor prognosis when advanced. They are usually associated with worsening pain difficult to control. Patients and Methods Zoledronic acid was used in a 63-year-old man with metastatic chondrosarcoma and in a 66-year-old woman with a diagnosis of sacrum chordoma both reporting severe pain related to tumor. Results In the first case, zoledronic acid was able to maintain pain control despite disease progression following chemotherapy, in the other case, zoledronic acid only produced significant clinical benefit. Conclusion Control of pain associated with bone tumors such as chondrosarcoma and chondroma may significantly improve from use of zoledronic acid, independently from tumor response to other treatments. Evaluation on larger series are needed to confirm the clinical effect of this bisphosphonate on such tumors.

  7. Role of inflammation gene polymorphisms on pain and response to radiotherapy in multiple myeloma patients with painful bone destructions

    OpenAIRE

    Rudžianskienė, Milda; Inčiūra, Arturas; Gerbutavičius, Rolandas; Dambrauskienė, Rūta; Rudžianskas, Viktoras; Juozaitytė, Elona

    2016-01-01

    Background: Previous researches have demonstrated, that the severity of pain perception and it’s response to analgesia is highly dependent on gene polymorphism encoding for cytokines. We evaluated 12 single nucleotide polymorphisms (SNP) in 6 genes encoding for cytokines in multiple myeloma patients (n = 81) and assessed their influence on pain severity and response to palliative radiotherapy. Methods: Pain intensity was assessed by Visual Analogue Scale. The total dose of opioids was convert...

  8. [Correlation analysis of bone marrow edema degree and serum inflammatory factors change with knee joint pain symptoms in patients with bone contusion around the knee joint].

    Science.gov (United States)

    Li, Songiun; An, Rongze; Wang, Zhaojie; Kuang, Lipeng; Tan, Weiyuan; Fang, Cunxun

    2014-05-01

    To explore the correlation between the degree of bone marrow edema (BME) and the content change of tumor necrosis factor alpha (TNF-alpha) and matrix metalloproteinase 3 (MMP-3) and the knee pain symptoms in patients with bone contusion around the knee joint. Thirty patients (30 knees) of bone contusion around the knee joint were chosen as the trial group between October 2009 and April 2012. According to visual analogue scale (VAS), 30 patients were divided into mild group (10 cases), moderate group (10 cases), and severe group (10 cases); according to MRI morphological changes, the patients were divided into type I group (12 cases), type II group (11 cases), and type III group (7 cases). Ten patients (10 knees) with soft tissue injury of the knee were chosen as control group. No significant difference was found (P > 0.05) in gender, age, causes, side, and admission time after injury between 2 groups. The serum contents of MMP-3 and TNF-alpha were detected and statistically analysed between different degrees of pain groups and between different degrees of BME groups. Correlation was analysed between BME and inflammatory factor changes and VAS score. The MMP-3 and TNF-alpha contents in trial group [(29.580 +/- 6.870) (microg/L and (23.750 +/- 7.096) ng/L] were significantly higher than those in control group [(8.219 +/- 1.355) microg/L and (6.485 +/- 1.168) ng/L] (t = 9.686, P = 0.000; t = 7.596, P =0.000). The MMP-3 and TNF-alpha contents in patients with different degrees of pain and BME were significantly higher than those in patients of control group (P pain (P 0.05). Multiple linear regression analysis showed that TNF-alpha content was significantly correlated with VAS score (P = 0.000). Knee pain symptoms are not related to the degree of BME in patients with bone contusion around the knee joint. Inflammatory factor TNF-alpha content is the main influence factor of knee joint pain symptoms.

  9. Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Verdam, Mathilde G.E.; Oort, Frans J.; Jobsen, Jan J.; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.M.; Graeff, Alexander de; Linden, Yvette M. van der

    2016-01-01

    Purpose: To study the course of quality of life (QoL) after radiation therapy for painful bone metastases. Patients and Methods: The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics. Results: In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (−0.11 to −0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions. Conclusion: Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.

  10. Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Department of Radiotherapy, Radboud University Medical Center, Nijmegen (Netherlands); Verdam, Mathilde G.E. [Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Oort, Frans J. [Research Institute of Child Development and Education, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Jobsen, Jan J. [Department of Radiotherapy, Medisch Spectrum Twente, Enschede (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, Radboud University Medical Center, Nijmegen (Netherlands); Marijnen, Corrie A.M. [Department of Radiotherapy, Leiden University Medical Center, Leiden (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Linden, Yvette M. van der [Department of Radiotherapy, Leiden University Medical Center, Leiden (Netherlands)

    2016-08-01

    Purpose: To study the course of quality of life (QoL) after radiation therapy for painful bone metastases. Patients and Methods: The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics. Results: In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (−0.11 to −0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions. Conclusion: Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.

  11. Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome

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    Wang David A

    2009-05-01

    Full Text Available Abstract Background Autogenous Iliac Crest Bone Graft (ICBG has been the "gold standard" for spinal fusion. However, bone graft harvest may lead to complications, such as chronic pain, numbness, and poor cosmesis. The long-term impact of these complications on patient function and well-being has not been established but is critical in determining the value of expensive bone graft substitutes such as recombinant bone morphogenic protein. We thus aimed to investigate the long-term complications of ICBG. Our second aim was to evaluate the psychometric properties of a new measure of ICBG morbidity that would be useful for appropriately gauging spinal surgery outcomes. Methods Prospective study of patients undergoing spinal fusion surgery with autologous ICBG. The SF-36v2, Oswestry Disability Index, and a new 14-item follow-up questionnaire addressing persistent pain, functional limitation, and cosmesis were administered with an 83% response rate. Multiple regression analyses examined the independent effect of ICBG complications on physical and mental health and disability. Results The study population included 170 patients with a mean age of 51.1 years (SD = 12.2 and balanced gender (48% male. Lumbar fusion patients predominated (lumbar = 148; cervical n = 22. At 3.5 years mean follow-up, 5% of patients reported being bothered by harvest site scar appearance, 24% reported harvest site numbness, and 13% reported the numbness as bothersome. Harvest site pain resulted in difficulty with household chores (19%, recreational activity (18%, walking (16%, sexual activity (16%, work activity (10%, and irritation from clothing (9%. Multivariate regression analyses revealed that persistent ICBG complications 3.5 years post-surgery were associated with significantly worse disability and showed a trend association with worse physical health, after adjusting for age, workers' compensation status, surgical site pain, and arm or leg pain. There was no association

  12. Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome.

    Science.gov (United States)

    Schwartz, Carolyn E; Martha, Julia F; Kowalski, Paulette; Wang, David A; Bode, Rita; Li, Ling; Kim, David H

    2009-05-29

    Autogenous Iliac Crest Bone Graft (ICBG) has been the "gold standard" for spinal fusion. However, bone graft harvest may lead to complications, such as chronic pain, numbness, and poor cosmesis. The long-term impact of these complications on patient function and well-being has not been established but is critical in determining the value of expensive bone graft substitutes such as recombinant bone morphogenic protein. We thus aimed to investigate the long-term complications of ICBG. Our second aim was to evaluate the psychometric properties of a new measure of ICBG morbidity that would be useful for appropriately gauging spinal surgery outcomes. Prospective study of patients undergoing spinal fusion surgery with autologous ICBG. The SF-36v2, Oswestry Disability Index, and a new 14-item follow-up questionnaire addressing persistent pain, functional limitation, and cosmesis were administered with an 83% response rate. Multiple regression analyses examined the independent effect of ICBG complications on physical and mental health and disability. The study population included 170 patients with a mean age of 51.1 years (SD = 12.2) and balanced gender (48% male). Lumbar fusion patients predominated (lumbar = 148; cervical n = 22). At 3.5 years mean follow-up, 5% of patients reported being bothered by harvest site scar appearance, 24% reported harvest site numbness, and 13% reported the numbness as bothersome. Harvest site pain resulted in difficulty with household chores (19%), recreational activity (18%), walking (16%), sexual activity (16%), work activity (10%), and irritation from clothing (9%). Multivariate regression analyses revealed that persistent ICBG complications 3.5 years post-surgery were associated with significantly worse disability and showed a trend association with worse physical health, after adjusting for age, workers' compensation status, surgical site pain, and arm or leg pain. There was no association between ICBG complications and mental health in

  13. Criteria for palliation of bone metastases - Clinical applications

    International Nuclear Information System (INIS)

    2008-02-01

    Bone metastases are a frequent complication of cancer. It is estimated that they arise in 14-70% of all tumour patients, while it was reported that they occur in 70-85% patients in autopsy material. Although they may arise from any primary malignant tumour, certain tumours such as breast, prostate, lung, thyroid, kidney and myeloma have a predilection for a spread to bone. Bone metastases frequently cause pain, but there are also clinical situations with bone metastases causing no pain at all. The overall importance of the problem of bone metastases is well recognized by the fact that each year hundreds of thousands of cancer patients develop bone metastases. For example, more than 100 000 new patients develop this condition in the United States of America, although the prevalence is estimated to be double the number of new cases. While it is virtually unknown how many cancer patients in the developing countries develop bone metastases, it is not unrealistic to expect that these figures largely surpass those coming from the developed countries. The reason is simply that more patients in the developing countries are diagnosed as having locally advanced or metastatic cancer that will eventually widely disseminate, including bone metastasis as well. Furthermore, at least some of the cancer patients may survive prolonged periods of time. They can also develop earlier and more severe symptoms than patients harbouring other types (locations) of metastases, emphasizing the importance of the overall problem of painful bone metastases. In addition, there is a big socioeconomic problem of bone metastasis, burdening health care systems worldwide, while having continuous adverse psychological effect on both patients and their families. The management of patients with metastatic bone pain must be a multidisciplinary approach and includes the use of analgesia, radiotherapy, surgery, chemotherapy, hormone treatment, radioisotopes and bisphosphonates. Analgesia, with non

  14. Criteria for palliation of bone metastases - Clinical applications

    International Nuclear Information System (INIS)

    2007-04-01

    Bone metastases are a frequent complication of cancer. It is estimated that they arise in 14-70% of all tumour patients, while it was reported that they occur in 70-85% patients in autopsy material. Although they may arise from any primary malignant tumour, certain tumours such as breast, prostate, lung, thyroid, kidney and myeloma have a predilection for a spread to bone. Bone metastases frequently cause pain, but there are also clinical situations with bone metastases causing no pain at all. The overall importance of the problem of bone metastases is well recognized by the fact that each year hundreds of thousands of cancer patients develop bone metastases. For example, more than 100 000 new patients develop this condition in the United States of America, although the prevalence is estimated to be double the number of new cases. While it is virtually unknown how many cancer patients in the developing countries develop bone metastases, it is not unrealistic to expect that these figures largely surpass those coming from the developed countries. The reason is simply that more patients in the developing countries are diagnosed as having locally advanced or metastatic cancer that will eventually widely disseminate, including bone metastasis as well. Furthermore, at least some of the cancer patients may survive prolonged periods of time. They can also develop earlier and more severe symptoms than patients harbouring other types (locations) of metastases, emphasizing the importance of the overall problem of painful bone metastases. In addition, there is a big socioeconomic problem of bone metastasis, burdening health care systems worldwide, while having continuous adverse psychological effect on both patients and their families. The management of patients with metastatic bone pain must be a multidisciplinary approach and includes the use of analgesia, radiotherapy, surgery, chemotherapy, hormone treatment, radioisotopes and bisphosphonates. Analgesia, with non

  15. Meta-analysis of oral Chinese herbal medicine as an adjuvant treatment in relieving pain secondary to bone metastases.

    Science.gov (United States)

    Wang, Shi-Jun; Xu, Juan; Gong, Dan-Dan; Man, Chang-Feng; Fan, Yu

    2013-10-14

    To assess the effectiveness of oral Chinese herbal medicine (CHM) in relieving pain secondary to bone metastases in patients. The searched electronic literature databases included both English and Chinese articles published in the MEDLINE, EMBASE, Wanfang database and China National Knowledge Infrastructure (up to December 2012). The studies included randomized controlled trials (RCTs) comparing CHM plus conventional treatment with conventional treatment alone for patients with pain secondary to bone metastases. The outcomes were the odds ratio (OR) with 95% confidence intervals (CI) for the pain-relief rate and adverse events. A total of 16 RCTs involving 1,008 patients were identified and analyzed. All of the included RCTs were associated with a moderate to high risk of bias. In the metaanalysis, CHM plus conventional treatment increased the pain-relief rate compared with the conventional treatment alone (OR, 2.59; 95% CI 1.95 to 3.45). In subgroup analysis, the pooled OR of the pain-relief rate of CHM plus conventional treatment compared with conventional treatment was 3.11 (95% CI 2.01 to 4.79) for CHM plus bisphosphonates, 2.24 (95% CI 1.33 to 3.78) for CHM plus analgesics, 2.28 (95% CI 1.09 to 4.79) for CHM plus radiotherapy, and 2.22 (95% CI 0.95 to 5.15) for CHM plus analgesics and bisphosphonates. The adverse events included nausea, vomiting, dizziness, fever, and constipation. No serious adverse events were reported in any of the included studies. CHM interventions appear to have beneficial effects on pain secondary to bone metastases in patients. However, published efficacy trials are small in size to draw any firm conclusions.

  16. {sup 177}Lu-DOTMP: a viable agent for palliative radiotherapy of painful bone metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Das, T.; Chakraborty, S.; Banerjee, S. [Radiopharmaceuticals Div., Bhabha Atomic Research Centre, Mumbai (India); Sarma, H.D. [Radiation Biology and Health Sciences Div., Bhabha Atomic Research Centre, Mumbai (India)

    2008-07-01

    The suitable nuclear decay characteristics [T{sub 1/2} = 6.73 d, E{sub {beta}}{sub (max)} = 497 keV, E{sub {gamma}} = 113 keV (6.4%), 208 keV (11%)] as well as the feasibility of large-scale production with adequate specific activity and radionuclidic purity using a moderate flux reactor are important attributes towards {sup 177}Lu to be considered as a promising radionuclide for palliative care in painful bone metastasis. The present study describes the preparation of {sup 177}Lu complex of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid (DOTMP) and its preliminary biological evaluation in animal models with an aim to proposing it as a viable radiopharmaceutical for bone pain palliation. The choice DOTMP as the polyaminophosphonic acid carrier ligand is based on the enhanced thermodynamic stability and kinetic inertness of the metal-ligand complexes with macrocyclic chelators. {sup 177}Lu was produced with a specific activity of {proportional_to} 12 GBq/mg ({proportional_to} 324 mCi/mg) and radionuclidic purity of 99.98% by irradiation of natural Lu{sub 2}O{sub 3} target at a thermal neutron flux of {proportional_to} 6 x 10{sup 13} n/cm{sup 2} s for 21 d. {sup 177}Lu-DOTMP complex was prepared in high yield and excellent radiochemical purity (> 99%) using DOTMP synthesized and characterized in-house. The complex exhibited excellent in-vitro stability at room temperature. Biodistribution studies in Wistar rats showed rapid skeletal accumulation of the injected activity [(1.60{+-}0.19)% per gram in femur at 3 h post-injection] with fast clearance from blood and minimal uptake in any of the major organs. Scintigraphic studies carried out in normal Wistar rats and New Zealand white rabbits also demonstrated significant accumulation of the agent in skeleton and almost no retention in any other vital organs. (orig.)

  17. Resveratrol attenuates bone cancer pain through regulating the expression levels of ASIC3 and activating cell autophagy.

