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Rapid pain reduction following loading-dose ibandronate in bone metastases
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Abstracts / Bone 48 (2011) S22–S55
Recent studies suggest a negative impact of vitamin D deficiency on MM disease progression. Myeloma patients may be at risk of hypocalcemia because of subclinical vitamin D deficiency. Recognition of vitamin D deficiency is important as treatment with vitamin D can alleviate morbidity associated with hypocalcemia and hyperparathyroidism. Conflict of interest statement: None declared. doi:10.1016/j.bone.2010.10.073
P-18 Rapid pain reduction following loading-dose ibandronate in bone metastases A.A. Kurtha,*, A. Müllerb, B. Habermanna, C. Eberhardtc a Orthopaedic Surgery, University Medical Center, Mainz, Germany b Outpatient Cancer Center, Frankfurt, Germany c Orthopaedic Surgery, Klinikum, Hanau, Germany Introduction: Severe and sometimes intractable bone pain is often the first symptom of metastatic bone disease. In many cases the standard pain therapy is not sufficient and side effects are severe. Several clinical trials have demonstrated that ibandronate can cause effective and sustained relief from metastatic bone pain by standard dosage and a longer observation period. Particularly in the first weeks after diagnosis of bone metastasis it is necessary to reduce pain and prevent quality of life. Methods: 26 patients with bone pain from newly diagnosed skeletal metastases were treated with loading-dose intravenous ibandronate (6 mg infused over 1 h on 3 consecutive days). All patients were previously untreated with bisphosphonates and obtained a symptomatic pain therapy with opioids or nonsteroidal anti-inflammatory drugs. The bone pain severity was rated by the patients daily on a visual analogue scale (VAS, range: 0 (no pain) to 10 (worst pain imaginable)), within 3 weeks all patients were referred to further therapy (e.g. radiation, surgery, and chemotherapy). Results: In 23 patients loading-dose ibandronate therapy significantly reduced bone pain within the first 5 to 7 days (VAS day 0: 6.8 vs. day 7: 3.7). Only 3 patients showed no response concerning a distinct pain reduction within the first days of therapy. There was no increase in pain medication and no severe side effects during the treatment. Discussion: This clinical pilot study using an intensive high dosed ibandronate-therapy demonstrated that the loading-dose concept resulted in a remarkable reduction of metastatic bone pain within days after initiation. These findings are in concordance with earlier clinical trials evaluating a loading-dose ibandronate-therapy in other tumour types. Controlled clinical trials in a variety of tumour entities are mandatory to provide evidence based recommendations for a routine use of the concept of ibandronate loading dose. Conflict of interest statement: A. Kurth, Roche, Advisor, clinical and preclinical studies. doi:10.1016/j.bone.2010.10.074
P-19 Prospective clinical trial to evaluate the value of radiofrequence ablation and cement augmentation of spinal metastases D. Proschek, B. Habermann, M. Tonak, P. Proschek, A.A. Kurth* Department of Orthopaedic Surgery, University Medical Center, Mainz, Germany Minimal invasive interventions for spinal metastases are promising therapies. Along with thermo-ablative procedures, cement
augmentation of the tumor bearing vertebral bodies is increasingly used. Both procedures are frequently combined. To our knowledge, there is no evidence in the literature whether a combination of radiofrequence ablation and cement augmentation is of benefit for patients with spinal metastases with regard to pain reduction, improvement of quality of life and local recurrence rate. Methods: For this study, 16 female patients suffering from breast cancer and painful spinal metastases were included. RFA of the bone metastases was performed under local anaesthesia and via bipolar and impededance control. The patients were divided into two groups: one group (8 patients ) was undergoing RFA only, whereas the other group ( 8 patients) was additionally treated with cement augmentation after thermal ablation where the cavity was filled with bone cement. All techniques were CT-guided. Pain, quality of life and possible complications were evaluated. Results: Average patient age was 59.5 years. Post ablation follow up was performed for 