Abstract
The skeleton is one of the commonest sites of metastatic cancer, and skeletal metastases are associated with significant morbidity which may seriously affect the patients quality of life. There are two main reasons for wanting to detect skeletal metastases, (a) The diagnosis of a painful lesion in a patient who may or may not be known to have cancer, and (b) the staging of cancer. The latter includes both the assessment of the extent of dissemination in a patient with metastatic cancer and the assessment of a patient with apparently “early” cancer in an attempt to stage the disease before starting treatment. However, once a skeletal metastasis has been diagnosed, it is not sufficient to know only about the presence of the metastasis. There are several other questions that must be answered before the patient can be adequately treated. These include: (a) the exact site of the lesion(s); (b) the degree and site of dissemination; (c) the presence of any complications — hypercalcaemia, impending fracture, pathological fracture, spinal instability or neural compression; (d) soft-tissue involvement; and (e) the vascularity of the lesion.
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References
Adams, IE, Isherwood I (1983) Conventional and new techniques in radiological diagnosis. In: Stoll BA, Parbhoo S (eds) Bone metastasis, monitoring and treatment. Raven, New York, pp 107–148
Avrahami E, Tadmor R, Dally O, Hadar H (1989) Early MR demonstration of spinal metastases in patients with normal radiographs and CT and radionuclide bone scans. J Comput Assist Tomogr 13: 598–602
Bellamy EA, Nicholas D, Ward M, Coombes RC, Powles TJ, Husband JE (1987) Comparison of computed tomography and conventional radiology in the assess-ment of treatment response of lytic bone metastases in patients with carcinoma of the breast. Clin Radiol 38: 351–355
Bernat JL, Greenberg ER, Barrett J (1983) Suspected epidural compression of the spinal cord and cauda equina by metastatic carcinoma: clinical diagnosis and survival. Cancer 51: 1953–1957
Bertin KC, Horstman J, Coleman SS (1984) Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease. J Bone Joint Surg [Am] 66: 770–773
Best JJK, Forbes WSEC, Adams NM, Isherwood I (1979) Computed tomographic scanning and radioisotope bone scanning: a comparison. In: Gerhardt P, van Kalck G (eds) Total body computed tomography. Thieme, Stuttgart, pp 216–221
Bishop MC, Hardy JG, Taylor MC, Wastie ML, Lemberger RJ (1985) Bone imaging and serum phosphatases in prostatic carcinoma. Br J Urol 57: 317–324
Bonner JA, Lichter AS (1990) A caution about the use of MRI to diagnose spinal cord compresson. N Engl J Med 322: 556–557
Bydder GM, Brown J, Niendorf HP, Young IR (1985) Enhancement of cervical intraspinal tumours in MR imaging with intravenous gadolinium-DTPA. J Comput Assist Tomogr 9: 847–851
Carmody RF, Yang PJ, Seeley GW, Seeger JF, Unger EC, Johnson JE (1989) Spinal cord compression due to metastatic disease; diagnosis with MR imaging versus myelography. Radiology 173: 225–229
Clarke SEM (1991) Isotope therapy for bone metastases. In: Rubens R D, Fogelman I (eds) Bone metastases. Diagnosis and treatment. Springer, Berlin Heidelberg New York, pp 187–205
Coleman RE, Mashiter G, Fogelman I et al. (1988 a) Osteocalcin: a potential marker of metastatic bone disease and response to treatment. Eur J Cancer Clin Oncol 24: 1211–1217
Coleman RE, Whitaker KB, Moss DW, Mashiter G, Fogelman I, Rubens RD (1988 b) Biochemical prediction of response in bone metastases to treatment. Br J Cancer 58: 205–210
Coleman RE, Rubens RD (1987) The clinical course of bone metastases from breast cancer. Br J Cancer 55: 61–66
Cuschieri A, Jarvie R, Taylor WH, Cant E, Furnival CM, Blumgart LH (1978) Three- centre study on urinary hydroxyproline excretion in cancer of the breast. Br J Cancer 37: 1002–1005