    Science.gov (United States)

    Zhu, Haili; Ding, Jieqiong; Wu, Ji; Liu, Tingting; Liang, Jing; Tang, Qiong; Jiao, Ming

    2017-11-01

    Bone cancer pain (BCP) is one of the most common pains in patients with malignant cancers. The mechanism underlying BCP is largely unknown. Our previous studies and the increasing evidence both have shown that acid-sensing ion channels 3 (ASIC3) is an important protein in the pathological pain state in some pain models. We hypothesized that the expression change of ASIC3 might be one of the factors related to BCP. In this study, we established the BCP model through intrathecally injecting rat mammary gland carcinoma cells (MRMT-1) into the left tibia of Sprague-Dawley female rats, and found that the BCP rats showed bone destruction, increased mechanical pain sensitivities and up-regulated ASIC3 protein expression levels in L4-L6 dorsal root ganglion. Then, resveratrol, which was intraperitoneally injected into the BCP rats on post-operative Day 21, dose-dependently increased the paw withdrawal threshold of BCP rats, reversed the pain behavior, and had an antinociceptive effect on BCP rats. In ASIC3-transfected SH-SY5Y cells, the ASIC3 protein expression levels were regulated by resveratrol in a dose- and time-dependent manner. Meanwhile, resveratrol also had an antinociceptive effect in ASIC3-mediated pain rat model. Furthermore, resveratrol also enhanced the phosphorylation of AMPK, SIRT1, and LC3-II levels in ASIC3-transfected SH-SY5Y cells, indicating that resveratrol could activate the AMPK-SIRT1-autophagy signal pathway in ASIC3-transfected SH-SY5Y cells. In BCP rats, SIRT1 and LC3-II were also down-regulated. These findings provide new evidence for the use of resveratrol as a therapeutic treatment during BCP states. © The Author 2017. Published by Oxford University Press on behalf of the Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan

    International Nuclear Information System (INIS)

    Damle, Nishikant A.; Tripathi, Madhavi; Singhal, Abhinav; Bal, Chandrasekhar; Praveen Kumar; Kandasamy, Devasenathipathi; Jana, Manisha

    2012-01-01

    Complex regional pain syndrome (CRPS) is usually associated with trauma. Rarely, it may be seen in association with malignancies. We present here the bone scan and X-ray findings in the case of a 56-year-male-patient with adenocarcinoma lung who also had non-traumatic CRPS without involvement of the stellate ganglion. The case highlights the fact that spontaneous development of reflex sympathetic dystrophy may be associated with a neoplastic etiology. (author)

  19. Percutaneous acetabuloplasty for metastatic acetabular lesions

    Directory of Open Access Journals (Sweden)

    Logroscino Giandomenico

    2008-05-01

    Full Text Available Abstract Background Osteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective. Methods We report a retrospective study in 25 such patients (30 acetabuli who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC, Eastern Cooperative Oncology Group (ECOG. The results obtained were analysed using the χ2 Test and Fisher's exact test. Significance was sent at P Results Marked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition. Complete pain relief was achieved in 15 of our 25 (59% of patients, and pain reduction was achieved in the remaining 10 (41% patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12% between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences. Conclusion Percutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

  20. Conditional TNF-α Overexpression in the Tooth and Alveolar Bone Results in Painful Pulpitis and Osteitis.

    Science.gov (United States)

    Hall, B E; Zhang, L; Sun, Z J; Utreras, E; Prochazkova, M; Cho, A; Terse, A; Arany, P; Dolan, J C; Schmidt, B L; Kulkarni, A B

    2016-02-01

    Tumor necrosis factor-α (TNF-α) is a proalgesic cytokine that is commonly expressed following tissue injury. TNF-α expression not only promotes inflammation but can also lead to pain hypersensitivity in nociceptors. With the established link between TNF-α and inflammatory pain, we identified its increased expression in the teeth of patients affected with caries and pulpitis. We generated a transgenic mouse model (TNF-α(glo)) that could be used to conditionally overexpress TNF-α. These mice were bred with a dentin matrix protein 1 (DMP1)-Cre line for overexpression of TNF-α in both the tooth pulp and bone to study oral pain that would result from subsequent development of pulpitis and bone loss. The resulting DMP1/TNF-α(glo) mice show inflammation in the tooth pulp that resembles pulpitis while also displaying periodontal bone loss. Inflammatory infiltrates and enlarged blood vessels were observed in the tooth pulp. Pulpitis and osteitis affected the nociceptive neurons innervating the orofacial region by causing increased expression of inflammatory cytokines within the trigeminal ganglia. With this new mouse model morphologically mimicking pulpitis and osteitis, we tested it for signs of oral pain with an oral function assay (dolognawmeter). This assay/device records the time required by a mouse to complete a discrete gnawing task. The duration of gnawing required by the DMP1/TNF-α(glo) mice to complete the task was greater than that for the controls; extended gnaw time in a dolognawmeter indicates reduced orofacial function. With the DMP1/TNF-α(glo) mice, we have shown that TNF-α expression alone can produce inflammation similar to pulpitis and osteitis and that this mouse model can be used to study dental inflammatory pain. © International & American Associations for Dental Research 2015.

  1. Reactive oxygen species scavengers ameliorate mechanical allodynia in a rat model of cancer-induced bone pain

    Directory of Open Access Journals (Sweden)

    Ya-Qun Zhou

    2018-04-01

    Full Text Available Cancer-induced bone pain (CIBP is a frequent complication in patients suffering from bone metastases. Previous studies have demonstrated a pivotal role of reactive oxygen species (ROS in inflammatory and neuropathic pain, and ROS scavengers exhibited potent antinociceptive effect. However, the role of spinal ROS remains unclear. In this study, we investigated the analgesic effect of two ROS scavengers in a well-established CIBP model. Our results found that intraperitoneal injection of N-tert-Butyl-α-phenylnitrone (PBN, 50 and 100 mg/kg and 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol, 100 and 200 mg/kg significantly suppressed the established mechanical allodynia in CIBP rats. Moreover, repeated injection of PBN and Tempol showed cumulative analgesic effect without tolerance. However, early treatment with PBN and Tempol failed to prevent the development of CIBP. Naive rats received repetitive injection of PBN and Tempol showed no significant change regarding the nociceptive responses. Finally, PBN and Tempol treatment notably suppressed the activation of spinal microglia in CIBP rats. In conclusion, ROS scavengers attenuated established CIBP by suppressing the activation of microglia in the spinal cord. Keywords: Cancer-induced bone pain, Reactive oxygen species, PBN, Tempol

  2. Interesting bone scans - unusual findings

    International Nuclear Information System (INIS)

    Dobson, M.; Wadhwa, S.S.; Mansberg, R.; Fernandes, V.B.

    1997-01-01

    A 59-year-old female with carcinoma of the colon and known liver metastatic disease was referred for bone scan to evaluate for bone metastases. Although no bone metastases were found, there was abnormal uptake noted in the liver corresponding to a metastatic calcified lesion. The only other findings were of degenerative disease in the cervical spine, right shoulder and small joints of the hands. A 69-year-old male with carcinoma of the prostate and right side low back pain was referred for bone scan. No focal abnormalities to suggest metastatic disease were identified; findings within the cervical spine, lumber spine and knees were presumed secondary to degenerative disease. Intermittent pain persisted and the patient was referred for a repeat bone scan six months later. Previous scan findings of degenerative disease and no metastatic disease were confirmed; however, closer inspection revealed an enlarged right kidney with significant retention of tracer in the pelvicalyceal system suggesting possible obstruction. A Retrograde pyelogram was performed, and no obvious obstruction demonstrated. As bone scan findings were very suggestive of obstruction, a DTPA scan with lasix was performed showing a dilated right collecting system with no functional obstruction. Given the degree of dilation, it is possible that the patient experiences intermittent PUJ obstruction causing his symptoms. A 33-year-old male with insulin dependent diabetes mellitus and viral arthritis was referred for a bone scan. A three phase revealed increased uptake in the region of the knee and leR proximal tibia. Delayed whole body images revealed multiple focal areas of osteoblastic activity in the leR tibia. Abnormal uptake was also seen in the upper third of the leR femur. The remainder of the skeletal survey was normal. X-ray correlation of the leR tibia and femoral findings was undertaken. Combinating unilateral changes on bone scan and X-ray although very suggestive of sclerotic polyostotic

  3. Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment

    International Nuclear Information System (INIS)

    Bedard, Gillian; Hoskin, Peter; Chow, Edward

    2014-01-01

    Introduction: Radiation therapy has been shown to successfully palliate bone metastases. A number of systematic reviews and large clinical trials have reported response rates for initial treatment and retreatment. Objective: To determine overall response rates of patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Methods: Intent-to-treat and evaluable patient statistics from a systematic review of palliative radiotherapy trials for initial treatment of bone metastases and a randomized clinical trial of retreatment were pooled and analyzed to determine the overall response rates for patients receiving initial treatment and retreatment. Results: In the intent-to-treat calculation, 71–73% of patients had an overall response to radiation treatment and in the evaluable patient population; 85–87% of patients did so. Response rates varied slightly whether patients underwent single or multiple fractions in initial treatment or retreatment. Conclusions: Single and multiple fraction radiation treatment yielded very similar overall response rates. Patients treated with a single fraction for both initial and repeat radiation experience almost identical overall response to those patients treated with multiple fraction treatment. It is therefore recommended that patients with uncomplicated painful bone metastases be treated with a single 8 Gy fraction of radiation at both the initial treatment and retreatment

  4. An interesting case of peripheral vascular disease, vascular reperfusion, and subsequent development of pain due to Paget's disease of bone.

    Science.gov (United States)

    Kwun, Sunna; Tucci, Joseph R

    2013-01-01

    To present a case of Paget's disease of bone that was unmasked after vascular reperfusion. In this case study, we review the presentation, evaluation, diagnosis, and management of a patient with Paget's disease and peripheral vascular disease. A 79-year-old-woman with a history of coronary artery heart disease and recent finding of a T5 compression fracture was hospitalized for evaluation of right lower extremity claudication. Angiography demonstrated a focal complete occlusion of the distal right femoral and popliteal arteries. A self-expanding stent was placed in the distal femoral and popliteal arteries. Approximately 48 hours after the procedure, the patient developed severe, right lower leg pain. On endocrine evaluation, the patient was found to have clinical signs suggesting Paget's disease of bone, which was subsequently confirmed by imaging. This patient's development of severe pain following reperfusion of distal femoral and popliteal arteries is in keeping with the known and aforementioned hypervascularity of pagetic bone. The finding of increased warmth over an area of skeletal deformation should always raise the possibility of Paget's disease of bone.

  5. A comparison inhibitory effects of cisplatin and MNPs-PEG-cisplatin on the adhesion capacity of bone metastatic breast cancer.

    Science.gov (United States)

    Mokhtari, Mohammad Javad; Koohpeima, Fatemeh; Mohammadi, Hadi

    2017-10-01

    To date, high mortality in women due to malignancy breast cancer related to the metastasis to the bone is a significant challenge. As, magnetic nanoparticles (MNPs) conjugated with the biocompatible polymers was employed for the delivery of some hydrophobic anticancer agents, the main aim of the current research was to assess whether cisplatin-loaded MNPs enhanced the anticancer effect of free cisplatin in breast cancer cells. MNPs decorated with PEG were synthesized by an improved coprecipitation technique, and then cisplatin was loaded onto the MNPs via a simple mixing method. Afterward, its morphology, size, chemical structure, magnetic property, hydrodynamic diameter, zeta potential, and crystal structure were characterized by scanning and transmittance electron microscopy, Fourier transforms infrared spectroscopy, vibrating sample magnetometer, dynamic light scattering, and X-ray powder diffraction and flame atomic absorption spectroscopy respectively. Additionally, the effects of cisplatin and MNPs-PEG-cisplatin on viability, migration and adhesion capacity of T47D cells were investigated by evaluating α2-integrin and β1-integrin; mRNAs were assessed by real-time RT-PCR. Consequently, the in vitro assay results showed a considerable dose-dependent inhibitory effect of cisplatin and MNPs-PEG-cisplatin on proliferation, migration, and adhesion of T47D cells. Finally, current research was shown that MNPs-PEG-cisplatin strongly increased anticancer effects compared with free cisplatin in the T47D cell line. © 2017 John Wiley & Sons A/S.

  6. Value of bone scintigraphy for pre-, postoperative assessment and follow-up study of breast cancer

    International Nuclear Information System (INIS)

    Lee, Hae Giu; Park, Jeong Mi; Chung, Soo Kyo; Kim, Choon Yul; Bahk, Yong Whee

    1985-01-01

    Early detection of neoplastic disease and metastatic spread is very important. Carcinoma of the breast is known to readily metastasize to the bone. The use of Tc-99m-phosphate as bone imaging agent has been shown to demonstrate early evidence of bone metastasis well before radiographic evidence is visualized and as thus become a very useful technique for establishing and monitoring the bony metastatic element of breast cancer. In this study, serial bone imaging studies were performed to monitor the management of 84 breast cancer patients before and after mastectomy and biopsy. We attempted to analyse bone scans of breast cancer and to correlate the scan findings with the clinical stage, status of lymph nodes, distant metastasis, bone pain, and laboratory data. The following useful patterns were emerged: 1. Positive bone scan rate was definitely higher in clinical stage III and IV (42, 57%) than in stage I and II (4, 18%) in initial studies. However, no correlation between positive bone scan rate and clinical stage was found in follow up studies. 2. Positive bone scan rate was high in both groups with locally advanced tumor (T3 and T4) and distant metastasis. 3. No correlation between positive bone scan and status of lymph node involvement was noted. 4. Positive bone scan rate was also very high in patients with bone pain and abnormal laboratory data

  7. Bone marrow adsorbed dose of rhenium-186-HEDP and the relationship with decreased platelet counts

    International Nuclear Information System (INIS)

    Klerk, J.M.H. de; Dieren, E.B. van; Schip, A.D. van het

    1996-01-01

    Rhenium-186(Sn)-1,1-hydroxyethylidene diphosphonate ( 186 Re-HEDP) has been used for palliation of metastatic bone pain. The purpose of this study was to find a relationship between the bone marrow absorbed dose and the toxicity, expressed as the percentage decrease in the peripheral blood platelet count. The bone marrow absorbed dose was calculated according to the MIRD model using data obtained from ten treatments of patients suffering from metastatic prostate cancer; noninvasive and pharmacokinetic method were used. The bone marrow doses were related to toxicity using the pharmacodynamic sigmoid E max model. The mean bone marrow absorbed doses using the noninvasive and pharmacokinetic methods were in a close range to each other (1.07 mGy/MBq and 1.02 mGy/MBq, respectively). There was a good relationship between the toxicity and the bone marrow absorbed dose (r = 0.80). Furthermore, the EDrm 50 (i.e., the bone marrow absorbed dose producing a 50% platelet decrease) to bone marrow for 186 Re-HEDP was on the order of 2 Gy. Although the function of normal bone marrow is affected by metastases in patients with metastatic bone disease, the MIRD model can be used to relate toxicity to the bone marrow absorbed dose after a therapeutic dosage of 186 Re-HEDP. 33 refs., 1 fig., 1 tab

  8. Metastatic Cancer

    Science.gov (United States)

    Metastatic cancer is cancer that spreads from its site of origin to another part of the body. Learn how cancer spreads, possible symptoms, common sites where cancer spreads, and how to find out about treatment options.

  9. Tibial stress reaction presenting as bilateral shin pain in a man taking denosumab for giant cell tumor of the bone.

    Science.gov (United States)

    Lim, Sian Yik; Rastalsky, Naina; Choy, Edwin; Bolster, Marcy B

    2015-12-01

    Prolonged bisphosphonate use has been associated with increased risk of atypical femoral fractures. Very few cases of atypical femoral fractures have been reported with denosumab. We report a case of bilateral tibial stress reactions in a 60-year-old man with no history of osteoporosis who was on prolonged high-dose denosumab for the treatment of giant cell tumor of bone. He presented with a 3-month history of pain in his bilateral shins worsening with activity and improving with rest. Although initial radiographs were unremarkable, he was found to have changes consistent with a stress reaction on magnetic resonance imaging of the distal tibia. To our knowledge, bilateral tibial stress reactions have not been previously reported with anti-resorptive therapies (neither bisphosphonates nor denosumab). Our case is intriguing in terms of the development of stress reactions as a precursor to stress fractures which may also relate to atypical fractures. Our case suggests a possible association between denosumab use and stress reactions. Of note the indication for denosumab in our case was for the treatment of giant cell tumor of bone where the Food and Drug Administration (FDA) approved dose is substantially higher than the FDA approved dose for osteoporosis treatment. Although rare, clinicians should consider the possibility of stress fractures in patients on anti-resorptive medications such as denosumab, especially when a patient presents with new onset thigh pain, hip pain or pain over an area affecting the long bones. Evaluation by imaging of affected areas should be pursued to enable early detection and intervention, as well as prevention of morbidity and associated ongoing risk to the patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Treatment of Hormone Resistance with Docetaxel in Metastatic Prostate Cancer Patients: Results of a Clinical Experience at Omid Hospital, Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Mina Tajvidi

    2017-01-01

    Full Text Available Background: Metastatic prostate cancer is one of the most important cancers among men worldwide. Androgen ablation therapy can be used in treatment of these patients; however, most will progress to metastatic hormone-refractory prostate cancer. In this regard, docetaxel has been approved to treat metastatic hormone-refractory prostate cancer in the United States. In this study, we aimed to investigate the results of this treatment modality in metastatic prostate cancer patients from Iran. Methods:We evaluated PSA response and bone pain relief in 18 metastatic prostate cancer patients who underwent treatment with docetaxel at a dose of 75 mg/m2 intravenously on the first day of treatment. The treatment was repeated every three weeks (6 cycles along with 10 mg of prednisolone. Results: Of 18 patients, 39% had >50% decline in PSA levels.There were 16% of the patients with a PSA decline of approximately 30% to 50% of the pre-treatment levels. In addition, 29% of the patients had progressive PSA levels during chemotherapy. Among them, 55% had significant pain relief. Conclusion: This research showed the effectiveness of docetaxel to decrease PSA levels in metastatic hormone-refractory prostate cancer patients from Iran. Docetaxel was also valuable in alleviation of pain in these patients. However, prospective studies should validate this approach.

  11. A health information system in radiotherapy to support health personnel in evaluation of standard pain in patients with bone metastases

    International Nuclear Information System (INIS)

    Santos, Maria E.M.; Vieira, Jose W.; Melo, Jonathan A.; Lima, Fernando R.A.