20.4 months. Significant pain reduction could be shown for both groups (ave: 51.7%) Improvement of quality of life was achieved in both groups as well. No complications or side effects occurred. The CT guided follow-up demonstrated complete ablation of the tumor and no local recurrence rates for both groups were observed. Conclusion: RFA is an effective and safe option in the treatment of spinal metastases. Additional cement application seems to have no influence on further pain reduction, improvement of quality of life and local recurrence rate. Additional cement augmentation should therefore only be performed at tumor bearing vertebral bodies with an increased fracture risk. Conflict of interest statement: None declared. doi:10.1016/j.bone.2010.10.075
P-20 Abstract not presented doi:10.1016/j.bone.2010.10.076
P-21 Metastatic bone disease of the mandible — A case report B. Drozdzowskaa,*, A. Raczkowska-Siostrzonekb, R. Koszowskib a Dept of Pathology, Medical University of Silesia, Zabrze, Poland b Dept of Oral Surgery, Medical University of Silesia, Bytom, Poland Introduction: Breast cancer is the most common cancer in adult women in Poland. About 70% of these women have got cancerinduced bone disease which causes hypercalcemia, bone pains and fractures. Cancers are responsible also for metastatic bone disease — the bones are – after lungs and liver – the third site of metastases. Method: The authors present a case of 70-year old woman with history of breast cancer a few years ago. The patient visited her dentist because of numbness of lower left lip. Results: The patients was under oncologic control and every year she visited oncologist. No bone metastases were noted. X-ray examination recommended by dentist revealed bone resorption of root apex of 35th tooth. Biopsy from a lesion was taken. Histopathological examination revealed breast cancer metastases (Fig. 1). It was confirmed by immuhistochemical reaction showing the presence of estrogen (Fig. 2) and progesterone receptors in breast gland structures. Discussion: 40–60% women with breast cancer has got metastatic bone disease and axial skeleton is the common site of metastases. Among bones the mandible is a rare site of metastases but the most common cancer in which metastases is in the mandible is breast cancer.
Abstracts / Bone 48 (2011) S22–S55
Recent studies suggest a negative impact of vitamin D deficiency on MM disease progression. Myeloma patients may be at risk of hypocalcemia because of subclinical vitamin D deficiency. Recognition of vitamin D deficiency is important as treatment with vitamin D can alleviate morbidity associated with hypocalcemia and hyperparathyroidism. Conflict of interest statement: None declared. doi:10.1016/j.bone.2010.10.073
P-18 Rapid pain reduction following loading-dose ibandronate in bone metastases A.A. Kurtha,*, A. Müllerb, B. Habermanna, C. Eberhardtc a Orthopaedic Surgery, University Medical Center, Mainz, Germany b Outpatient Cancer Center, Frankfurt, Germany c Orthopaedic Surgery, Klinikum, Hanau, Germany Introduction: Severe and sometimes intractable bone pain is often the first symptom of metastatic bone disease. In many cases the standard pain therapy is not sufficient and side effects are severe. Several clinical trials have demonstrated that ibandronate can cause effective and sustained relief from metastatic bone pain by standard dosage and a longer observation period. Particularly in the first weeks after diagnosis of bone metastasis it is necessary to reduce pain and prevent quality of life. Methods: 26 patients with bone pain from newly diagnosed skeletal metastases were treated with loading-dose intravenous ibandronate (6 mg infused over 1 h on 3 consecutive days). All patients were previously untreated with bisphosphonates and obtained a symptomatic pain therapy with opioids or nonsteroidal anti-inflammatory drugs. The bone pain severity was rated by the patients daily on a visual analogue scale (VAS, range: 0 (no pain) to 10 (worst pain imaginable)), within 3 weeks all patients were referred to further therapy (e.g. radiation, surgery, and chemotherapy). Results: In 23 patients loading-dose ibandronate therapy significantly reduced bone pain within the first 5 to 7 days (VAS day 0: 6.8 vs. day 7: 3.7). Only 3 patients showed no response concerning a distinct pain reduction within the first days of therapy. There was no increase in pain medication