Daffner RH, Lupetin AR, Dash N, Deeb ZL, Sefczek RJ, Schapiro RL (1986) MRI in the detection of malignant infiltration of bone marrow. AJR 146: 353–358
Diel IJ, Kaufman M, Goerner R, Costa SD, Kaul S, Bustert G (1992) Detection of tumour cells in bone marrow of patients with primary breast cancer: a prognostic factor for distant metastases. J Clin Oncol 10: 1534–1539
Edelstyn GA, Gillespie PJ, Grebbell FS (1967) The radiological demonstration of osseous metastases. Experimental observations. Clin Radiol 18: 158–162
Ell PJ, Dixon HJ, Abdullah AZ (1980) Unusual spread of juxta cortical osteosarcoma. J Nucl Med 21: 190–191
Fidler M (1981) Incidence of fracture through metastases in long bones. Acta Orthop Scand 52: 623–627
Frank J, Ling A, Patronas N, Carrasquillo J, Horvath K, Dwyer A (1989) Compari-son of magnetic resonance imaging and radionuclide bone scan in the evaluation of primary and metastatic disease in the bone. Proc ASCO 8: 7 (abstract 25)
Front D, Schneck SO, Frankel A, Robinson E (1979) Bone metastases and bone pain in breast cancer. Are they closely associated? JAMA 242: 1747–1748
Galasko CSB (1972) Skeletal metastases and mammary cancer. Ann R Coll Surg Engl 50: 3–28
Galasko CSB (1975) The significance of occult skeletal metastases, detected by skeletal scintigraphy, in patients with otherwise apparently “early” mammary carcinoma. Br J Surg 62: 694–696
Galasko CSB (1977) The mechanism of uptake of bone-seeking isotopes by skeletal metastases. In: Medical radionuclide imaging, vol 2. International Atomic Energy Agency, Vienna, pp 125–134
Galasko CSB ( 1984 a) The pathophysiological basis for skeletal scintigraphy. In: Galasko CSB, Weber DA (eds) Radionuclide scintigraphy in orthopaedics. Churchill Livingstone, Edinburgh, pp 34–49
Galasko CSB ( 1984 b) Irradiated bone. In: Galasko CSB, Weber DA (eds) Radionuclide scintigraphy in orthopaedics. Churchill Livingstone, Edinburgh, pp 210–234
Galasko CSB (1986) Skeletal metastases. Butterworths, London
Galasko CSB, Doyle FH ( 1972 a) The response to therapy of skeletal metastases from mammary cancer. Assessment by scintigraphy. Br J Surg 59: 85–88
Galasko CSB, Doyle FH ( 1972 b) The detection of skeletal metastases from mam-mary cancer. A regional comparison between radiology and scintigraphy. Clin Radiol 23: 295–297
Galasko CSB, Sylvester BS (1978) Back pain in patients treated for malignant tumours. Clin Oncol 4: 273–283
Galasko CSB, Bush H, Sutton ML (1982) Tumours of bone, cartilage and synovium. In: Hainan KE (ed) Treatment of cancer. Chapman and Hall, London, pp 623–651
Gielen F, Dequeker J, Drochmans A, Wildiers J, Merlevde M (1976) Relevance of hydroxyproline excretion to bone metastasis in breast cancer. Br J Cancer 34: 279–285
Godersky JC, Smoker WR, Knutzon R (1987) Use of magnetic resonance imaging in the evaluation of metastatic spinal disease. Neurosurgery 31: 676–680
Grainger R, Reda M, Fitzpatrick JM (1984) Calcium excretion in metastatic prostatic carcinoma. Br J Urol 56: 687–689
Hagenau C, Grosh W, Currie M, Wiley RG (1987) Comparison of spinal magnetic resonance imaging and myelography in cancer patients. J Clin Oncol 5: 1663–1669
Harris AL, Cantwell BMJ, Carmichael J, Dawes P, Robinson A, Farndon J, Wilson R (1989) Phase II study of low dose aminoglutethimide 250 mg/day plus hydro-cortisone in advanced post-menopausal breast cancer. Eur J Cancer Clin Oncol 25: 1105–1111
Hayward JL, Carbone PP, Heuson JC, Kumaoka S, Segaloff A, Rubens RD (1977) Assessment of response to therapy in advanced breast cancer. A project of the programme on clinical oncology of the International Union Against Cancer. Cancer 39: 1289–1294
Hollis PH, Malis LI, Zappulla RA (1986) Neurological deterioration after lumbar puncture below complete spinal subarachnoid block. J Neurosurg 64: 253–256
Hortobagyi GN, Libshitz HI, Seabold JE (1984) Osseous metastases of breast can-cer. Clinical, biochemial, radiographic and scintigraphic evaluation of response to therapy. Cancer 53: 577–582