    2013-01-01

    Radiation therapy is a medical specialty that uses ionizing radiation sources, and can be applied to relieve the pain. The Numerical Dosimetry Group (GDN) of Recife-PE, Brazil presented in June 2012 the SISRAD (Health information system in radiotherapy), developed to organize information about data of patients with bone metastasis, aiming to evaluate patterns of pain after radiation treatment. They have since been carried out interviews with this type of patient and the answers have been added to a data file of the software. Were developed some graphical visualization tools as well as data sheets. The current version of SISRAD reads the data file and displays graphics and numerical results, with options to save them or print them. In this paper is presented a roadmap for the health care professional use with efficiency the SISRAD to form quantitative profiles of intensity of pain that their patients, on their responsibility, feel after the radiation treatment. A hypothesis used in SISRAD consists of organizing the responses of the patients supposing them free from other effects other than those arising from the permanence of the pain he felt before treatment or modification by the treatment. So the way the information is handled in the SISRAD enable the trader can discern patterns of pain and, consequently, improve the quality of treatment. In this sense the computational tool here presented can be classified as educational software for health professionals

  12. Inter- and Intra-Observer Repeatability of Quantitative Whole-Body, Diffusion-Weighted Imaging (WBDWI in Metastatic Bone Disease.

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    Matthew D Blackledge

    Full Text Available Quantitative whole-body diffusion-weighted MRI (WB-DWI is now possible using semi-automatic segmentation techniques. The method enables whole-body estimates of global Apparent Diffusion Coefficient (gADC and total Diffusion Volume (tDV, both of which have demonstrated considerable utility for assessing treatment response in patients with bone metastases from primary prostate and breast cancers. Here we investigate the agreement (inter-observer repeatability between two radiologists in their definition of Volumes Of Interest (VOIs and subsequent assessment of tDV and gADC on an exploratory patient cohort of nine. Furthermore, each radiologist was asked to repeat his or her measurements on the same patient data sets one month later to identify the intra-observer repeatability of the technique. Using a Markov Chain Monte Carlo (MCMC estimation method provided full posterior probabilities of repeatability measures along with maximum a-posteriori values and 95% confidence intervals. Our estimates of the inter-observer Intraclass Correlation Coefficient (ICCinter for log-tDV and median gADC were 1.00 (0.97-1.00 and 0.99 (0.89-0.99 respectively, indicating excellent observer agreement for these metrics. Mean gADC values were found to have ICCinter = 0.97 (0.81-0.99 indicating a slight sensitivity to outliers in the derived distributions of gADC. Of the higher order gADC statistics, skewness was demonstrated to have good inter-user agreement with ICCinter = 0.99 (0.86-1.00, whereas gADC variance and kurtosis performed relatively poorly: 0.89 (0.39-0.97 and 0.96 (0.69-0.99 respectively. Estimates of intra-observer repeatability (ICCintra demonstrated similar results: 0.99 (0.95-1.00 for log-tDV, 0.98 (0.89-0.99 and 0.97 (0.83-0.99 for median and mean gADC respectively, 0.64 (0.25-0.88 for gADC variance, 0.85 (0.57-0.95 for gADC skewness and 0.85 (0.57-0.95 for gADC kurtosis. Further investigation of two anomalous patient cases revealed that a very small

  13. Radiotherapy Suppresses Bone Cancer Pain through Inhibiting Activation of cAMP Signaling in Rat Dorsal Root Ganglion and Spinal Cord

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    Guiqin Zhu

    2016-01-01

    Full Text Available Radiotherapy is one of the major clinical approaches for treatment of bone cancer pain. Activation of cAMP-PKA signaling pathway plays important roles in bone cancer pain. Here, we examined the effects of radiotherapy on bone cancer pain and accompanying abnormal activation of cAMP-PKA signaling. Female Sprague-Dawley rats were used and received tumor cell implantation (TCI in rat tibia (TCI cancer pain model. Some of the rats that previously received TCI treatment were treated with X-ray radiation (radiotherapy. Thermal hyperalgesia and mechanical allodynia were measured and used for evaluating level of pain caused by TCI treatment. PKA mRNA expression in dorsal root ganglion (DRG was detected by RT-PCR. Concentrations of cAMP, IL-1β, and TNF-α as well as PKA activity in DRG and the spinal cord were measured by ELISA. The results showed that radiotherapy significantly suppressed TCI-induced thermal hyperalgesia and mechanical allodynia. The level of PKA mRNA in DRG, cAMP concentration and PKA activity in DRG and in the spinal cord, and concentrations of IL-1β and TNF-α in the spinal cord were significantly reduced by radiotherapy. In addition, radiotherapy also reduced TCI-induced bone loss. These findings suggest that radiotherapy may suppress bone cancer pain through inhibition of activation of cAMP-PKA signaling pathway in DRG and the spinal cord.

  14. Protocol of plain radiographs, hip ultrasound, and triple phase bone scans in the evaluation of the painful pediatric hip

    International Nuclear Information System (INIS)

    Alexander, J.E.; Seibert, J.J.; Aronson, J.; Williamson, S.L.; Glasier, C.M.; Rodgers, A.B.; Corbitt, S.L.

    1988-01-01

    A useful protocol for the evaluation of hip pain in the pediatric patient, using a combination of plain radiographs, hip ultrasound (US), and triple phase radionuclide bone scans is presented. Patients with hip pain were initially evaluated by plain radiographs of the pelvis and hips. If no diagnosis was reached, the hips were studied for effusions by real-time hip ultrasonography. If an effusion was present, the joint was aspirated for diagnosis. If no effusion was present by US or if no diagnosis was reached by aspiration, triple phase radionuclide bone scans were performed. Fifty patients were evaluated by this prospective protocol, and the diagnosis was reached in 48 of the 50 cases (10 by plain radiographs, 16 by US, and aspiration of the joint, and 22 by triple phase bone scans). Hip effusions were found in 20 patients by US, with no false positives or false negatives. Previous studies for detecting effusions by US have emphasized absolute measurements of the capsular width, but we report a typical appearance of the hip capsule when fluid is present (a bulging convex capsule). When no effusion is present, the capsule is concave and parallels the long axis of the femoral neck

  15. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

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    Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chow, Edward, E-mail: edward.chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Bedard, Gillian; Zhang, Liying [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Fairchild, Alysa [Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada); Vassiliou, Vassilios [Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia (Cyprus); Alm El-Din, Mohamed A. [Department of Clinical Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Tanta (Egypt); Jesus-Garcia, Reynaldo [Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo (Brazil); Kumar, Aswin [Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum (India); Forges, Fabien [Inserm CIE3, Saint Etienne University Hospital, Saint-Etienne (France); Unit of Clinical Research, Innovation, and Pharmacology, Saint Etienne University Hospital, Saint-Etienne (France); Tseng, Ling-Ming [Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (China); Hou, Ming-Feng [Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (China); Chie, Wei-Chu [Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan (China); Bottomley, Andrew [European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels (Belgium)

    2012-11-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  16. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    International Nuclear Information System (INIS)

    Zeng Liang; Chow, Edward; Bedard, Gillian; Zhang, Liying; Fairchild, Alysa; Vassiliou, Vassilios; Alm El-Din, Mohamed A.; Jesus-Garcia, Reynaldo; Kumar, Aswin; Forges, Fabien; Tseng, Ling-Ming; Hou, Ming-Feng; Chie, Wei-Chu; Bottomley, Andrew

    2012-01-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  17. Targeting G-Protein Signaling for the Therapeutics of Prostate Tumor Bone Metastases and the Associated Chronic Bone Pain

    Science.gov (United States)

    2015-09-01

    Cancer Bone Metastasis, heterotrimeric G protein  subunits, G protein-coupled receptors, signal transduction 16. SECURITY CLASSIFICATION OF: 17...TRPV1 expression/function in cultured mouse DRG sensory neurons. Accomplishments: we initially attempted to manipulate Gsignaling in isolated DRG ...increase in AKT activation. Since AKT activation will activate TRPV1 channel in DRG neurons, we cannot further assess the effect of G1 and Gt

  18. Metastatic skeletal leiomyomatosis (leiomyomatosis ossea)

    International Nuclear Information System (INIS)

    Pimentel, Jose Raimundo; De Almeida, Ana Luzia Brito; Aymore, Ierece Lins; Pinto, Edna Pottes; Osthoff, Laura; Smith, Julius

    2002-01-01

    We present a unique case of metastatic leiomyomatosis to the skeleton. The very extensive involvement of the axial and peripheral skeleton with ''ring'' lesions and associated cyclical premenstrual pain eventually led to the correct diagnosis and total relief with hormonal therapy. (orig.)

  19. Metastatic skeletal leiomyomatosis (leiomyomatosis ossea)

    Energy Technology Data Exchange (ETDEWEB)

    Pimentel, Jose Raimundo [Radiologic Clinic Felippe Mattoso, Rio de Janeiro (Brazil); De Almeida, Ana Luzia Brito; Aymore, Ierece Lins [Claudio Lemos Surgical Pathology Laboratory, Rio de Janeiro (Brazil); Pinto, Edna Pottes [Edna Pottes Pinto Clinic, Rio de Janeiro (Brazil); Osthoff, Laura [Basilio Clinic, Rio de Janeiro (Brazil); Smith, Julius [National Cancer Institute (INCA), Rio de Janeiro (Brazil)

    2002-01-01

    We present a unique case of metastatic leiomyomatosis to the skeleton. The very extensive involvement of the axial and peripheral skeleton with ''ring'' lesions and associated cyclical premenstrual pain eventually led to the correct diagnosis and total relief with hormonal therapy. (orig.)

  20. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    International Nuclear Information System (INIS)

    Wu, Jackson Sai-Yiu; Wong, Rebecca KS; Lloyd, Nancy S; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy

    2004-01-01

    This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently

  1. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    Directory of Open Access Journals (Sweden)

    Bezjak Andrea

    2004-10-01

    Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

  2. [Correlation of RANKL/OPG, dickkopf-1 and bone marrow edema in rheumatoid arthritis with the complaint of knee pain].

    Science.gov (United States)

    Li, Min; Wu, Xiao-hui; Yin, Geng; Xie, Qi-bing

    2015-03-01

    To investigate the correlation of the receptor activator of nuclear factor kappa-B ligand (RANKL)/serum osteoprotegerin (OPG) system, Dickkopf-1 (DKK-1) and bone marrow edema (BME) in rheumatoid arthritis (RA) with the complaint of knee pain. The clinical data of 50 cases of RA with the complaint of knee pain were collected. According to MRI finding, half of them (25 cases) had bone marrow edema (BME). Each patient received the measurement of serum OPG, RANKL, DKK-1, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti cyclic citrullinated peptide antibody (CCP), rheumatoid factort(RF). The clinical symptoms, disease activity score 28 (DAS28), were compared between BME and non-BME griups, and the correlation between RANKL/OPG system, DKK-1 and BME of RA was analyzed. Compared with non BME group, BME group had shorter course (P=0.000), higher DAS28 score (P=0.009), CRP (P=0:000), RF (P=0.033) and CCP (P=0.012). lower level of serum OPG (P=0.000), higher level of RANKL (P=0.000), RANKL/OPG (P=0.000), and DKK-1 (P=0.001). The severity of bone marrow edema was correlated with the serum RANKL (volume r(s)=0.31, P=0.027; degree r(s)=0.33, P=0.022), RANKL/OPG (volume r(s)=0.29, P=0.039; degree r(s)=0.28, P=0.043), DKK-1 (volume r(s)=0.33, P=0.021; degree r(s)=0.34, P=0.019). BME is one of the early signs of bone erosion in RA, there were more active inflammation, autoantibodies, and osteocasts in RA patients with BME.

  3. Use of radiopharmaceuticals for treating bone metastases

    International Nuclear Information System (INIS)

    Alberti Ramírez, Alejandro; Morín Zorrilla, José; Cruz Arencibia, Jorge

    2016-01-01

    Cancer prevalence is estimated at around 2% of the population and on average between 64-80% of patients with solid tumors develop bone metastases, being breast tumors, lung and prostate those who do more frequency. In this paper an estimate of the prevalence of bone pain from metastases, with reference to the data reported in the literature is presented. the different treatment techniques are summarized for pain management with special emphasis on Radionuclidic therapy, analyzing the different factors to consider for the selection of suitable radiopharmaceutical. cost data and cost-benefit of some radiopharmaceuticals for the purpose to take into account during their selection are provided. It is concluded that although the treatment of metastatic bone disease requires multidisciplinary therapies, Radionuclidic therapy is not sufficiently used, particularly by inadequate perception of risks and costs of radiopharmaceuticals, despite the undeniable support of its efficacy and tolerability. (author)

  4. Conditioned Medium of Bone Marrow-Derived Mesenchymal Stromal Cells as a Therapeutic Approach to Neuropathic Pain: A Preclinical Evaluation

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    Kelly Barbosa Gama

    2018-01-01

    Full Text Available Neuropathic pain is a type of chronic pain caused by injury or dysfunction of the nervous system, without effective therapeutic approaches. Mesenchymal stromal cells (MSCs, through their paracrine action, have great potential in the treatment of this syndrome. In the present study, the therapeutic potential of MSC-derived conditioned medium (CM was investigated in a mouse model of neuropathic pain induced by partial sciatic nerve ligation (PSL. PSL mice were treated by endovenous route with bone marrow-derived MSCs (1 × 106, CM, or vehicle. Gabapentin was the reference drug. Twelve hours after administration, neuropathic mice treated with CM exhibited an antinociceptive effect that was maintained throughout the evaluation period. MSCs also induced nonreversed antinociception, while gabapentin induced short-lasting antinociception. The levels of IL-1β, TNF-α, and IL-6 were reduced, while IL-10 was enhanced on sciatic nerve and spinal cord by treatment with CM and MSCs. Preliminary analysis of the CM secretome revealed the presence of growth factors and cytokines likely involved in the antinociception. In conclusion, the CM, similar to injection of live cells, produces a powerful and long-lasting antinociceptive effect on neuropathic pain, which is related with modulatory properties on peripheral and central levels of cytokines involved with the maintenance of this syndrome.

  5. Differential Expression of Matrix Metalloproteinase-2 Expression in Disseminated Tumor Cells and Micrometastasis in Bone Marrow of Patients with Nonmetastatic and Metastatic Prostate Cancer: Theoretical Considerations and Clinical Implications—An Immunocytochemical Study

    Directory of Open Access Journals (Sweden)

    Nigel P. Murray

    2012-01-01

    Full Text Available Matrix metalloproteinase-2 (MMP-2 is important in the dissemination and invasion of tumor cells and activates angiogenesis. We present an immunocytochemical study of MMP-2 expression in circulating prostate cells (CPCs, disseminated tumor cells (DTCs, and micrometastasis (mM in bone marrow of men with prostate cancer. Methods and Patients. Tumor cells were identified with anti-PSA immunocytochemistry. Positive samples underwent processing with anti-MMP-2, its expression was compared with Gleason score, concordance of expression, and metastatic and nonmetastatic disease. Results. 215 men participated, CPCs were detected in 62.7%, DTCs in 62.2%, and mM in 71.4% in nonmetastatic cancer; in metastatic cancer all had CPCs, DTCs, and mM detected. All CPCs and DTCs expressed MMP-2; in mM MMP-2 expression was positively associated with increasing Gleason score. MMP-2 expression in CPCs and DTCs showed concordance. In low grade tumors, mM and surrounding stromal cells were MMP-2 negative, with variable expression in high grade tumors; in metastatic disease, both mM and stromal cells were MMP-2 positive. Conclusions. CPCs and DTCs are different from mM, with inhibition of MMP-2 expression in mM of low grade tumors. With disease progression, MMP-2 expression increases in both mM and surrounding stromal cells, with implications for the use of bisphosphonates or MMP-2 inhibitors.

  6. Orbital metastasis: A rare manifestation of scapular bone osteosarcoma

    Directory of Open Access Journals (Sweden)

    Mohammad Taher Rajabi

    2014-01-01

    Full Text Available Purpose: To report a case of orbital metastasis from scapular bone osteosarcoma. Case Report: A 55-year-old man who was a known case of scapular bone osteosarcoma, was referred to our clinic with ocular symptoms including acute painful decreased vision, proptosis, conjunctival injection, and chemosis. He had undergone surgical excision of the original tumor and received systemic chemotherapy 4 months before. Imaging studies and incisional biopsy were performed for the orbital lesion, the histopathological examination confirmed the diagnosis of metastatic osteosarcoma. The patient was referred to the oncologist for palliative chemotherapy and further intervention; however, he deceased 2 months later due to sepsis in the context of immunosuppression. Conclusion: Metastatic involvement of the orbit due to osteosarcoma is a rare condition manifesting with orbital mass, pain, diplopia and ocular motility disturbance. Although there is no effective treatment, the combination of modalities such as chemotherapy, radiotherapy, and surgery may delay progression of the disease.

  7. Comparison of Intravenous Ketamine with Morphine in Pain Relief of Long Bones Fractures: a Double-Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Saeed Majidinejad

    2014-03-01

    Full Text Available Introduction: The selective medication for pain control in many clinical situations is morphine but its complications prevent its widespread use. Ketamine has been introduced as an alternative for morphine in some studies. However, the efficacy of its solitary use has not yet been evaluated. Therefore, the present study was undertaken to evaluate the effect of ketamine alone in relieving pain in trauma patients referring to an emergency unit. Methods: In this double-blind clinical trial, patients with long bone fractures were randomly divided into two groups of treatment with intravenous (IV morphine at a dose of 0.1 mg/kg and treatment with IV ketamine at a dose of 0.5 mg/kg. Pain severity of the patients was recorded before and 10 minutes after injection based on numeric rating scale. The means in the two groups were compared using independent t-test. Then the Kaplan-Meier curve and log rank analysis were used to evaluate the success of treatment. Results: A total of 126 patients were included in this study. The mean ages of the patients in the morphine and ketamine groups were 33.6±14.3 and 35.1±13.5 years, respectively (P=0.54. After therapeutic intervention, the pain severity significantly decreased in ketamine (2.7±1.8; P<0.0001 and morphine (2.4±1.5; P<0.0001 groups, with a similar effect of both medications on alleviating pain (P=0.28. The success rate of the treatment at 10-minute interval in groups receiving ketamine and morphine were 59 (93.65% and 61 (96.8% patients, respectively (P=0.62. Conclusion: The results of the present study showed that administration of ketamine at a low dose (0.5 mg/kg results in a significant decrease in the severity of acute pain in patients with fractures of long bones. This palliative effect is very similar to that of morphine. 

