Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Advanced prostate cancer is dominated by bone-forming osseous metastases. Understanding the biology behind this striking clinical manifestation is the key to its effective treatment. A clinical trial using a bone-targeting radiopharmaceutical agent, strontium 89, combined with chemotherapy showed increased survival time among patients with progression of prostate cancer in bone, suggesting that therapeutic strategies focused on treating the tumor in bone are effective. We and others thus hypothesize that interactions between prostate cancer cells and the bone microenvironment play a role in the progression of prostate cancer in bone. Clinical trials and basic science investigations aiming to understand such interactions have been carried out in parallel. In the laboratory studies, human bone marrow specimens have been collected for identification of proteins involved in the bidirectional interactions between prostate cancer cells and bone. In addition, specimens from bone biopsies of the cancer lesions have been used to generate xenografts in animals to establish animal models for testing therapeutic strategies. Clinical trials using agents to inhibit the stromal-prostate cancer interactions (e.g., docetaxel/imatinib or thalidomide) have been done. Analyses of the specimens from these trials provided support of our hypothesis and future development of diagnosis and therapy strategies.
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PMID:Understanding the biology of bone metastases: key to the effective treatment of prostate cancer. 1834 59

Bone pain associated with advanced prostate and other cancers is a frequent and significant complication. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the armamentarium for the treatment of multiple osseous metastases. The 3 radioisotopes currently approved for treatment of pain (strontium-89/(89)Sr, samarium-153/(153)Sm and rhenium-186/(186)Re) are discussed in this review including the approved dose, method of administration and indications for use.
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PMID:The use of radioisotopes for palliation of metastatic bone pain. 1855 62

Metastatic bone disease is often associated with severe pain in cancer patients, and has become an increasingly important quality-of-life issue. Radionuclides, such as strontium-89 (Sr-89), have provided effective palliation of metastatic bone pain. Although strontium follows the biochemical pathways of calcium in the body, changes in calcium homeostasis related to Sr-89 therapy have rarely been reported. We present a case of a 32-year-old male with poorly differentiated neuroendocrine carcinoma and extensive skeleton metastases who developed profound hypocalcemia after Sr-89 administration.
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PMID:Hypocalcemia associated with strontium-89 administration in a patient with diffuse bone metastases from neuroendocrine carcinoma. 1904 Dec 17

Squamous cell carcinoma of the cornea without involvement of the conjunctiva and limbus is a very rare condition. We report on a 68-year-old female patient. Lamellar keratectomy was performed combined with brachytherapy with strontium-90 for a total dose of 120 Gy (single daily dose: 10 Gy). Two months after treatment, a regression of neovascularization was noted. During 3.5 years of follow-up, no rubeosis of the iris, secondary glaucoma, or evidence of tumor recurrence was seen. There were no regional or distant metastases.
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PMID:[Squamous cell carcinoma of the "pure" cornea]. 1980 83

1. Cholesterin, whether suspended in dilute alcohol or in sodium oleate solution, when injected directly into tumors causes a marked acceleration both of the primary and of the metastatic growth. 2. The acceleration of the growth of the primary tumor by cholesterin is most evident in the premetastatic stage. 3. Lecithin, when injected in the form of an aqueous emulsion directly into tumors, diminishes the tendency to form metastases, retards the metastatic growth when it does occur, and in some instances also retards the primary growth. 4. The retardation due to lecithin is most evident in the metastatic stage. 5. Simultaneous injection of M/6 strontium chloride solution into the tumors does not appreciably affect the action of the lecithin.
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PMID:THE INFLUENCE OF LECITHIN AND CHOLESTERIN UPON THE GROWTH OF TUMORS. 1986 47

Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed.
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PMID:Systemic metabolic radiopharmaceutical therapy in the treatment of metastatic bone pain. 2011 78

Strontium-89 (Sr-89) is a pure emitter with maximum beta energy of 1.46 MeV, average beta energy of 0.58 MeV, and a physical half-life of 50.5 days. It is rapidly taken up by bone and preferentially retained at the sites of osseous metastases. Its biological half-life is >50 days at the metastatic sites, but about 14 days only in the normal bone. The dose of its absorption in the tumor-bearing bone ranges from 21 +/- 4 to 231 +/- 56 cGy/MBq, 2-25 times higher than in the normal bone. Strontium-89 therapy is an effective palliative treatment of bone metastases from prostate cancer, with analgesic effectiveness in 80%.
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PMID:[Strontium-89 for bone metastases from prostate cancer: an update]. 2036 60