Howell A, Mackintosh J, Jones M et al. (1988) The definition of the “no change” category in patients treated with endocrine therapy and chemotherapy for advanced carcinoma of the breast. Eur J Cancer Clin Oncol 24: 1567–1572
Jones AL, Williams MP, Powles TJ, Oliff JFC, Hardy JR, Cherryman G, Husband JE (1990) Magnetic resonance imaging in the detection of skeletal metastases in patients with breast cancer. Br J Cancer 62: 296–298
Kerin MJ, McAnena OJ, O’Malley VP, Grimes H, Given HF (1989) CA15-3: its relationship to clinical stage and progression to metastatic disease in breast cancer. Br J Surg 76: 838–839
Makoha FW, Britton KE (1980) Reversion of a “hot” spot to a “cold” spot in untreated metastatic bone disease - a case report. Nucl Med Commun 1: 233–238
Mansi JL, Berger U, Easton D et al. (1987) Micrometastases in bone marrow in patients with primary breast cancer: evaluation as an early predictor of bone metastases. Br Med J 295: 1093–1096
Mehta RC, Wilson MA, Perlman SB (1989) False-negative bone scan in extensive metastatic disease: CT and MR findings. J Comput Assist Tomogr 13: 717–719
Mettler FA Jr, Guiberteau MJ (1983) Essentials of nuclear medicine imaging. Grune and Stratton, Orlando, Florida
Muindi J, Coombes RC, Golding S, PowlesTJ, Khan O, Husband JE (1983) The role of computed tomography in the detection of bone metastases in breast cancer patients. Br J Radiol 56: 233–236
Niell HB, Palmieri GM, Neely CL, McDonald MW (1981) Postabsorptive urinary hydroxyproline test in patients with metastatic bone disease from breast cancer. Arch Intern Med 141: 1471–1473
Parbhoo SP (1985) Usefulness of current techniques in detecting and monitoring bone metastases from breast cancer. J R Soc Med 78 [Suppl 9]: 7–10
Powles TJ, Leese CL, Bondy PK (1975) Hydroxyproline excretion in patients with breast cancer and response to treatment. Br Med J 2: 164–166
Rafii M, Firooznia H, Golimbu C, Beranbaum E (1986) CT of skeletal metastasis. Semin Ultrasound CTMR 7: 371–379
Redmond J III, Spring DB, Munderloh SH, George CB, Mansour RP, Volk SA (1984) Spinal computed tomography scanning in the evaluation of metastatic disease. Cancer 54: 253–258
Roberts JG, Baum M (1975) Predictive value of hydroxyproline creatinine ratio in advanced breast cancer. Br Med J 2: 559
Rossleigh MA, Lovegrove FTA, Reynolds PM, Byrne MJ, Whitney BP (1984) The assessment of response to therapy of bone metastases in breast cancer. Aust NZ J Med 14: 19–22
Rubenstein M, Guinan PD, McKiel CF, Dubin A (198?) Review of acid phosphatase in the diagnosis and prognosis of prostatic cancers. Clin Physiol Biochem 6: 241–252
Stamey TA, Kabalin JN, McNeal JE et al. ( 1989 a) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatec-tomy treated patients. J Urol 141: 1076–1983
Stamey TA, Kabalin JN, Ferrari M, Yang N ( 1989 b) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. IV. Anti-androgen treated patients. J Urol 141: 1088–1090
Urwin GH, Percival RC, Yates AJP et al. (1985) Biochemical markers and skeletal metabolism in carcinoma of the prostate. Br J Urol 57: 711–714
Williams MP, Cherryman GR, Husband JE (1989) Magnetic resonance imaging in suspected metastatic spinal cord compression. Clin Radiol 40: 286–290
Winchester DP, Sener SF, Khandekar JD et al. (1979) Symptomatology as an indicator of recurrent or metastatic breast cancer. Cancer 43: 956–960
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Galasko, C.S.B. (1994). Diagnosis of Skeletal Metastases and Assessment of Response to Treatment. In: Diel, I.J., Kaufmann, M., Bastert, G. (eds) Metastatic Bone Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78596-2_8
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DOI: https://doi.org/10.1007/978-3-642-78596-2_8
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