  8. Efficacy and toxicity of Samarium-153-EDTMP locally produced in the treatment of painful skeletal metastases

    International Nuclear Information System (INIS)

    Olea, E.; Quintana, J.C.; Nagel, J.; Arenas, L.; Tomicic, M.; Gil, M.C.; Araya, G.

    2001-01-01

    Samarium-153 emits medium-energy beta particles an a gamma photon with a physical half-life of 46,3 hours. When chelated to ethylenediaminetetramethylenephosphonic acid (EDTMP), it is remarkably stable in vitro and in vivo. In this study we administered randomly 0,5 and 1,0 mCi/Kg body weight (two groups), to 30 patients with painful metastatic bone cancer. Slight and spontaneously reversible myelotoxicity was observed. A bigger leukocyte and platelet suppression was obtained with 1,0 mCi/kg than 0,5 mCi/Kg dose. Pain palliation was obtained in 66% of the treated patients. Our preliminary results indicate that 153 Sm-EDTMP is a promising radiotherapeutic agent for palliative treatment of metastatic bone cancer pain where a reactor is available and at a very affordable cost. (author)

  9. The role of single nucleotide polymorphism of IL-6 and IL-10 cytokine on pain severity and pain relief after radiotherapy in multiple myeloma patients with painful bone destructions

    Directory of Open Access Journals (Sweden)

    Rudzianskiene Milda

    2014-01-01

    Full Text Available Multiple myeloma (MM cells interact with bone marrow stromal cells stimulating transcription and secretion of cytokines like IL-6 and IL-10, which are implicated in the progression and dissemination of MM. Regulation of cytokines secretion is under genetic control through genetic polymorphisms in their coding and promoter sequences. It seems that single nucleotide polymorphism (SNP in the promoter region of various genes may regulate the plasma concentrations of cytokines. Cytokines could be also hypothesized to function as pain modulators as peripheral nociceptors are sensitized by cytokines. The aim was to determine if the SNP of IL-6 and IL-10 cytokines could influence the analgesic response of radiotherapy in the treatment of painful bone destructions in MM patients. 30 patients (19 women and 11 men, median age: 67 years with MM and painful bone destructions were treated with palliative radiotherapy. Pain was evaluated according to the visual analogue scale and analgesics intake. Pain scores and analgesics use were measured prior to radiotherapy as well as 4, 12 and 24 weeks afterward. Opioid analgesics were converted to the morphine-equivalent daily dose (MEDD. Genomic DNA was extracted from peripheral blood leukocytes and IL-6 and IL-10 gene promoter polymorphisms were analysed with polymerase chain reaction. 60% of patients reported severe pain prior to radiotherapy, which decreased to 13% at the first follow-up visit (p <0.001. The MEDD on admission to the hospital was 75 mg/day which decreased to 46 mg/day at the first follow-up visit (p = 0.033. A significant parameter in pain relief was: age < 65 years (p=0.029. We analysed 6 SNPs in the gene promoter region of IL-6 (-597 G/A, -572 G/C, -174 G/C and IL-10 (-592 A/C, -819 C/T, -1082 A/G as well as their relation with pain severity and analgesic consumption. Patients who are IL-10 -1082 A/G carriers are prone to respond better to radiotherapy than other patients (p<0.05. A borderline

  10. Radiation therapy of osteolytic bone metastases

    International Nuclear Information System (INIS)

    Weber, W.; Roesler, H.P.; Doll, G.; Dostert, M.; Kutzner, J.; Schild, H.

    1992-01-01

    Percutaneous radiotherapy is the most effective modality for treatment of metastatic bone cancer. Local irradiation improves overall quality of life by relieving pain in most patients. It also helps preventing complications as pathological fractures in lytic bone lesions by new bone formation. In a retrospective study on 100 patients, irradiated for lytic bone metastases, the radiotherapeutic effect on alleviation of pain and on recalcification rate was investigated. In our experience in 84% of the cases pain and disability associated with bone metastases could be decreased. 38% of the patients had complete relief of symptoms. A correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 67% of all irradiated skeletal areas (n=137) (recalcification rate in breast cancer 77%, in bronchial carcinoma 27%, and in renal cell carcinoma 25%). After a total dose of 30 Gy reduction of the metastases-associated pain was achieved in 81% of the cases and remineralization was observed in 70% of the cases. (orig.) [de

  11. Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases.

    Science.gov (United States)

    Yi, Yu Ri; Lee, Na Rea; Kwon, Young Suk; Jang, Ji Su; Lim, So Young

    2016-01-01

    Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases.

  12. Preparation, Biological Evaluation and Dosimetry Studies of 175Yb-Bis-Phosphonates for Palliative Treatment of Bone Pain

    Directory of Open Access Journals (Sweden)

    Ashraf Fakhari

    2015-10-01

    Full Text Available Objective: Optimized production and quality control of ytterbium-175 (Yb-175 labeled pamidronate and alendronate complexes as efficient agents for bone pain palliation has been presented. Methods: Yb-175 labeled pamidronate and alendronate (175Yb-PMD and 175Yb-ALN complexes were prepared successfully at optimized conditions with acceptable radiochemical purity, stability and significant hydroxyapatite absorption. The biodistribution of complexes were evaluated up to 48 h, which demonstrated significant bone uptake ratios for 175Yb-PAM at all-time intervals. It was also detected that 175Yb-PAM mostly washed out and excreted through the kidneys. Results: The performance of 175Yb-PAM in an animal model was better or comparable to other 175Yb-bone seeking complexes previously reported. Conclusion: Based on calculations, the total body dose for 175Yb-ALN is 40% higher as compared to 175Yb-PAM (especially kidneys indicating that 175Yb-PAM is probably a safer agent than 175Yb-ALN.

  13. Usefulness of asymmetry score on quantitative three-phase bone scintigraphy in the evaluation of complex regional pain syndrome

    International Nuclear Information System (INIS)

    Sampath, Santhosh; Mittal, Bhagwant Rai; Arun, Sasikumar; Sood, Ashwani; Bhattacharya, Anish; Sharma, Aman

    2013-01-01

    Complex regional pain syndrome (CRPS) is primarily a clinical diagnosis. Diagnostic imaging in CRPS can be used, especially to exclude other disorders. The sensitivity and specificity of three phase bone scintigraphy (TPBS) for the diagnosis of CRPS is variable throughout the literature. To establish a simple and effective quantitative approach to help in the diagnosis of CRPS by TPBS. TPBS done in patients (n = 68) with suspected CRPS was analyzed retrospectively. They were classified into bone scan positive group (BSP), bone scan negative group (BSN) and non-CRPS group based on diffusely increased periarticular uptake, symmetrical uptake, and focal uptake respectively. Asymmetry score (AS) was also measured between the affected and unaffected side. 16 patients showed focal uptake, 37 were in BSP group with mean AS score of 1.57 ± 0.5 and 15 were in BSN group with mean AS score of 1.01 ± 0.05. The mean AS was significantly different (P < 0.0001). AS of 1.06 had sensitivity and specificity of 96.43% and 100% respectively (P = 0.0001). There was a trend of negative correlation between the AS and the duration, r = −0.21; however, it was not statistically significant (P = 0.28). TPBS should be considered in the evaluation of CRPS to rule out patients who have focal involvement, not diagnostic of CRPS (~24% in this study). Quantitative AS of 1.06 can be included to support visual interpretation in the delayed phase

  14. Human bone marrow-derived and umbilical cord-derived mesenchymal stem cells for alleviating neuropathic pain in a spinal cord injury model

    OpenAIRE

    Yousefifard, Mahmoud; Nasirinezhad, Farinaz; Shardi Manaheji, Homa; Janzadeh, Atousa; Hosseini, Mostafa; Keshavarz, Mansoor

    2016-01-01

    Background Stem cell therapy can be used for alleviating the neuropathic pain induced by spinal cord injuries (SCIs). However, survival and differentiation of stem cells following their transplantation vary depending on the host and intrinsic factors of the cell. Therefore, the present study aimed to determine the effect of stem cells derived from bone marrow (BM-MSC) and umbilical cord (UC-MSC) on neuropathic pain relief. Methods A compression model was used to induce SCI in a rat model. A w...

  15. Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Grupo Oncológico Cooperativo del Sur.

    Science.gov (United States)

    Perez, J E; Machiavelli, M; Leone, B A; Romero, A; Rabinovich, M G; Vallejo, C T; Bianco, A; Rodriguez, R; Cuevas, M A; Alvarez, L A

    1990-08-01

    The medical records of 510 patients with metastatic breast cancer were retrospectively reviewed. Seventy-seven patients with metastases confined to skeleton and 73 patients bearing visceral-only disease were identified. All patients had a disease-free interval greater than or equal to 6 months and received systemic therapy with any of the following modalities: chemotherapy, hormonotherapy, or chemohormonotherapy. The clinical features, response to treatment, and survival were analyzed and compared for both groups. Median survival of patients with osseous metastases was 28 months, while it was 13 months for those patients with a visceral pattern (p less than 0.001). Response rates to first and second line systemic therapy for both metastatic patterns showed no significant differences, suggesting a similar degree of sensitivity or resistance in both groups. Objective regression to first therapy was 45% in the group with bony disease and 41% among patients with visceral involvement; median duration of response was 16 months and 13 months, respectively. In both groups progressive disease conserved the original metastatic pattern in most patients. We conclude that although a superiority in survival was evident for the osseous metastatic pattern, for these patients efforts should be made to select the least aggressive therapy in order to avoid excessive toxicity. Further studies are needed to confirm our findings.

  16. Metastatic chondroblastoma

    Directory of Open Access Journals (Sweden)

    Errol U. Hutagalung

    2001-03-01

    Full Text Available A case of chondroblastoma, which is a benign tumor of the bone, with distant metastases to the lung and abdominal wall is reported. The clinical course of the disease was progressive like that of malignant process. (Med J Indones 2001; 10:57-9Keywords : chondroblastoma, bone tumor

  17. Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy Avaliação retrospectiva do tratamento da dor óssea metastática com Samário-153-EDTMP

    Directory of Open Access Journals (Sweden)

    Marcelo Tatit Sapienza

    2004-01-01

    Full Text Available PURPOSE: The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment. METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10 before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data. RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%, with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%, 10 (14%, and 7 (10% patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer. Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4. CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures.OBJETIVO: O presente trabalho teve por objetivo avaliar o efeito paliativo da dor e a toxicidade medular associados ao tratamento com Samário-153-EDTMP em pacientes com metástases ósseas. MÉTODOS: O estudo foi realizado de forma retrospectiva, a partir do levantamento de prontuário de 178 pacientes submetidos a tratamento com 1mCi/kg de 153Sm

  18. Multispecies animal investigation on biodistribution, pharmacokinetics and toxicity of 177Lu-EDTMP, a potential bone pain palliation agent

    International Nuclear Information System (INIS)

    Mathe, Domokos; Balogh, Lajos; Polyak, Andras; Kiraly, Reka; Marian, Terez; Pawlak, Dariusz; Zaknun, John J.; Pillai, Maroor R.A.; Janoki, Gyozo A.

    2010-01-01

    Introduction: Radionuclide therapy (RNT) is an effective method for bone pain palliation in patients suffering from bone metastasis. Due to the long half-life, easy production and relatively low β- energy, 177 Lu [T 1/2 =6.73 days, E βmax =497 keV, E γ =113 keV (6.4%), 208 keV (11%)]-based radiopharmaceuticals offer logistical advantage for wider use. This paper reports the results of a multispecies biodistribution and toxicity studies of 177 Lu-EDTMP to collect preclinical data for starting human clinical trials. Methods: 177 Lu-EDTMP with radiochemical purity greater than 99% was formulated by using a lyophilized kit of EDTMP (35 mg of EDTMP, 5.72 g of CaO and 14.1 mg of NaOH). Biodistribution studies were conducted in mice and rabbits. Small animal imaging was performed using NanoSPECT/CT (Mediso, Ltd., Hungary) and digital autoradiography. Gamma camera imaging was done in rabbits and dogs. Four levels of activity (9.25 through 37 MBq/kg body weight) of 177 Lu-EDTMP were injected in four groups of three dogs each to study the toxicological effects. Results: 177 Lu-EDTMP accumulated almost exclusively in the skeletal system (peak ca. 41% of the injected activity in bone with terminal elimination half-life of 2130 and 1870 h in mice and rabbits, respectively) with a peak uptake during 1-3 h. Excretion of the radiopharmaceutical was through the urinary system. Imaging studies showed that all species (mouse, rat, rabbit and dog) take up the compound in regions of remodeling bone, while kidney retention is not visible after 1 day postinjection (pi). In dogs, the highest applied activity (37 MBq/kg body weight) led to a moderate decrease in platelet concentration (mean, 160 g/L) at 1 week pi with no toxicity. Conclusion: The protracted effective half-life of 177 Lu-EDTMP in bone supports that modifying the EDTMP molecule by introducing 177 Lu does not alter its biological behaviour as a specific bone-seeking tracer. Species-specific pharmacokinetic behavior

  19. Multispecies animal investigation on biodistribution, pharmacokinetics and toxicity of {sup 177}Lu-EDTMP, a potential bone pain palliation agent

    Energy Technology Data Exchange (ETDEWEB)

    Mathe, Domokos [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary)], E-mail: mdomokos@hp.osski.hu; Balogh, Lajos; Polyak, Andras; Kiraly, Reka [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary); Marian, Terez [Institute of Nuclear Medicine, Debrecen University, Debrecen (Hungary); Pawlak, Dariusz [Institute of Atomic Energy, Radioisotope Centre POLATOM, Swierk-Otwock (Poland); Zaknun, John J.; Pillai, Maroor R.A. [International Atomic Energy Agency (IAEA), Vienna (Austria); Janoki, Gyozo A. [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary)

    2010-02-15

    Introduction: Radionuclide therapy (RNT) is an effective method for bone pain palliation in patients suffering from bone metastasis. Due to the long half-life, easy production and relatively low {beta}- energy, {sup 177}Lu [T{sub 1/2}=6.73 days, E{sub {beta}}{sub max}=497 keV, E{sub {gamma}}=113 keV (6.4%), 208 keV (11%)]-based radiopharmaceuticals offer logistical advantage for wider use. This paper reports the results of a multispecies biodistribution and toxicity studies of {sup 177}Lu-EDTMP to collect preclinical data for starting human clinical trials. Methods: {sup 177}Lu-EDTMP with radiochemical purity greater than 99% was formulated by using a lyophilized kit of EDTMP (35 mg of EDTMP, 5.72 g of CaO and 14.1 mg of NaOH). Biodistribution studies were conducted in mice and rabbits. Small animal imaging was performed using NanoSPECT/CT (Mediso, Ltd., Hungary) and digital autoradiography. Gamma camera imaging was done in rabbits and dogs. Four levels of activity (9.25 through 37 MBq/kg body weight) of {sup 177}Lu-EDTMP were injected in four groups of three dogs each to study the toxicological effects. Results: {sup 177}Lu-EDTMP accumulated almost exclusively in the skeletal system (peak ca. 41% of the injected activity in bone with terminal elimination half-life of 2130 and 1870 h in mice and rabbits, respectively) with a peak uptake during 1-3 h. Excretion of the radiopharmaceutical was through the urinary system. Imaging studies showed that all species (mouse, rat, rabbit and dog) take up the compound in regions of remodeling bone, while kidney retention is not visible after 1 day postinjection (pi). In dogs, the highest applied activity (37 MBq/kg body weight) led to a moderate decrease in platelet concentration (mean, 160 g/L) at 1 week pi with no toxicity. Conclusion: The protracted effective half-life of {sup 177}Lu-EDTMP in bone supports that modifying the EDTMP molecule by introducing {sup 177}Lu does not alter its biological behaviour as a specific bone

  20. Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

    International Nuclear Information System (INIS)

    Arcangeli, Giorgio; Giovinazzo, Giuseppe; Saracino, Biancamaria; D'Angelo, Luciano; Giannarelli, Diana; Arcangeli, Giancarlo; Micheli, Adriana

    1998-01-01

    Purpose: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites. Methods and Materials: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: (1) Conventional fractionation: 40-46 Gy/20-23 fractions in 5-5.5 weeks; (2) Short course: 30-36 Gy/10-12 fractions in 2-2.3 weeks; (3) Fast course: 8-28 Gy/1-4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score ≤ 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively. Results: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast (p = 0.04) and in prostate metastases (p 0.002), respectively. A significant difference in pain relief was detected among

  1. Cancer Pain Physiology

    DEFF Research Database (Denmark)

    Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

    2014-01-01

    Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells....... This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined...... to the mouse femur. This model prompted related approaches and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer induced bone pain results in progressive bone destruction, elevated osteoclast activity...