While fractures at the spine, wrist and hip are regarded as classical osteoporotic fractures, all fragility fractures in the elderly should be considered as osteoporotic once pathological fracture (e.g. metastatic disease) has been excluded. The assessment of fracture risk should take account of specific risk factors in addition to bone mineral density (BMD). The WHO has produced FRAX, a well validated tool that estimates the probability of a major osteoporotic fracture in the next 10 years. The algorithm is specifically designed for primary care. After age and prior fragility fracture, BMD is the next major determinant of fracture risk. Rather than scanning all individuals with a risk factor, measurements should be targeted to those whose probability of fracture lies close to the intervention threshold where knowledge of BMD will influence management. Individuals with a low trauma vertebral fracture or low BMD for age should be investigated for underlying causes of osteoporosis. Secondary causes account for up to 40% of cases of osteoporosis in women and 60% in men. The goal of osteoporosis management is to reduce the future risk of fracture. Lifestyle modification includes measures to reduce falls risk and bone loss such as exercise, adequate dietary calcium and avoidance of smoking and excessive alcohol consumption. All patients with an osteoporotic fracture and those at high risk should be assessed for falls risk. Combined therapy, with calcium and vitamin D, has been shown to reduce hip fracture risk in the frail elderly and should be considered in all older patients who are housebound or in residential care. Alendronate and risedronate are available as once-weekly preparations with evidence for significant reductions in vertebral and non-vertebral fractures. Denosumab is approved for osteoporosis in postmenopausal women at increased risk of fractures. Strontium ranelate has been shown to reduce fracture risk significantly in postmenopausal women.
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PMID:Preventing osteoporotic fractures in older people. 2137 Jul 10

Bone metastases are a major problem in the clinical management of patients with prostate cancer. Despite the use of analgesic for the relief of such pain, the outcomes are not often satisfactory. Strontium-89 (89Sr) is a pure beta-emitting radioisotope to be avidly concentrated in the areas of high osteoblastic activity. The aim of this study was to evaluate the efficacy of 89Sr in the therapy for bone metastases of prostate carcinoma. 116 patients received intravenous injection of 89Sr at the dose of 3mCi (111MBq). All patients underwent physical examination and Karnofsky's Performance Score (KPS) evaluation before and after administration; the analgesic effects were evaluated by scores of pain. The complete response (CR) was defined as scores of pain > 75%; no response (NR) was defined as scores of pain < 25% the remaining was partial response (PR). The changes of bone metastases were screened by CT, MRI and 99mTc-MDP bone scintigraphy according to the standards of WHO. After the treatment with 89Sr, the total response rate was 80.2%. In the 116 cases, 21 cases (18.1%) displayed complete response and 72 cases (62.1%) displayed partial response, but 23 cases (19.2%) showed no response. The mean score on Karnfsky's performance status (KPS) was 20.0% higher. About 1/3 cases exhibited an obvious decrease in the number of metastases, and some foci disappeared. Thirteen cases (12%) showed a greater decrease in prostate-specific antigen (PSA) value. 89Sr chloride is an effective and safe therapy of the bone metastases from prostate cancer.
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PMID:[Preliminary application of strontium-89 for the treatment of bone metastases from prostate cancer]. 2137 74

Bone pain due to skeletal metastases constitutes the most common type of cancer-related pain. The management of bone pain remains challenging and is not standardized. In patients with multifocal osteoblastic metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. The lack of general knowledge about radiopharmaceuticals, their clinical utility and safety profiles, constitutes the major cause for their underutilization. Our goal is to review the indications, selection criteria, efficacy, and toxicities of two approved radiopharmaceuticals for bone pain palliation: strontium-89 and samarium-153. Finally, a brief review of the data on combination therapy with bisphosphonates or chemotherapy is included.
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PMID:Radiopharmaceuticals: when and how to use them to treat metastatic bone pain. 2205 89


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