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Jones fractures in patients with metastatic breast cancer (MBC)
ABSTRACTS / Bone 38 (2006) S65 – S87
y) decided not to have the infusion. The patients were followed to clinical healing on the basis of the radiographic healing, ultra sound examination and a subjective stability test (weight-bearing test). Results: The frame was removed after 78.5 (SD 12.6) days in the treated group compared to 91 (SD 13.4) in the non-treated group (P = 0.02). One patient in the Zometa group had a delayed union (16 weeks +5 days) compared to none in the control group. In the Zometa group 11/12 were healed before twelve weeks, at the first examination considering frame removal, compared to 5/12 (ns) in the controls. 11/12 Zometatreated patients reported an episode of flu-like symptoms after the injections. Conclusion: In this pilot study it appears that bisphosphonate treatment increases the strength of healing callus and allows a shorter fixation time during bone healing. A randomized study has been started. doi:10.1016/j.bone.2006.01.053
108 Bisphosphonate use for metastatic breast cancer – too much? too little? too late to start again? M. Vanhuyse , M.C. Gainford, W. Ooi, G. Dranitsaris, M. Clemons Division of Medical Oncology, TSRCC, Toronto, Canada Background: Randomized controlled trials (RCTs) have confirmed a significant benefit for bisphosphonate (BP) use in terms of a reduction in skeletal related events (SREs) in breast cancer patients with bony metastases. However patients selected for RCTs tend to have a better overall prognosis than non-RCT populations. The generalizability of RCT results to patients outside of the clinical trial setting is unknown. Material and methods: Between 2000– 2001, data from breast cancer patients with bony metastases who received a BP at 3 Canadian Cancer Centres were reviewed. SREs were defined as pathological bone fracture, spinal cord compression, tumor induced hypercalcaemia and surgery or radiation to bone. Proportion of SREs and other clinical outcomes were compared to treatment arms of 3 published placebo vs BP RCTs. Results: Of 190 non-RCT patients analyzed, 29.4% had bone only metastatic disease compared with 47%, 62% and 66% in RCTs. The non-RCT group also had a significantly lower fracture rate: 12.6% vs 25–36%, P < 0.05. Time to first SRE was shorter in nonRCT group: 189 days vs >367 d, 393 d and 312 d. Conclusion: The population of pts included in RCTs is probably not truly representative of the patients that we see in our daily practice. RCTs tended to include more pts with bone only disease and therefore a better overall prognosis. This in addition to the use of serial imaging that may detect asymptomatic metastases may have overestimated the magnitude of the benefits from BPs. doi:10.1016/j.bone.2006.01.054
S85
109 Jones fractures in patients with metastatic breast cancer (MBC) C. Van Poznak , P. Boland, C. Morris, M. Dickler, C. Hudis, J. Healey Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA Background: Jones fracture is an ‘‘atypical fracture’’ which involves the base of 5th metatarsal at metaphyseal-diaphyseal junction and differs from the common avulsion fracture of the styloid process. We report 2 patients with MBC without evidence of metastases at the fracture site who required surgical repair of a Jones fracture. Case histories: (1) Diagnosed with MBC at age 28, pamidronate therapy was initiated in 1999 and was changed to zoledronic acid in 2001. In 7/04 after minor trauma to her right foot she experienced a Jones fracture refractory to conservative measures with casting and non-weightbearing status. In 2/05 surgical intervention with percutaneous allograft bone grafting and internal fixation of the 5th metatarsal was performed. Bisphosphonate therapy was held postoperatively. The fracture was slow to heal but did heal by 8/05. (2) Diagnosed with MBC at age 32; pamidronate was initiated in 12/98 and bisphosphonate therapy was changed to zoledronic acid in 8/02. In 8/02 a fracture of the 5th metatarsal was diagnosed which initially responded to conservative measures but subsequently the bone became refractured and did not respond to conservative measures. In 12/03 zoledronic acid was discontinued for worsening renal function and potential interference with fracture healing. The fracture did not spontaneously heal and in 2/04 the patient underwent open reduction and internal fixation of the nonunion of the 5th metatarsal with local autograft and allograft. By 5/04 the fracture had healed. Discussion: The frequency of Jones fractures in patients with MBC is unknown. Unique to these case reports are the patients_ young age at diagnosis of MBC, the duration of intravenous bisphosphonates use and anticancer treatments which included chemotherapies and trastuzumab. doi:10.1016/j.bone.2006.01.055
110 Treating bone metastases from solid tumors with a combination of ibandronate and radiotherapy: Clinical evaluation and radiological assessment V. Vassiliou a, C. Kalogeropoulou b, Ch. Christopoulos a, E.K. Solomou b, D. Kardamakis a a Department of Radiotherapy, University of Patras Medical School, Patras, Greece b Department of Radiology, University of Patras Medical School, Patras, Greece Ibandronate is a single-nitrogen bisphosphonate with proven efficacy for the palliation of metastatic bone pain. This study