  2. Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain: A Study Supported by Differential Diagnostic Local Anesthetic Blocks.

    Science.gov (United States)

    Jain, Anuj; Jain, Suruchi; Agarwal, Anil; Gambhir, Sanjay; Shamshery, Chetna; Agarwal, Amita

    2015-12-01

    Conventional radiologic modalities provide details only about the anatomic aspect of the various structures of the spine. Frequently the structures that show abnormal morphology may not be the cause of low back pain (LBP). Functional imaging in the form of bone scan along with single photon emission computerized tomography (SPECT/CT) may be helpful in identifying structures causing pain, whether morphologically normal or not. The objective of this study is to evaluate the role of bone scan with SPECT/CT in management of patients with LBP. This is randomized double-blinded controlled study performed on 80 patients with LBP aged 20 to 80 years, ASA physical status I to III. Patients were randomized into bone scan and control groups consisting of 40 patients each. On the basis of the clinical features and radiologic findings a clinical diagnosis was made. After making a clinical diagnosis, the patients in bone scan group were subjected to bone scan with SPECT/CT. On the basis of the finding of the bone scan and SPECT/CT, a new working diagnosis was made and intervention was performed according to the new working diagnosis. Diagnostic blocks in the control group were given based on clinical diagnosis. Controlled comparative diagnostic blocks were performed with local anesthetic. The pain score just after the diagnostic block and at the time of discharge (approximately 4 h later) was recorded; the pain relief was recorded in percentage. In both the groups, sacroilitis was the most common diagnosis followed by facet joint arthropathy. The number of patients obtaining pain relief of >50% was significantly higher in the bone scan-positive group as compared with the control group. Three new clinical conditions were identified in the bone scan group. These conditions were multiple myeloma, avascular necrosis of the femoral head, and ankylosing spondylitis. Bone scan with SPECT/CT was found to complement the clinical workup of patients with LBP. Inclusion of bone scan with

  3. Comparison of [68Ga]Ga-PSMA-11 PET/CT with [18F]NaF PET/CT in the evaluation of bone metastases in metastatic prostate cancer patients prior to radionuclide therapy.

    Science.gov (United States)

    Uprimny, Christian; Svirydenka, Anna; Fritz, Josef; Kroiss, Alexander Stephan; Nilica, Bernhard; Decristoforo, Clemens; Haubner, Roland; von Guggenberg, Elisabeth; Buxbaum, Sabine; Horninger, Wolfgang; Virgolini, Irene Johanna

    2018-05-16

    The purpose of this study was to investigate the diagnostic performance of 68 Ga-PSMA-11 PET/CT in the evaluation of bone metastases in metastatic prostate cancer (PC) patients scheduled for radionuclide therapy in comparison to [ 18 F]sodium fluoride ( 18 F-NaF) PET/CT. Sixteen metastatic PC patients with known skeletal metastases, who underwent both 68 Ga-PSMA-11 PET/CT and 18 F-NaF PET/CT for assessment of metastatic burden prior to radionuclide therapy, were analysed retrospectively. The performance of both tracers was calculated on a lesion-based comparison. Intensity of tracer accumulation of pathologic bone lesions on 18 F-NaF PET and 68 Ga-PSMA-11 PET was measured with maximum standardized uptake values (SUV max ) and compared to background activity of normal bone. In addition, SUV max values of PET-positive bone lesions were analysed with respect to morphologic characteristics on CT. Bone metastases were either confirmed by CT or follow-up PET scan. In contrast to 468 PET-positive lesions suggestive of bone metastases on 18 F-NaF PET, only 351 of the lesions were also judged positive on 68 Ga-PSMA-11 PET (75.0%). Intensity of tracer accumulation of pathologic skeletal lesions was significantly higher on 18 F-NaF PET compared to 68 Ga-PSMA-11 PET, showing a median SUV max of 27.0 and 6.0, respectively (p PET, with a median SUV max of 1.0 in comparison to 2.7 on 18 F-NaF PET; however, tumour to background ratio was significantly higher on 18 F-NaF PET (9.8 versus 5.9 on 68 Ga-PSMA-11 PET; p = 0.042). Based on morphologic lesion characterisation on CT, 18 F-NaF PET revealed median SUV max values of 23.6 for osteosclerotic, 35.0 for osteolytic, and 19.0 for lesions not visible on CT, whereas on 68 Ga-PSMA-11 PET median SUV max values of 5.0 in osteosclerotic, 29.5 in osteolytic, and 7.5 in lesions not seen on CT were measured. Intensity of tracer accumulation between 18 F-NaF PET and 68 Ga-PSMA-11 PET was significantly higher in osteosclerotic (p

  4. Mice with cancer-induced bone pain show a marked decline in day/night activity

    Directory of Open Access Journals (Sweden)

    Lisa A. Majuta

    2017-10-01

    Conclusion:. Even when the tumor is confined to a single load-bearing bone, CIBP drives a significant loss of activity, which increases with disease progression. Understanding the mechanisms that drive this reduction in activity may allow the development of therapies that allow CIBP patients to better maintain their activity and functional status.

  5. Single fraction versus multiple fraction radiotherapy for palliation of painful vertebral bone metastases: A prospective study

    Directory of Open Access Journals (Sweden)

    Dipanjan Majumder

    2012-01-01

    Conclusions: Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

  6. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain of metastasis in the patient with advanced urachal carcinoma

    International Nuclear Information System (INIS)

    Arakawa, Yasuhiro; Inoue, Daisuke; Sakuyama, Toshikazu; Nagasaki, Eijiro; Aiba, Keisuke

    2011-01-01

    We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time. (author)

  7. Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study

    DEFF Research Database (Denmark)

    Albert, HB; Manniche, C; Sørensen, JS

    2008-01-01

    OBJECTIVE: The aim of this study was to assess the clinical effect of antibiotic treatment in a cohort of patients with low-back pain (LBP) and Modic changes Type 1 (bone oedema) following a lumbar herniated disc. DESIGN: This was a prospective uncontrolled trial of 32 LBP patients who had Modic...... and LBP at 14 months follow-up (n = 37) were invited to participate in this subsequent antibiotic trial but five did not meet the inclusion criteria. RESULTS: 29 patients completed the treatment, as three patients dropped out due to severe diarrhoea. At the end of treatment and at long-term follow...... changes and were treated with Amoxicillin-clavulanate (500 mg/125 mg) 3 x day for 90 days. All patients had previously participated in a randomised controlled trial (RCT) that investigated active conservative treatment for a lumbar herniated disc (n = 166). All patients in that RCT who had Modic changes...

  8. Unusual metastatic localizations of differentiated thyroid carcinoma

    International Nuclear Information System (INIS)

    Ben Rais, N.; Ghfir, I.

    2007-01-01

    Full text: Introduction: The majority of thyroid cancers have a slow evolution, a more often loco-regional extension, and a good forecast. Remote metastases, when they exist, generally touch the osseous skeleton and/or pulmonary tissue. However, unusual metastatic localizations much more exceptional are possible. The authors report through these work five cases of atypical metastasis of differentiated thyroid carcinoma followed in Nuclear Medicine department of Ibn Sina hospital in Rabat under the directives of Professor N Ben Rais. Materials and methods: Our five patients had initially undergone a total thyroidectomy for differentiated thyroid carcinoma histologically confirmed. They had profited 4 weeks after the surgical gesture from a reference isotopic exploration (131 Iodine whole body scan and thyroglobulin dosage). The paraclinic assessment was supplemented by a computed tomography (CT). Results: Revealing symptomatology in the first 69 year old patient was dominated by blindness associated with an elective up-take of radioactive 131-Iodine on the level of hypophyseal gland extending to the sphenoid bone. The second 55 year old patient reported right basithoracic pains resisting to the usual antalgic treatment with a bulky mass driving back the kidney right to the bottom at CT with and important up-take 131-Iodine at whole body scan; a surrenalectomy was thus carried out with conservation of the kidney. The three other patients presented at the clinical examination dermohypodermic nodular lesions of various localizations whose anatomopathologic study had confirmed their thyroid metastatic origin. In the 5 patients the rate of thyroglobulin was considerably high. An activity of 3,7 GBq 131-Iodine was managed with the 5 patients. The evolution was marked, in the short run, at the first patient by a recovery partial of the sight, the disappearance of pain in the second patient and a remarkable reduction of thyroglobulin level for all our patients. Conclusion

  9. Pain

    OpenAIRE

    H.W. Snyman

    1980-01-01

    The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  10. Pain

    Directory of Open Access Journals (Sweden)

    H.W. Snyman

    1980-09-01

    Full Text Available The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  11. Does transcutaneous electrical nerve stimulation (TENS) alleviate the pain experienced during bone marrow sampling in addition to standard techniques? A randomised, double-blinded, controlled trial.

    Science.gov (United States)

    Tucker, David L; Rockett, Mark; Hasan, Mehedi; Poplar, Sarah; Rule, Simon A

    2015-06-01

    Bone marrow aspiration and trephine (BMAT) biopsies remain important tests in haematology. However, the procedures can be moderately to severely painful despite standard methods of pain relief. To test the efficacy of transcutaneous electrical nerve stimulation (TENS) in alleviating the pain from BMAT in addition to standard analgesia using a numerical pain rating scale (NRS). 70 patients requiring BMAT were randomised (1:1) in a double-blind, placebo-controlled trial. -35 patients received TENS impulses at a strong but comfortable amplitude (intervention group) and 35 patients received TENS impulses just above the sensory threshold (control group) (median pulse amplitude 20 and 7 mA, respectively). Patients and operators were blinded to group allocation. Pain assessments were made using a numerical pain scale completed after the procedure. No significant difference in NRS pain recalled after the procedure was detected (median pain score 5.7 (95% CI 4.8 to 6.6) in control vs 5.6 (95% CI 4.8 to 6.4) in the intervention group). However, 100% of patients who had previous experience of BMAT and >94% of participants overall felt they benefited from using TENS and would recommend it to others for this procedure. There were no side effects from the TENS device, and it was well tolerated. TENS is a safe, non-invasive adjunct to analgesia for reducing pain during bone marrow biopsy and provides a subjective benefit to most users; however, no objective difference in pain scores was detected when using TENS in this randomised controlled study. NCT02005354. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Effect of re-irradiation for painful bone metastases on urinary markers of osteoclast activity (NCIC CTG SC.20U)

    International Nuclear Information System (INIS)

    Chow, Edward; DeAngelis, Carlo; Chen, Bingshu E.; Azad, Azar; Meyer, Ralph M.; Wilson, Carolyn; Kerba, Marc; Bezjak, Andrea; Wilson, Paula; Nabid, Abdenour; Greenland, Jonathan; Rees, Gareth; Vieth, Reinhold; Wong, Rebecca K.S.; Hoskin, Peter

    2015-01-01

    Purpose: The NCIC CTG Symptom Control.20 randomized trial (SC.20) confirmed the effectiveness of re-irradiation to painful bone metastases. This companion study correlates urinary markers of osteoclast activity with response to re-irradiation, survival and skeletal related events (SREs). Methods: Pain response was assessed using the International Consensus Endpoints. Urinary markers of bone turnover-pyridinoline (PYD), deoxypyridinoline (DPD), N-telopeptide (NTX), Alpha and Beta cross-laps of C-telopeptide (CTX)-before and 1 month after re-irradiation were correlated to response to re-irradiation and then to both, either or none of the initial and re-irradiation: frequent responders (response to both); eventual responders (response to re-irradiation only); eventual non-responders (response to initial radiation only), and absolute non-responders (no response to both). Results: Significant differences between 40 responders and 69 non-responders to re-irradiation existed for PYD (p = 0.03) and DPD (p = 0.04) at baseline. When patients were categorized as frequent responders (N = 34), eventual responders (6), eventual non-responders (59) and absolute non-responders (10), the mean values of all markers in the absolute non-responders at baseline and the follow-up were about double those for the other three groups with statistically significant difference for DPD (p = 0.03) at baseline. Absolute non-responders had the worst survival. The few occurrences of the SREs did not allow meaningful comparisons among the groups. Conclusion: There were significant differences between responders and non-responders to re-irradiation for PYD and DPD at baseline. The urinary markers in the absolute non-responders were markedly elevated at both baseline and follow-up with a statistically significant difference for DPD at baseline

  13. The inhibition of subchondral bone lesions significantly reversed the weight-bearing deficit and the overexpression of CGRP in DRG neurons, GFAP and Iba-1 in the spinal dorsal horn in the monosodium iodoacetate induced model of osteoarthritis pain.

    Directory of Open Access Journals (Sweden)

    Degang Yu

    Full Text Available Chronic pain is the most prominent and disabling symptom of osteoarthritis (OA. Clinical data suggest that subchondral bone lesions contribute to the occurrence of joint pain. The present study investigated the effect of the inhibition of subchondral bone lesions on joint pain.Osteoarthritic pain was induced by an injection of monosodium iodoacetate (MIA into the rat knee joint. Zoledronic acid (ZOL, a third generation of bisphosphonate, was used to inhibit subchondral bone lesions. Joint histomorphology was evaluated using X-ray micro computed tomography scanning and hematoxylin-eosin staining. The activity of osteoclast in subchondral bone was evaluated using tartrate-resistant acid phosphatase staining. Joint pain was evaluated using weight-bearing asymmetry, the expression of calcitonin gene-related peptide (CGRP in the dorsal root ganglion (DRG, and spinal glial activation status using glial fibrillary acidic protein (GFAP and ionized calcium binding adaptor molecule-1 (Iba-1 immunofluorescence. Afferent neurons in the DRGs that innervated the joints were identified using retrograde fluorogold labeling.MIA injections induced significant histomorphological alterations and joint pain. The inhibition of subchondral bone lesions by ZOL significantly reduced the MIA-induced weight-bearing deficit and overexpression of CGRP in DRG neurons, GFAP and Iba-1 in the spinal dorsal horn at 3 and 6 weeks after MIA injection; however, joint swelling and synovial reaction were unaffected.The inhibition of subchondral bone lesions alleviated joint pain. Subchondral bone lesions should be a key target in the management of osteoarthritic joint pain.

  14. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Directory of Open Access Journals (Sweden)

    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  15. Disseminated intravascular coagulation in a patient with metastatic prostate cancer: Fatal outcome following strontium-89 therapy

    Energy Technology Data Exchange (ETDEWEB)

    Leong, C.; McKenzie, R.; Coupland, D.B. [Univ. of British Columbia, (Canada)] [and others

    1994-10-01

    A patient with metastatic prostate cancer was found to have low-grade disseminated intravascular coagulation (DIC). He had significant bone pain despite external-beam radiotherapy and was given {sup 89}Sr with subsequent thrombocytopenia and epistaxis. The patient died from generalized hemorrhage 36 days postinjection. Although it is not possible to establish a causal relationship between {sup 89}Sr and DIC, practitioners should be alert to complications associated with the primary disorder which might occur at a time to raise concern about the intervention. 8 refs., 1 tab.

  16. The effectiveness of samarium-153 (153Sm) lexidronam (EDTMP) in treatment of bone metastases

    International Nuclear Information System (INIS)

    Ma Yubo; Huang Gang; Liu Jianjun

    2004-01-01

    Objectives: To evaluate the effectiveness of samarium-153 (153Sm) lexidronam (EDTMP) in treatment of bone metastases. Methods: 380 patients with bone metastases were studied (221 men, 159 women; average age 65.3 y; ranged 27-91 y; average weight 59.3 kg, ranged 39-95 kg). The tumor types were prostate carcinoma (n=155), pulmonary carcinoma (n=92), breast cancer (n=57), gastric carcinoma (n=12), colorectal carcinoma (n=22), nasopharyngeal carcinoma (n=8), lymphoma (n=8), hepatic carcinoma (n=6), ovary carcinoma (n=4) and others (n=16). All patients were received 135Sm-EDTMP 0.8 or 1.0 mCi/kg during 1 to 7 course of treatment. Patients and physician evaluations were used to assess pain relief. Numbers of metastatic foci and activity of ROIs were used to observe post-therapy change in bone scanning. Results: In 380 patients, pain relief was observed in 257 patients (67.6%). Persistence of pain relief was seen through 2 to 24 weeks. The mean relief time is 5.8±3.4 weeks. KPS score was higher 10% than pre-therapy (71.2%±9.6% Vs 80.9%±10.3%, p<0.001). Numbers of metastatic foci (11.2+8.8 Vs 8.4±5.7, p<0.001) and activity of ROIs (3.28±2.04 Vs 2.15±0.94, p<0.01) were less than pre-therapy. Bone marrow suppression was mild and reversible (5.87±1.56 Vs 4.94±1.16 x 109/L). Conclusions: 153Sm-EDTMP provided relief of pain associated with bone metastases and inhibition of metastatic foci. As a relief drug of painful bone metastases, 153Sm-EDTMP is safe and effective. (authors)

  17. Dosing related effects of zoledronic acid on bone markers and creatinine clearance in patients with multiple myeloma and metastatic breast cancer

    DEFF Research Database (Denmark)

    Søe, Kent; Delaissé, Jean-Marie; Jakobsen, Erik H

    2014-01-01

    phase II clinical trial we investigated the effect of Zol treatment on the serum levels of the bone markers collagen type 1 cross-linked C-telopeptide (CTX) and bone specific alkaline phosphatase (bALP) as well as on creatinine clearance (kidney function) in response to dosing and duration of treatment...