and no severe side effects during the treatment. Discussion: This clinical pilot study using an intensive high dosed ibandronate-therapy demonstrated that the loading-dose concept resulted in a remarkable reduction of metastatic bone pain within days after initiation. These findings are in concordance with earlier clinical trials evaluating a loading-dose ibandronate-therapy in other tumour types. Controlled clinical trials in a variety of tumour entities are mandatory to provide evidence based recommendations for a routine use of the concept of ibandronate loading dose. Conflict of interest statement: A. Kurth, Roche, Advisor, clinical and preclinical studies. doi:10.1016/j.bone.2010.10.074
P-19 Prospective clinical trial to evaluate the value of radiofrequence ablation and cement augmentation of spinal metastases D. Proschek, B. Habermann, M. Tonak, P. Proschek, A.A. Kurth* Department of Orthopaedic Surgery, University Medical Center, Mainz, Germany Minimal invasive interventions for spinal metastases are promising therapies. Along with thermo-ablative procedures, cement
augmentation of the tumor bearing vertebral bodies is increasingly used. Both procedures are frequently combined. To our knowledge, there is no evidence in the literature whether a combination of radiofrequence ablation and cement augmentation is of benefit for patients with spinal metastases with regard to pain reduction, improvement of quality of life and local recurrence rate. Methods: For this study, 16 female patients suffering from breast cancer and painful spinal metastases were included. RFA of the bone metastases was performed under local anaesthesia and via bipolar and impededance control. The patients were divided into two groups: one group (8 patients ) was undergoing RFA only, whereas the other group ( 8 patients) was additionally treated with cement augmentation after thermal ablation where the cavity was filled with bone cement. All techniques were CT-guided. Pain, quality of life and possible complications were evaluated. Results: Average patient age was 59.5 years. Post ablation follow up was performed for 20.4 months. Significant pain reduction could be shown for both groups (ave: 51.7%) Improvement of quality of life was achieved in both groups as well. No complications or side effects occurred. The CT guided follow-up demonstrated complete ablation of the tumor and no local recurrence rates for both groups were observed. Conclusion: RFA is an effective and safe option in the treatment of spinal metastases. Additional cement application seems to have no influence on further pain reduction, improvement of quality of life and local recurrence rate. Additional cement augmentation should therefore only be performed at tumor bearing vertebral bodies with an increased fracture risk. Conflict of interest statement: None declared. doi:10.1016/j.bone.2010.10.075
P-20 Abstract not presented doi:10.1016/j.bone.2010.10.076
P-21 Metastatic bone disease of the mandible — A case report B. Drozdzowskaa,*, A. Raczkowska-Siostrzonekb, R. Koszowskib a Dept of Pathology, Medical University of Silesia, Zabrze, Poland b Dept of Oral Surgery, Medical University of Silesia, Bytom, Poland Introduction: Breast cancer is the most common cancer in adult women in Poland. About 70% of these women have got cancerinduced bone disease which causes hypercalcemia, bone pains and fractures. Cancers are responsible also for metastatic bone disease — the bones are – after lungs and liver – the third site of metastases. Method: The authors present a case of 70-year old woman with history of breast cancer a few years ago. The patient visited her dentist because of numbness of lower left lip. Results: The patients was under oncologic control and every year she visited oncologist. No bone metastases were noted. X-ray examination recommended by dentist revealed bone resorption of root apex of 35th tooth. Biopsy from a lesion was taken. Histopathological examination revealed breast cancer metastases (Fig. 1). It was confirmed by immuhistochemical reaction showing the presence of estrogen (Fig. 2) and progesterone receptors in breast gland structures. Discussion: 40–60% women with breast cancer has got metastatic bone disease and axial skeleton is the common site of metastases. Among bones the mandible is a rare site of metastases but the most common cancer in which metastases is in the mandible is breast cancer.