y) decided not to have the infusion. The patients were followed to clinical healing on the basis of the radiographic healing, ultra sound examination and a subjective stability test (weight-bearing test). Results: The frame was removed after 78.5 (SD 12.6) days in the treated group compared to 91 (SD 13.4) in the non-treated group (P = 0.02). One patient in the Zometa group had a delayed union (16 weeks +5 days) compared to none in the control group. In the Zometa group 11/12 were healed before twelve weeks, at the first examination considering frame removal, compared to 5/12 (ns) in the controls. 11/12 Zometatreated patients reported an episode of flu-like symptoms after the injections. Conclusion: In this pilot study it appears that bisphosphonate treatment increases the strength of healing callus and allows a shorter fixation time during bone healing. A randomized study has been started. doi:10.1016/j.bone.2006.01.053
108 Bisphosphonate use for metastatic breast cancer – too much? too little? too late to start again? M. Vanhuyse , M.C. Gainford, W. Ooi, G. Dranitsaris, M. Clemons Division of Medical Oncology, TSRCC, Toronto, Canada Background: Randomized controlled trials (RCTs) have confirmed a significant benefit for bisphosphonate (BP) use in terms of a reduction in skeletal related events (SREs) in breast cancer patients with bony metastases. However patients selected for RCTs tend to have a better overall prognosis than non-RCT populations. The generalizability of RCT results to patients outside of the clinical trial setting is unknown. Material and methods: Between 2000– 2001, data from breast cancer patients with bony metastases who received a BP at 3 Canadian Cancer Centres were reviewed. SREs were defined as pathological bone fracture, spinal cord compression, tumor induced hypercalcaemia and surgery or radiation to bone. Proportion of SREs and other clinical outcomes were compared to treatment arms of 3 published placebo vs BP RCTs. Results: Of 190 non-RCT patients analyzed, 29.4% had bone only metastatic disease compared with 47%, 62% and 66% in RCTs. The non-RCT group also had a significantly lower fracture rate: 12.6% vs 25–36%, P < 0.05. Time to first SRE was shorter in nonRCT group: 189 days vs >367 d, 393 d and 312 d. Conclusion: The population of pts included in RCTs is probably not truly representative of the patients that we see in our daily practice. RCTs tended to include more pts with bone only disease and therefore a better overall prognosis. This in addition to the use of serial imaging that may detect asymptomatic metastases may have overestimated the magnitude of the benefits from BPs. doi:10.1016/j.bone.2006.01.054
S85
109 Jones fractures in patients with metastatic breast cancer (MBC) C. Van Poznak , P. Boland, C. Morris, M. Dickler, C. Hudis, J. Healey Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA Background: Jones fracture is an ‘‘atypical fracture’’ which involves the base of 5th metatarsal at metaphyseal-diaphyseal junction and differs from the common avulsion fracture of the styloid process. We report 2 patients with MBC without evidence of metastases at the fracture site who required surgical repair of a Jones fracture. Case histories: (1) Diagnosed with MBC at age 28, pamidronate therapy was initiated in 1999 and was changed to zoledronic acid in 2001. In 7/04 after minor trauma to her right foot she experienced a Jones fracture refractory to conservative measures with casting and non-weightbearing status. In 2/05 surgical intervention with percutaneous allograft bone grafting and internal fixation of the 5th metatarsal was performed. Bisphosphonate therapy was held postoperatively. The fracture was slow to heal but did heal by 8/05. (2) Diagnosed with MBC at age 32; pamidronate was initiated in 12/98 and bisphosphonate therapy was changed to zoledronic acid in 8/02. In 8/02 a fracture of the 5th metatarsal was diagnosed which initially responded to conservative measures but subsequently the bone became refractured and did not respond to conservative measures. In 12/03 zoledronic acid was discontinued for worsening renal function and potential interference with fracture healing. The fracture did not spontaneously heal and in 2/04 the patient underwent open reduction and internal fixation of the nonunion of the 5th metatarsal with local autograft and allograft. By 5/04 the fracture had healed. Discussion: The frequency of Jones fractures in patients with MBC is unknown. Unique to these case reports are the patients_ young age at diagnosis of MBC, the duration of intravenous bisphosphonates use and anticancer treatments which included chemotherapies and trastuzumab. doi:10.1016/j.bone.2006.01.055
110 Treating bone metastases from solid tumors with a combination of ibandronate and radiotherapy: Clinical evaluation and radiological assessment V. Vassiliou a, C. Kalogeropoulou b, Ch. Christopoulos a, E.K. Solomou b, D. Kardamakis a a Department of Radiotherapy, University of Patras Medical School, Patras, Greece b Department of Radiology, University of Patras Medical School, Patras, Greece Ibandronate is a single-nitrogen bisphosphonate with proven efficacy for the palliation of metastatic bone pain. This study