  18. Efficacy of SPECT over planar bone scan in the diagnosis of solitary vertebral lesions in patients with low back pain

    International Nuclear Information System (INIS)

    Sudhakar, Pushpalatha; Bhushan, Shanti M.; Ranadhir, G.; Prabhakar Rao, V.V.S.; Sharma, Anshu Rajnish; Narsimuhulu, G.

    2010-01-01

    The purpose of our study has been to evaluate the efficacy of single photon emission computed tomography (SPECT) over planar bone scan in identifying solitary vertebral lesions in patients with low backache and its ability to differentiate various pathologies according to the uptake pattern. Materials and Methods: The study included twenty patients out of whom six patients presented with known carcinoma and fourteen patients with low back pain. SPECT was done in all following planar skeletal survey. Benign and malignant lesions were identified according to the uptake pattern in vertebral elements, based on Gary F. Gates observations. Final diagnosis was obtained by means of biopsy or correlation with radiograph or computed tomography (CT) or magnetic resonance imaging (MRI), and/or follow up. Results: SPECT detected additional 30% of solitary vertebral lesions that were obscured on planar scan. Seven out of twenty were localized in anterior vertebral body and were diagnosed as benign ostophytes in six and osteoma in one substantiating the previous observations. Out of six cases of known carcinoma, three were having solitary metastases and showed posterior vertebral body uptake with pedicle involvement. SPECT could localize specific lesions as source of pain in eleven patients with low back pain (78%) and identified various etiologies including benign tumors (osteoid osteoma and osteoma), facet arthritis, discitis, transverse process fractures and spondylolysis. Conclusion: Our study highlighted the higher diagnostic value of SPECT over planar skeletal scintigraphy in localizing solitary vertebral lesions in low backache patients. Based on SPECT pattern, malignant and benign lesions could be differentiated in the given clinical context. (author)

  19. Costal chondrosarcoma requiring differential diagnosis from metastatic tumor.

    Science.gov (United States)

    Matsuoka, Katsunari; Ueda, Mitsuhiro; Miyamoto, Yoshihiro

    2017-02-01

    Although chondrosarcoma is a common malignant bone tumor, cases arising in the rib are relatively rare. We experienced a case of chondrosarcoma arising in the right 10th rib during follow-up after lung cancer surgery. Although the finding of an osteolytic mass suggested a metastatic bone tumor, 18F-fluorodeoxyglucose positron-emission tomography demonstrated low fluorodeoxyglucose uptake, and a primary bone tumor was suspected. The bone tumor was resected and diagnosed as chondrosarcoma. Four years after resection, there has been no recurrence or metastasis. Positron-emission tomography was useful for differential diagnosis between a chondrosarcoma and a metastatic bone tumor.

  20. Radiation therapy for metastatic spinal tumors

    International Nuclear Information System (INIS)

    Kida, Akio; Fukuda, Haruyuki; Taniguchi, Shuji; Sakai, Kazuaki

    2000-01-01

    The results of radiation therapy for metastatic spinal tumors were evaluated in terms of pain relief, improvement of neurological impairment, and survival. Between 1986 and 1995, 52 symptomatic patients with metastatic spinal tumors treated with radiation therapy were evaluated. The patients all received irradiation of megavoltage energy. Therapeutic efficacy was evaluated in terms of pain relief and improvement of neurological impairment. Pain relief was observed in 29 (61.7%) of 47 patients with pain. Therapy was effective for 17 (70.8%) of 24 patients without neurological impairment, and efficacy was detected in 12 (52.2%) of 23 patients with neurological impairment. Improvement of neurological symptoms was obtained in seven (25.0%) of 28 patients with neurological impairment. Radiation therapy was effective for pain relief in patients with metastatic spinal tumors. In patients with neurological impairment, less pain relief was observed than in those without impairment. Improvement of neurological impairment was restricted, but radiation therapy was thought to be effective in some cases in the early stage of neurological deterioration. Radiation therapy for metastatic spinal tumors contraindicated for surgery was considered effective for improvement of patients' activities of daily living. (author)

  1. Bilateral downregulation of Nav1.8 in dorsal root ganglia of rats with bone cancer pain induced by inoculation with Walker 256 breast tumor cells

    International Nuclear Information System (INIS)

    Miao, Xue-Rong; Gao, Xiao-Fei; Wu, Jing-Xiang; Lu, Zhi-Jie; Huang, Zhang-Xiang; Li, Xiao-Qing; He, Cheng; Yu, Wei-Feng

    2010-01-01

    Rapid and effective treatment of cancer-induced bone pain remains a clinical challenge and patients with bone metastasis are more likely to experience severe pain. The voltage-gated sodium channel Nav1.8 plays a critical role in many aspects of nociceptor function. Therefore, we characterized a rat model of cancer pain and investigated the potential role of Nav1.8. Adult female Wistar rats were used for the study. Cancer pain was induced by inoculation of Walker 256 breast carcinosarcoma cells into the tibia. After surgery, mechanical and thermal hyperalgesia and ambulation scores were evaluated to identify pain-related behavior. We used real-time RT-PCR to determine Nav1.8 mRNA expression in bilateral L4/L5 dorsal root ganglia (DRG) at 16-19 days after surgery. Western blotting and immunofluorescence were used to compare the expression and distribution of Nav1.8 in L4/L5 DRG between tumor-bearing and sham rats. Antisense oligodeoxynucleotides (ODNs) against Nav1.8 were administered intrathecally at 14-16 days after surgery to knock down Nav1.8 protein expression and changes in pain-related behavior were observed. Tumor-bearing rats exhibited mechanical hyperalgesia and ambulatory-evoked pain from day 7 after inoculation of Walker 256 cells. In the advanced stage of cancer pain (days 16-19 after surgery), normalized Nav1.8 mRNA levels assessed by real-time RT-PCR were significantly lower in ipsilateral L4/L5 DRG of tumor-bearing rats compared with the sham group. Western-blot showed that the total expression of Nav1.8 protein significantly decreased bilaterally in DRG of tumor-bearing rats. Furthermore, as revealed by immunofluorescence, only the expression of Nav1.8 protein in small neurons down regulated significantly in bilateral DRG of cancer pain rats. After administration of antisense ODNs against Nav1.8, Nav1.8 protein expression decreased significantly and tumor-bearing rats showed alleviated mechanical hyperalgesia and ambulatory-evoked pain. These

  2. Interventional Analgesic Management of Lung Cancer Pain.

    Science.gov (United States)

    Hochberg, Uri; Elgueta, Maria Francisca; Perez, Jordi

    2017-01-01

    Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.

  3. Low Dose I-131 MIBG therapy as an adjunct for bone pain palliation in pediatric patients with end-stage neuroblastoma: a pilot study

    International Nuclear Information System (INIS)

    Pascual, Thomas; Herbert, Anthony; Howman-Giles, Robert

    2009-01-01

    Full text: Objective: This study describes the initial experience in the use of low-dose 1-131 MIBG in patients with metastaticl refractory Neuroblastoma given at 18.5 Mbql Kg (0.5 mCi/Kg )to (1) achieve disease palliation (i.e., pain I symptom control) and improvement in the quality of life, through subjective response from patient/carers and (2) allow day-admission to minimize hospital stay providing more quality time between the patients and carers. Methods: Patients with refractory and metastatic Neuroblastoma whose primary treatment goal at that particular stage is pain palliation were given low-dose 1-131 M IBG at a dose of 18.5 Mbql Kg ( 0.5 mCil Kg)l. Assessment of subjective pain relief following 1-131 MIBG was done through interviews from hospital visits of the patient and home visits by the team. Results: Four patients underwent Low-Dose 1-131 MIBG Therapy for pain palliation between May 2007- March 2008. Median age was 5.75 years old and median total dose given was 539 Mbql patient (14.5 mCil patient). All patients at a cenain time had relief from disease pain allowing them to communicate with family and participate in physical activities not priyiledged before. Observations gathered from carersl parents revealed that the overall quality-of-life improved after the 1-131 MIBG therapy with concurrent pain medication protocol. Conclusion: This initial I pilot study described achievement of disease palliation (i.e., pain and symptom control) and improvement in the quality of life of Stage IV Neuroblastoma patients and allows day-admissions providing more quality time between the patient and the family and reduces patient anxiety.

  4. Carbenoxolone as a novel therapy for attenuation of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah

    2018-01-01

    to elucidate the underlying mechanisms using the two specific blockers 37,43Gap27 and 43Gap26. Compared with vehicle treatment, chronic systemic administration of 20 mg/kg or 40 mg/kg carbenoxolone caused a significantly later onset and attenuation of movement-evoked and on-going pain, assessed with limb use...... and weight-bearing respectively. In addition, the carbenoxolone-treated groups demonstrated a significant delay in time to reach the humane endpoint. Acute intrathecal administration of 37,43Gap27 significantly attenuated both limb use and weight-bearing, whereas 43Gap26 had a less pronounced effect...

  5. High-fat diet exacerbates pain-like behaviors and periarticular bone loss in mice with CFA-induced knee arthritis.

    Science.gov (United States)

    Loredo-Pérez, Aleyda A; Montalvo-Blanco, Carlos E; Hernández-González, Luis I; Anaya-Reyes, Maricruz; Fernández Del Valle-Laisequilla, Cecilia; Reyes-García, Juan G; Acosta-González, Rosa I; Martínez-Martínez, Arisai; Villarreal-Salcido, Jaira C; Vargas-Muñoz, Virginia M; Muñoz-Islas, Enriqueta; Ramírez-Rosas, Martha B; Jiménez-Andrade, Juan M

    2016-05-01

    Our aim was to quantify nociceptive spontaneous behaviors, knee edema, proinflammatory cytokines, bone density, and microarchitecture in high-fat diet (HFD)-fed mice with unilateral knee arthritis. ICR male mice were fed either standard diet (SD) or HFD starting at 3 weeks old. At 17 weeks, HFD and SD mice received intra-articular injections either with Complete Freund's Adjuvant (CFA) or saline into the right knee joint every 7 days for 4 weeks. Spontaneous pain-like behaviors and knee edema were assessed for 26 days. At day 26 post-first CFA injection, serum levels of IL-1β, IL-6, and RANKL were measured by ELISA, and microcomputed tomography analysis of knee joints was performed. HFD-fed mice injected with CFA showed greater spontaneous pain-like behaviors of the affected extremity as well as a decrease in the weight-bearing index compared to SD-fed mice injected with CFA. Knee edema was not significantly different between diets. HFD significantly exacerbated arthritis-induced bone loss at the distal femoral metaphysis but had no effect on femoral diaphyseal cortical bone. HFD did not modify serum levels of proinflammatory cytokines. HFD exacerbates pain-like behaviors and significantly increases the magnitude of periarticular trabecular bone loss in a murine model of unilateral arthritis. © 2016 The Obesity Society.

  6. Predictive implications of bone turnover markers after palliative treatment with 186Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

    International Nuclear Information System (INIS)

    Zafeirakis, Athanasios; Papatheodorou, Georgios; Arhontakis, Athanasios; Gouliamos, Athanasios; Vlahos, Lambros; Limouris, Georgios S.

    2010-01-01

    To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with 186 Re-1,1-hydroxyethylidene diphosphonate ( 186 Re-HEDP). Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with 186 Re-HEDP. None had received any treatment that would have interfered with bone metabolism before 186 Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment. Pain response was correlated only with pretreatment ΝΤx/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p=0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to 186 Re-HEDP treatment were a posttreatment decrease in NTx of ≥20% (RR=3.44, p=0.0005) and a pretreatment NTx/PINP ratio of ≥1.2 (RR=3.04, p=0.036) NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with 186 Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response. (orig.)

  7. Predictive implications of bone turnover markers after palliative treatment with {sup 186}Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

    Energy Technology Data Exchange (ETDEWEB)

    Zafeirakis, Athanasios [401 Army Hospital of Athens, Department of Nuclear Medicine, Athens (Greece); Papatheodorou, Georgios [401 Army Hospital of Athens, Clinical Research Unit, Athens (Greece); Arhontakis, Athanasios [401 Army Hospital of Athens, Department of Urology, Athens (Greece); Gouliamos, Athanasios; Vlahos, Lambros [Aretaieion University Hospital, Athens Medical School, Department of Radiology, Athens (Greece); Limouris, Georgios S. [Aretaieion University Hospital, Athens Medical School, Department of Nuclear Medicine, Athens (Greece)

    2010-01-15

    To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with {sup 186}Re-1,1-hydroxyethylidene diphosphonate ({sup 186}Re-HEDP). Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with {sup 186}Re-HEDP. None had received any treatment that would have interfered with bone metabolism before {sup 186}Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment. Pain response was correlated only with pretreatment {nu}{tau}x/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p=0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to {sup 186}Re-HEDP treatment were a posttreatment decrease in NTx of {>=}20% (RR=3.44, p=0.0005) and a pretreatment NTx/PINP ratio of {>=}1.2 (RR=3.04, p=0.036) NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with {sup 186}Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response. (orig.)

  8. The Effects of Bone Mineral Density and Level of Serum Vitamin-D on Pain and Quality of Life in Fibromialgia Patients - Original Investigation

    Directory of Open Access Journals (Sweden)

    Ayşegül Küçükali Türkyılmaz

    2010-12-01

    Full Text Available Aim: The purpose of this study is to determine bone mineral density (BMD and the levels of serum 25-OH-vitamin D3 in premenopausal Fibromyalgia Syndrome (FMS patients, and to examine the effect of them to the pain and quality of life in premenopausal FMS patients. Material and Methods: Premenouposal 30 patients with fibromyalgia and 30 healthy controls included the study. The demographic characteristic, serum values, vitamin D levels, bone mineral density measurements, Visual Analog Scala (VAS, Beck Depression Inventory (BDI, Short Form- 36 (SF-36 and Fibromyalgia Impact Questionery Form (FIQ were determined. Patient and control group were compared in terms of these parameters. Results: There was no significant difference of Vitamin D levels and bone mineral density between case and controls. There was no significant difference between the groups with low and high vitamin D levels in terms of VAS, FIQ, BDI in SF-36 in FMS patients. There was no significant change with regard to VAS, FIQ, BDI, and SF36 between FMS patients with high or low BMD. Conclusion: There is no difference of vitamin D levels and bone mineral density between FMS patients and control group, vitamin D levels and bone mineral density have no effect on pain and quality of life in premenopausal patients with FMS. (From the World of Osteoporosis 2010;16:53-7

  9. Comparative proteomic investigation of metastatic and non-metastatic osteosarcoma cells of human and canine origin.

    Directory of Open Access Journals (Sweden)

    Jahnabi Roy

    Full Text Available Osteosarcoma is the most common bone cancer in dogs and people. In order to improve clinical outcomes, it is necessary to identify proteins that are differentially expressed by metastatic cells. Membrane bound proteins are responsible for multiple pro-metastatic functions. Therefore characterizing the differential expression of membranous proteins between metastatic and non-metastatic clonal variants will allow the discovery of druggable targets and consequently improve treatment methodology. The objective of this investigation was to systemically identify the membrane-associated proteomics of metastatic and non-metastatic variants of human and canine origin. Two clonal variants of divergent in vivo metastatic potential from human and canine origins were used. The plasma membranes were isolated and peptide fingerprinting was used to identify differentially expressed proteins. Selected proteins were further validated using western blotting, flow cytometry, confocal microscopy and immunohistochemistry. Over 500 proteins were identified for each cell line with nearly 40% of the proteins differentially regulated. Conserved between both species, metastatic variants demonstrated significant differences in expression of membrane proteins that are responsible for pro-metastatic functions. Additionally, CD147, CD44 and vimentin were validated using various biochemical techniques. Taken together, through a comparative proteomic approach we have identified several differentially expressed cell membrane proteins that will help in the development of future therapeutics.

  10. Comparative proteomic investigation of metastatic and non-metastatic osteosarcoma cells of human and canine origin.

    Science.gov (United States)

    Roy, Jahnabi; Wycislo, Kathryn L; Pondenis, Holly; Fan, Timothy M; Das, Aditi

    2017-01-01

    Osteosarcoma is the most common bone cancer in dogs and people. In order to improve clinical outcomes, it is necessary to identify proteins that are differentially expressed by metastatic cells. Membrane bound proteins are responsible for multiple pro-metastatic functions. Therefore characterizing the differential expression of membranous proteins between metastatic and non-metastatic clonal variants will allow the discovery of druggable targets and consequently improve treatment methodology. The objective of this investigation was to systemically identify the membrane-associated proteomics of metastatic and non-metastatic variants of human and canine origin. Two clonal variants of divergent in vivo metastatic potential from human and canine origins were used. The plasma membranes were isolated and peptide fingerprinting was used to identify differentially expressed proteins. Selected proteins were further validated using western blotting, flow cytometry, confocal microscopy and immunohistochemistry. Over 500 proteins were identified for each cell line with nearly 40% of the proteins differentially regulated. Conserved between both species, metastatic variants demonstrated significant differences in expression of membrane proteins that are responsible for pro-metastatic functions. Additionally, CD147, CD44 and vimentin were validated using various biochemical techniques. Taken together, through a comparative proteomic approach we have identified several differentially expressed cell membrane proteins that will help in the development of future therapeutics.

  11. A randomized trial of nature scenery and sounds versus urban scenery and sounds to reduce pain in adults undergoing bone marrow aspirate and biopsy.

    Science.gov (United States)

    Lechtzin, Noah; Busse, Anne M; Smith, Michael T; Grossman, Stuart; Nesbit, Suzanne; Diette, Gregory B

    2010-09-01

    Bone marrow aspiration and biopsy (BMAB) is painful when performed with only local anesthetic. Our objective was to determine whether viewing nature scenes and listening to nature sounds can reduce pain during BMAB. This was a randomized, controlled clinical trial. Adult patients undergoing outpatient BMAB with only local anesthetic were assigned to use either a nature scene with accompanying nature sounds, city scene with city sounds, or standard care. The primary outcome was a visual analog scale (0-10) of pain. Prespecified secondary analyses included categorizing pain as mild and moderate to severe and using multiple logistic regression to adjust for potential confounding variables. One hundred and twenty (120) subjects were enrolled: 44 in the Nature arm, 39 in the City arm, and 37 in the Standard Care arm. The mean pain scores, which were the primary outcome, were not significantly different between the three arms. A higher proportion in the Standard Care arm had moderate-to-severe pain (pain rating ≥4) than in the Nature arm (78.4% versus 60.5%), though this was not statistically significant (p = 0.097). This difference was statistically significant after adjusting for differences in the operators who performed the procedures (odds ratio = 3.71, p = 0.02). We confirmed earlier findings showing that BMAB is poorly tolerated. While mean pain scores were not significantly different between the study arms, secondary analyses suggest that viewing a nature scene while listening to nature sounds is a safe, inexpensive method that may reduce pain during BMAB. This approach should be considered to alleviate pain during invasive procedures.

  12. Quality assurance experience with the randomized neuropathic bone pain trial (Trans-Tasman Radiation Oncology Group, 96.05)

    International Nuclear Information System (INIS)

    Roos, Daniel E.; Davis, Sidney R.; Turner, Sandra L.; O'Brien, Peter C.; Spry, Nigel A.; Burmeister, Bryan H.; Hoskin, Peter J.; Ball, David L.

    2003-01-01

    Background and purpose: Trans-Tasman Radiation Oncology Group 96.05 is a prospective randomized controlled trial comparing a single 8 Gy with 20 Gy in five fractions of radiotherapy (RT) for neuropathic pain due to bone metastases. This paper summarizes the quality assurance (QA) activities for the first 234 patients (accrual target 270). Materials and methods: Independent audits to assess compliance with eligibility/exclusion criteria and appropriateness of treatment of the index site were conducted after each cohort of approximately 45 consecutive patients. Reported serious adverse events (SAEs) in the form of cord/cauda equina compression or pathological fracture developing at the index site were investigated and presented in batches to the Independent Data Monitoring Committee. Finally, source data verification of the RT prescription page and treatment records was undertaken for each of the first 234 patients to assess compliance with the protocol. Results: Only one patient was found conclusively not to have genuine neuropathic pain, and there were no detected 'geographical misses' with RT fields. The overall rate of detected infringements for other eligibility criteria over five audits (225 patients) was 8% with a dramatic improvement after the first audit. There has at no stage been a statistically significant difference in SAEs by randomization arm. There was a 22% rate of RT protocol variations involving ten of the 14 contributing centres, although the rate of major dose violations (more than ±10% from protocol dose) was only 6% with no statistically significant difference by randomization arm (P=0.44). Conclusions: QA auditing is an essential but time-consuming component of RT trials, including those assessing palliative endpoints. Our experience confirms that all aspects should commence soon after study activation

  13. Powered bone marrow biopsy procedures produce larger core specimens, with less pain, in less time than with standard manual devices

    Directory of Open Access Journals (Sweden)

    Larry J. Miller

    2011-07-01

    Full Text Available Bone marrow sampling remains essential in the evaluation of hematopoietic and many non-hematopoietic disorders. One common limitation to these procedures is the discomfort experienced by patients. To address whether a Powered biopsy system could reduce discomfort while providing equivalent or better results, we performed a randomized trial in adult volunteers. Twenty-six subjects underwent bilateral biopsies with each device. Core samples were obtained in 66.7% of Manual insertions; 100% of Powered insertions (P=0.002. Initial mean biopsy core lengths were 11.1±4.5 mm for the Manual device; 17.0±6.8 mm for the Powered device (P<0.005. Pathology assessment for the Manual device showed a mean length of 6.1±5.6 mm, width of 1.0±0.7 mm, and volume of 11.0±10.8 mm3. Powered device measurements were mean length of 15.3±6.1 mm, width of 2.0±0.3 mm, and volume of 49.1±21.5 mm3 (P<0.001. The mean time to core ejection was 86 seconds for Manual device; 47 seconds for the Powered device (P<0.001. The mean second look overall pain score was 33.3 for the Manual device; 20.9 for the Powered (P=0.039. We conclude that the Powered biopsy device produces superior sized specimens, with less overall pain, in less time.

  14. Knee pain

    Science.gov (United States)

    ... Fracture of the kneecap or other bones. Iliotibial band syndrome . Injury to the thick band that runs from your hip to the outside ... of your knee pain. When to Contact a Medical Professional Call your provider if: You cannot bear ...

  15. Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Uemura, Akihiro; Fujimoto, Hajime; Osaka, Iwao; Yasuda, Shigeo; Goto, Nobuaki; Shinozaki, Masami; Ito, Hisao

    2001-01-01

    The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n=11), TAE followed by radiotherapy (group B, n=17), or radiotherapy alone (group C, n=11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief. (orig.)

  16. Chronic low back pain is associated with reduced vertebral bone mineral measures in community-dwelling adults

    Directory of Open Access Journals (Sweden)

    Briggs Andrew M

    2012-03-01

    Full Text Available Abstract Background Chronic low back pain (CLBP experienced in middle-age may have important implications for vertebral bone health, although this issue has not been investigated as a primary aim previously. This study investigated the associations between CLBP and dual energy X-ray absorptiometry (DXA-derived vertebral bone mineral measures acquired from postero-anterior and lateral-projections, among community-dwelling, middle-aged adults. Methods Twenty-nine adults with CLBP (11 male, 18 female and 42 adults with no history of LBP in the preceding year (17 male, 25 female were evaluated. Self-reported demographic and clinical data were collected via questionnaires. Areal bone mineral density (aBMD was measured in the lumbar spine by DXA. Apparent volumetric (ap.v BMD in the lumbar spine was also calculated. Multiple linear regression models were used to examine associations between study group (CLBP and control and vertebral DXA variables by gender, adjusting for height, mass and age. Results There was no difference between groups by gender in anthropometrics or clinical characteristics. In the CLBP group, the mean (SD duration of CLBP was 13.3 (10.4 years in males and 11.6 (9.9 years in females, with Oswestry Disability Index scores of 16.2 (8.7% and 15.4 (9.1%, respectively. Males with CLBP had significantly lower adjusted lateral-projection aBMD and lateral-projection ap.vBMD than controls at L3 with mean differences (standard error of 0.09 (0.04 g/cm2 (p = 0.03 and 0.02 (0.01 g/cm3 (p = 0.04. These multivariate models accounted for 55% and 53% of the variance in lateral-projection L3 aBMD and lateral-projection L3 ap.vBMD. Conclusions CLBP in males is associated with some lumbar vertebral BMD measures, raising important questions about the mechanism and potential clinical impact of this association.

  17. Tin-117m(4+)-DTPA for palliation of pain from osseous metastases: A pilot study

    International Nuclear Information System (INIS)

    Atkins, H.L.; Mausner, L.F.; Srivastava, S.C.

    1995-01-01

    The physical and biological attributes of 117m Sn(4+)-DTPA indicate that it should be an effective agent for palliative therapy of painful bony metastatic disease. The aim of this study was to evaluate whether or not this agent could effectively reduce pain while sparing the hemopoietic marrow from adverse effects. Fifteen patients (10 males and 5 females) with painful bony metastases from various primary cancers were included in the study. Seven patients received 1.22 to 3.11 MBq/kg of 117m Sn intravenously (Group 1) and eight patients received 4.85 to 5.77 MBq/kg (Group 2). All but one were treated as outpatients and followed for a minimum of 2 mo. In the first group, pain relief was nonassessable in four patients because of death or additional treatment of soft-tissue disease by another modality. One patient had no relief of pain, one had complete relief of pain and one had transient relief of pain. No myelotoxicity was observed. For Group 2, three patients achieved complete relief of pain, two good relief, two partial relief and one began to experience pain relief when he suffered a pathological fracture 2 mo most-treatment. None of these patients had myelotoxicity. Tin-117m(4+)-DTPA can reduce pain from metastatic disease to bone without inducing adverse reactions related to bone marrow. Further studies are needed to assess tolerance levels for the bone marrow and to evaluate response rates and duration of effect. 6 refs., 4 figs., 4 tabs

  18. Two Domains of Vimentin Are Expressed on the Surface of Lymph Node, Bone and Brain Metastatic Prostate Cancer Lines along with the Putative Stem Cell Marker Proteins CD44 and CD133

    Energy Technology Data Exchange (ETDEWEB)

    Steinmetz, Nicole F. [Case Western Reserve University, Department of Biomedical Engineering, 10900 Euclid Ave, Cleveland, OH 44106 (United States); Maurer, Jochen [Sanford-Burnham, Medical Research Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037 (United States); Sheng, Huiming [Torrey Pines Institute for Molecular Studies, Division of Immune Regulation, 3550 General Atomics Court, San Diego, CA 92121 (United States); Bensussan, Armand [INSERM U976, Hôpital Saint Louis, F-75475 Paris (France); Department of Immunology, Dermatology and Oncology, Univ Paris Diderot, Sorbonne Paris Cité, UMRS976 F-75475 Paris (France); Maricic, Igor; Kumar, Vipin [Torrey Pines Institute for Molecular Studies, Laboratory of Autoimmunity, 3550 General Atomics Court, San Diego, CA 92121 (United States); Braciak, Todd A., E-mail: tbraciak@tpims.org [Torrey Pines Institute for Molecular Studies, Division of Immune Regulation, 3550 General Atomics Court, San Diego, CA 92121 (United States)

    2011-07-13

    Vimentin was originally identified as an intermediate filament protein present only as an intracellular component in many cell types. However, this protein has now been detected on the surface of a number of different cancer cell types in a punctate distribution pattern. Increased vimentin expression has been indicated as an important step in epithelial-mesenchymal transition (EMT) required for the metastasis of prostate cancer. Here, using two vimentin-specific monoclonal antibodies (SC5 and V9 directed against the coil one rod domain and the C-terminus of the vimentin protein, respectively), we examined whether either of these domains would be displayed on the surface of three commonly studied prostate cancer cell lines isolated from different sites of metastases. Confocal analysis of LNCaP, PC3 and DU145 prostate cancer cell lines (derived from lymph node, bone or brain prostate metastases, respectively) demonstrated that both domains of vimentin are present on the surface of these metastatic cancer cell types. In addition, flow cytometric analysis revealed that vimentin expression was readily detected along with CD44 expression but only a small subpopulation of prostate cancer cells expressed vimentin and the putative stem cell marker CD133 along with CD44. Finally, Cowpea mosaic virus (CPMV) nanoparticles that target vimentin could bind and internalize into tested prostate cancer cell lines. These results demonstrate that at least two domains of vimentin are present on the surface of metastatic prostate cancer cells and suggest that vimentin could provide a useful target for nanoparticle- or antibody- cancer therapeutic agents directed against highly invasive cancer and/or stem cells.

  19. Pain and Nociception

    DEFF Research Database (Denmark)

    Falk, Sarah; Dickenson, Anthony H

    2014-01-01

    Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditiona...

  20. Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shinya; Hayashi; Hidekazu; Tanaka; Hiroaki; Hoshi

    2014-01-01

    The incidence of bone metastases(BMs)from hepatocellular carcinoma(HCC)is relatively low compared to those of other cancers,but it has increased recently,especially in Asian countries.Typically,BMs from HCC appear radiologically as osteolytic,destructive,and expansive components with large,bulky soft-tissue masses.These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth.They often compress the peripheral nerves,spinal cord,or cranial nerves,causing not only bone pain but also neuropathic pain and neurological symptoms.In patients with spinal BMs,the consequent metastatic spinal cord compression(MSCC)causes paralysis.Skull base metastases(SBMs)with cranial nerve involvement can cause neurological symptoms.Therefore,patients with bony lesions often suffer from pain or neurological symptoms that have a severe,adverse effect on the quality of life.External-beam radiotherapy(EBRT)can effectively relieve bone pain and neurological symptoms caused by BMs.However,EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies.Furthermore,the optimal dosing schedule remains unclear,despite clinical evidence to support single-fraction ra-diation schedules for primary cancers.In this review,we outline data describing palliative EBRT for BMs from HCC in the context of(1)bone pain;(2)MSCC;and(3)SBMs.

  1. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao [Shandong Provincial Hospital Affiliated to Shandong University, Department of Oncology, Jinan, Shandong Province (China); Zhang, Kaixian [Teng Zhou Central People' s Hospital Affiliated to Jining Medical College, Department of Oncology, Tengzhou, Shandong Province (China)

    2015-10-15

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  2. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    International Nuclear Information System (INIS)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao; Zhang, Kaixian

    2015-01-01

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  3. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

    Science.gov (United States)

    Côté, Pierre; van der Velde, Gabrielle; Cassidy, J David; Carroll, Linda J; Hogg-Johnson, Sheilah; Holm, Lena W; Carragee, Eugene J; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L; Guzman, Jaime; Peloso, Paul M

    2009-02-01

    Systematic review and best evidence synthesis. To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. Previous reviews of the etiology of neck pain in workers relied on cross-sectional evidence. Recently published cohorts and randomized trials warrant a re-analysis of this body of research. We systematically searched Medline for literature published from 1980-2006. Retrieved articles were reviewed for relevance. Relevant articles were critically appraised. Articles judged to have adequate internal validity were included in our best evidence synthesis. One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers.

  4. Predicting factors associated with frailty in aged patients with bone-arthrosis pain in the clinic.

    Science.gov (United States)

    Li, Bao-Lin; Li, Wei; Bi, Jia-Qi; Meng, Qing-Gang; Fei, Jian-Feng

    2016-11-01

    To identify frail and pre-frail patients in a group of patients older than 60 years. The phenotype model of Fried's method was used to identify frailty and pre-frailty in total of 78 participants. Cognitive ability and psychosocial function tests were also given to 59 of the 78 patients. Prevalence of frailty and pre-frailty was 14.1% (11/78) and 46.2% (36/78), respectively. Of the 5 phenotype variables, weak grip strength was the most commonly seen variable with 53.8% of all participants and 100% in the frail group. Low energy expenditure, however, was not self-reported by any participant in the current study (0%). Prevalence of frailty in the present study is associated with chronological age. The current study indicates that 4 phenotypic variables (unintentional weight loss, self-reported exhaustion, gait speed and grip strength) contribute to the development to frailty, and that cognitive impairment and psychosocial frailty also predict frailty or pre-frailty in the patients older than 60 years old irrespective of chronic pain or osteoarthritis. The findings of the current study suggest frailty and pre-frailty are common in senior Chinese patients with chronic diseases. Recognition and identification of frailty in a rehabilitation clinic or hospital might help physicians to provide appropriate counseling to patients and families about adverse outcomes of certain treatments such as surgery, and could optimize management of coexisting chronic diseases that might contribute to or be affected by frailty.

  5. Label-free Raman spectroscopy provides early determination and precise localization of breast cancer-colonized bone alterations.

    Science.gov (United States)

    Zhang, Chi; Winnard, Paul T; Dasari, Sidarth; Kominsky, Scott L; Doucet, Michele; Jayaraman, Swaathi; Raman, Venu; Barman, Ishan

    2018-01-21

    Breast neoplasms frequently colonize bone and induce development of osteolytic bone lesions by disrupting the homeostasis of the bone microenvironment. This degenerative process can lead to bone pain and pathological bone fracture, a major cause of cancer morbidity and diminished quality of life, which is exacerbated by our limited ability to monitor early metastatic disease in bone and assess fracture risk. Spurred by its label-free, real-time nature and its exquisite molecular specificity, we employed spontaneous Raman spectroscopy to assess and quantify early metastasis driven biochemical alterations to bone composition. As early as two weeks after intracardiac inoculations of MDA-MB-435 breast cancer cells in NOD-SCID mice, Raman spectroscopic measurements in the femur and spine revealed consistent changes in carbonate substitution, overall mineralization as well as crystallinity increase in tumor-bearing bones when compared with their normal counterparts. Our observations reveal the possibility of early stage detection of biochemical changes in the tumor-bearing bones - significantly before morphological variations are captured through radiographic diagnosis. This study paves the way for a better molecular understanding of altered bone remodeling in such metastatic niches, and for further clinical studies with the goal of establishing a non-invasive tool for early metastasis detection and prediction of pathological fracture risk in breast cancer.

  6. Relationship between knee pain and the presence, location, size and phenotype of femorotibial denuded areas of subchondral bone as visualized by MRI.

    Science.gov (United States)

    Cotofana, S; Wyman, B T; Benichou, O; Dreher, D; Nevitt, M; Gardiner, J; Wirth, W; Hitzl, W; Kwoh, C K; Eckstein, F; Frobell, R B

    2013-09-01

    Conflicting associations between imaging biomarkers and pain in knee osteoarthritis (OA) have been reported. A relation between pain and denuded areas of subchondral bone (dABs) has been suggested and this study explores this relationship further by relating the presence, phenotype, location and size of dABs to different measures of knee pain. 633 right knees from the Osteoarthritis Initiative (OAI) (250 men, age 61.7 ± 9.6 yrs, BMI 29.4 ± 4.7 kg/m(2)) were included. Manual segmentation of the femorotibial cartilage plates was performed on 3 T coronal fast low angle shot with water excitation (FLASHwe) images. dABs were defined as areas where the subchondral bone was uncovered by cartilage. The following measures of pain were used: weightbearing-, non-weightbearing-, moderate-to-severe-, infrequent- and frequent knee pain. Using pain measures from subjects without dABs as a reference, those with at least one dAB had a 1.64-fold higher prevalence ratio [PR, 95% confidence interval (CI) 1.24-2.18] to have frequent and 1.45-fold higher for moderate-to-severe knee pain (95% CI 1.13-1.85). Subjects with dABs in central subregions had a 1.53-fold increased prevalence of having weightbearing pain (95% CI 1.20-1.97), especially when the central subregion was moderately (>10%) denuded (PR 1.81, 95% CI 1.35-2.42). Individuals with cartilage-loss-type dABs had a slightly higher prevalence (PR 1.13, 95% CI 1.00-1.27) of having frequent knee pain compared to individuals with intra-chondral-osteophyte-type dABs. This study supports a positive relation between femorotibial dABs and knee pain, especially when the dABs are located centrally (i.e., in weightbearing regions) or when the respective central subregion is moderately denuded. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  7. Neck Pain

    Science.gov (United States)

    ... Vomiting Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath ... worse or doesn’t get better. Start OverDiagnosisYour pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  8. Metastatic adenocarcinoma of prostate in a 28-year-old male: The outcome is poor in young patients?

    Directory of Open Access Journals (Sweden)

    Renu Madan

    2015-01-01

    Full Text Available Prostate cancer is common in older patients. Rarity in younger population limits the study of natural history and prognosis in this population. Most of the published data has reported poor outcome in younger patients with metastatic prostate cancer. Here, we report a case of prostate cancer in 28-year-old male who presented with bone metastasis. After bilateral inguinal orchidectomy, he was started on anti-androgen therapy and received palliative radiotherapy for bone metastasis. There was only a slight decrease in prostate-specific antigen (PSA level and pelvic disease post treatment. Subsequently, he was started on opioid analgesics (by World Health Organization, WHO, step ladder in view of persistent pain. The index case is being presented for its rarity and probable poor outcome in young patients and to stress on the fact that the possibility of primary prostatic adenocarcinoma should be investigated in a male presenting with bone metastasis irrespective of the age.

  9. Lipoxins and aspirin-triggered lipoxin alleviate bone cancer pain in association with suppressing expression of spinal proinflammatory cytokines

    Directory of Open Access Journals (Sweden)

    Hu Shan

    2012-12-01

    Full Text Available Abstract Background The neuroinflammatory responses in the spinal cord following bone cancer development have been shown to play an important role in cancer-induced bone pain (CIBP. Lipoxins (LXs, endogenous lipoxygenase-derived eicosanoids, represent a unique class of lipid mediators that possess a wide spectrum of anti-inflammatory and pro-resolving actions. In this study, we investigated the effects of intrathecal injection with lipoxin and related analogues on CIBP in rats. Methods The CIBP model was induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Mechanical thresholds were determined by measuring the paw withdrawal threshold to probing with a series of calibrated von Frey filaments. Lipoxins and analogues were administered by intrathecal (i.t. or intravenous (i.v. injection. The protein level of LXA4 receptor (ALX was tested by western blot. The localization of lipoxin receptor in spinal cord was assessed by fluorescent immunohistochemistry. Real-time PCR was carried out for detecting the expression of pro-inflammatory cytokines. Results Our results demonstrated that: 1 i.t. injection with the same dose (0.3 nmol of lipoxin A4 (LXA4, lipoxin B4 (LXB4 or aspirin-triggered-15-epi-lipoxin A4 (ATL could alleviate the mechanical allodynia in CIBP on day 7 after surgery. ATL showed a longer effect than the others and the effect lasted for 6 hours. ATL administered through i.v. injection could also attenuate the allodynia in cancer rats. 2 The results from western blot indicate that there is no difference in the expression of ALX among the naive, sham or cancer groups. 3 Immunohistochemistry showed that the lipoxin receptor (ALX-like immunoreactive substance was distributed in the spinal cord, mainly co-localized with astrocytes, rarely co-localized with neurons, and never co-localized with microglia. 4 Real-time PCR analysis revealed that, compared with vehicle, i.t. injection with ATL could significantly

  10. Vertebroplasty in the treatment of back pain

    International Nuclear Information System (INIS)

    Muto, Mario; Muto, Emanuale; Izzo, Roberto; Diano, Alvaro Antonio; Lavagna, Arcangelo; Di Furia, Ugo

    2005-01-01

    Purpose: The aim of this study is to show the utility of vertebroplasty in the treatment of some types of back pain. Vertebroplasty is a venous embolisation of the vertebral body performed under computed tomography (CT) or fluoroscopy guidance with transpedicular, anterolateral, intercostovertebral or posterolateral approach with acrylic element. Materials and methods: We report our experience in 85 patients suffering from low back and thoracic pain and treated with percutaneous vertebroplasty owing to osteoporotic vertebral compression fractures, vertebral haemangiomas or secondary lytic lesions of the spine. Patient selection was performed on the basis of physical examination, magnetic resonance or less frequently, with bone scan. CT has a minor role in selected cases to evaluate the integrity of the posterior wall. We treated 55 patients affected by acute osteoporotic vertebral compression fracture, 10 patients with vertebral haemangioma and 20 patients with metastatic lesions. The patients were placed in the prone position and the procedure was performed under fluoroscopy guidance in 80 patients and under CT guidance in 5 patients affected by metastatic lesions. In no case was phlebography performed before the treatment. The approach adopted was bilateral in 45 patients and unilateral in the remaining 30 cases. Injection with a low viscosity cement was performed under fluoroscopy guidance with extreme precision in all cases. The amount of cement injected ranged from 4 ml (thoracic level) up to 12 ml (lumbar level). Results: The results were better for osteoporotic cases (95%) and patients with vertebral haemangioma (90%) than with metastatic lesions (77%), with improvement within 24-72 hours after the treatment. We noted asymptomatic cement leakage in 39 cases but only in 2 cases was there an acute radiculopathy due to epidural cement leakage, which was treated and resolved medically in 1 month. At follow-up no cases were noted of fractures of vertebral bodies

  11. Altering adsorbed proteins or cellular gene expression in bone-metastatic cancer cells affects PTHrP and Gli2 without altering cell growth

    Directory of Open Access Journals (Sweden)

    Jonathan M. Page

    2015-09-01

    Full Text Available The contents of this data in brief are related to the article titled “Matrix Rigidity Regulates the Transition of Tumor Cells to a Bone-Destructive Phenotype through Integrin β3 and TGF-β Receptor Type II”. In this DIB we will present our supplemental data investigating Integrin expression, attachment of cells to various adhesion molecules, and changes in gene expression in multiple cancer cell lines. Since the interactions of Integrins with adsorbed matrix proteins are thought to affect the ability of cancer cells to interact with their underlying substrates, we examined the expression of Integrin β1, β3, and β5 in response to matrix rigidity. We found that only Iβ3 increased with increasing substrate modulus. While it was shown that fibronectin greatly affects the expression of tumor-produced factors associated with bone destruction (parathyroid hormone-related protein, PTHrP, and Gli2, poly-l-lysine, vitronectin and type I collagen were also analyzed as potential matrix proteins. Each of the proteins was independently adsorbed on both rigid and compliant polyurethane films which were subsequently used to culture cancer cells. Poly-l-lysine, vitronectin and type I collagen all had negligible effects on PTHrP or Gli2 expression, but fibronectin was shown to have a dose dependent effect. Finally, altering the expression of Iβ3 demonstrated that it is required for tumor cells to respond to the rigidity of the matrix, but does not affect other cell growth or viability. Together these data support the data presented in our manuscript to show that the rigidity of bone drives Integrinβ3/TGF-β crosstalk, leading to increased expression of Gli2 and PTHrP.

  12. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39{+-}15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI{sup eventscan)}. Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI{sup eventscand}id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  13. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    International Nuclear Information System (INIS)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo

    2011-01-01

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39±15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI eventscan) . Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI eventscand id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  14. The impact of the opioids fentanyl and morphine on nociception and bone destruction in a murine model of bone cancer pain.

    NARCIS (Netherlands)

    ElMouedden, M.; Meert, T.F.

    2007-01-01

    Chronic pain resulting from metastasis into skeleton of certain neoplastic diseases remains poorly understood and relatively resistant to analgesic treatment. Opioids are the principal axis in drug therapy for this type of pain, especially at the end stage of cancer. Our aim was to examine whether,

  15. Prospective randomised multicenter trial on single fraction radiotherapy (8 Gyx1) versus multiple fractions (3 Gyx10) in the treatment of painful bone metastases

    International Nuclear Information System (INIS)

    Kaasa, Stein; Brenne, Elisabeth; Lund, Jo-Asmund; Fayers, Peter; Falkmer, Ursula; Holmberg, Matts; Lagerlund, Magnus; Bruland, Oivind

    2006-01-01

    Background and purpose: To investigate whether single-fraction radiotherapy is equal to multiple fractions in the treatment of painful metastases. Patients and methods: The study planned to recruit 1000 patients with painful bone metastases from four Norwegian and six Swedish hospitals. Patients were randomized to single-fraction (8 Gyx1) or multiple-fraction (3 Gyx10) radiotherapy. The primary endpoint of the study was pain relief, with fatigue and global quality of life as the secondary endpoints. Results: The data monitoring committee recommended closure of the study after 376 patients had been recruited because interim analyses indicated that, as in two other recently published trials, the treatment groups had similar outcomes. Both groups experienced similar pain relief within the first 4 months, and this was maintained throughout the 28-week follow-up. No differences were found for fatigue and global quality of life. Survival was similar in both groups, with median survival of 8-9 months. Conclusions: Single-fraction 8 Gy and multiple-fraction radiotherapy provide similar pain benefit. These results, confirming those of other studies, indicate that single-fraction 8 Gy should be standard management policy for these patients

  16. CT-guided percutaneous vertebroplasty combined with 125I-seed implantation for metastatic vertebral carcinoma involving the spinal canal: analysis of 23 cases

    International Nuclear Information System (INIS)

    Xie Xiaoxi; Lu Yinxiang; Ji Yong; Wang Xiaowei; Zhang Guodong

    2014-01-01

    Objective: To evaluate the safety and efficacy of CT-guided percutaneous vertebroplasty (PVP) combined with 125 I-seed implantation for the treatment of metastatic vertebral carcinoma involving the spinal canal. Methods: A total of 28 involved vertebrae were detected in 23 patients with metastatic vertebral carcinoma. Each patient had 1-2 diseased vertebrae. The lesions included cervical vertebra (n=4), thoracic vertebra (n=13) and lumbar vertebra (n=11). Destroyed posterior vertebral wall was seen in all involved vertebrae. Thirteen vertebrae found in 12 patients showed involvement of the epidural space. According to treatment planning system (TPS) CT-guided implantation of 125 I seeds was carried out first for cervical lesions, which was followed by PVP. For the thoracic and lumbar lesions, unilateral or bilateral puncturing with several particle needles was employed to implant the 125 I seeds, then, PVP with bone cement injection was performed. The complications and the clinical efficacy were analyzed. Results: Successful operation was obtained in all patients. The number of implanted 125 I seeds ranged from 4 to 30 per vertebra, and the volume of injected bone cement was 1-6 ml per vertebra. After the operation the pain relief rate was 86.9% (n=20). The incidence of bone cement leakage was 17.8% (5/28). One patient had radicular pain caused by neuropore leakage, which was relieved after medication. No serious complications, such as spinal cord injury or radiation myelitis, occurred. Conclusion: CT-guided PVP combined with 125 I-seed implantation is effective and safe for the treatment of metastatic vertebral carcinoma involving the spinal canal. This therapy can effectively relieve the pain and control the deterioration of tumor, besides, the incidence of bone cement leakage is very low. (authors)

  17. Metastatic breast carcinoma uncovered in an otherwise unremarkable “random colon biopsy”

    Directory of Open Access Journals (Sweden)

    Mike Black

    2016-06-01

    Full Text Available Breast cancer is one of the most devastating cancers afflicting women, being a main cause of cancer related death. Approximately 50% of these patients have developed regional or distant metastases at the time of diagnosis; hence, an early diagnosis and surgery with indicated neoadjuvant therapy are crucial in eradicating this disease and improving patient survival. A significant percentage of patients, even after initial satisfactory tumor removal, still face the threat of metastatic diseases which could plague a wide spectrum of body sites such as bones, lungs, central nervous system, liver and gastrointestinal tract (mostly upper gastrointestinal locations. Colonic and anorectal involvement by metastatic breast cancer has been less frequently reported in disseminated diseases. Typically, metastatic disease presents as a mass, enteric stenosis, or obstruction. Rare cases, however, may not form an endoscopically or radiologically recognizable lesion, and thus could be overlooked. Here we report a unique case of random colon biopsies in a patient presenting with epigastric pain, whose stomach biopsy showed Helicobacter pylori-associated chronic active gastritis. No colonoscopic lesion was present; however, microscopic examination of the “random biopsy” revealed scattered single and small clusters of tumor cells involving the lamina propria of the colonic mucosa, morphologically and immunophenotypically consistent with metastatic disease from breast carcinoma. The clinical presentation and histopathology of the case were reviewed and compared with limited cases reported in the literature. We conclude that high levels of suspicion and alertness are essential to identify occult microscopic gastrointestinal metastatic breast cancer in the absence of a grossly appreciable lesion.

  18. Ablation of musculoskeletal metastases: pain palliation, fracture risk reduction, and oligometastatic disease.

    Science.gov (United States)

    Kurup, Anil Nicholas; Callstrom, Matthew R

    2013-12-01

    Thermal ablation is an effective, minimally invasive alternative to conventional therapies in the palliation of painful musculoskeletal metastases and an emerging approach to obtain local tumor control in the setting of limited metastatic disease. Various thermal ablation technologies have been applied to bone and soft tissue tumors and may be used in combination with percutaneous cement instillation for skeletal lesions with or at risk for pathologic fracture. This article reviews current practices of percutaneous ablation of musculoskeletal metastases with an emphasis on radiofrequency ablation and cryoablation of painful skeletal metastases. © 2013 Elsevier Inc. All rights reserved.

  19. Bone scintigraphic assessment of multifocal sequelae of staphylococcus aureus septicemia, a case report

    International Nuclear Information System (INIS)

    Andriamisandratsoa, N.; Yu, O.; Grucker, D.; Bole, J.C.; Weber, J.C.

    2003-01-01

    A 71-year old patient suffering from untreated non-insulin-dependent diabetes presented anti-inflammatory drug-resistant lumbalgia with referred inguinal pain either on the right or left side, corresponding to the first signs of septicemia due to staphylococcus aureus, with urinary onset. Despite specific antibiotic treatment, pulmonary, cardiac and neurological complications followed. Simultaneous investigations by MRI and bone scintigraphy performed in the remitting patient showed multiple septic metastatic localization in the soft tissues and bones. It was hence necessary to pursue the antibiotic therapy to avoid relapses. (author)

  20. Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F FDG PET/CT and 99mTc HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

    International Nuclear Information System (INIS)

    Seo, Hyo Jung; Choi, Yun Jung; Kim, Hyun Jeong; Jeong, Youg Hyu; Cho, Arthur; Lee, Jae Hoon; Yun, Mijin; Choi, Hye Jin; Lee, Jong Doo; Kang, Won Jun

    2011-01-01

    Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with of without soft tissue formation from HCC. of 4,151 patients with HCC, 263 patients had bone metastases. Eighty five patients with bone metastasis from HCC underwent contrast enhanced FDG PET/CT. Fifty four of the enrolled subjects had recent 99mT c HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUVmax) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow up studies. Forty seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft tissue formation group had more frequent bone pain (77 vs. 37%, p<0.0001), higher SUVmax (6.02 vs. 3.52, p<0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non soft tissue formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion based analysis (98 vs. 53%, p=0.0015) and in patient based analysis (100 vs. 80%, p<0.001). Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast enhanced PET/CT will be useful in finding and delineating soft tissue forming bone metastasis from HCC.

  1. Biochemical parameters of bone metabolism in bone metastases of solid tumors (Review)

    NARCIS (Netherlands)

    Meijer, Wilhelmus; van der Veer, E; Willemse, P H

    1998-01-01

    The role of biochemical markers of bone metabolism in the diagnosis and monitoring of bone metastases in solid tumors is reviewed. Emphasis is on the recently developed markers, which may provide a more accurate quantitation of bone metabolism. In metastatic bone disease,