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Query: UMLS:C0151825 (bone pain)
 3,118 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radiotherapy may be indicated for the management of bone metastases because of associated pain, fracture, or neurologic complications. For metastatic bone pain, simple low-dose radiation treatment is usually effective for local problems. When there are multiple sites of bone pain, external beam irradiation using wide-field hemibody techniques is highly effective. An alternative to this approach is the administration of radioisotopes that may localize to the sites of bone metastases, either because they are tumor specific (radioiodine for thyroid cancer) or bone seeking (radioactive phosphorus [32P] and strontium [89Sr]). The primary treatment of pathologic fracture is surgery where possible, but radiotherapy has a major role in postoperative treatment and in treatment of fractures that are inoperable either because of their site, such as a rib or pelvis, or because of the general poor condition of the patient. For neurologic complications such as spinal cord compression or nerve root compression, radiotherapy appears to be as beneficial as decompressive surgery in most situations, except where there is bony instability. The role of radiotherapy in the prophylactic setting is discussed. Prevention of pathologic fracture and spinal cord compression may be possible in high-risk patients.
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PMID:Radiotherapy in the management of bone pain. 754 90

Oncology applications in nuclear medicine include both the staging of tumors, e.g., bone scanning, and monitoring response to therapy with tumor-specific radionuclides such as 67Ga-citrate and 201Tl-chloride. An increasing role for positron emission tomography and monoclonal antibody studies in oncology is emerging, and therapeutic applications in thyroid cancer and in the treatment of metastatic bone pain are achieving impressive results. This area is likely to become the fastest growing component of nuclear medicine practice over the next decade.
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PMID:Tumor imaging and therapy. 833 72

The most commonly used radionuclides for cancer patients in Japan have been still 67Ga and 201T1 chloride. In addition to the diagnosis of lung cancer and thyroid tumor, 201T1 is recently applied to patients with brain tumor, bone and soft tissue tumor and parathynoid adenoma. Comparing to Nuclear Cardiology and Brain Nuclear Medicine, where many new radiopharmaceuticals have been developed, there are few new drugs in Nuclear Oncology. In other words, new radiopharmaceuticals are expected to be developed for the diagnosis and/or therapy of cancer. In addition to 131I for thyroid cancer, new radiopharmaceuticals such as 111In-octreotide and 99mTc(V)-DMSA have been clinically employed. In spite of strong expectation, radiolabeled monoclonal antibodies have not been clinically used in Japan. However, the technique of humanized antibodies has been established and in U.S.A., 131I-labeled antibodies are reported to be effective for the treatment of malignant lymphoma. 89Sr is useful for the relief of bone pain caused by the bone metastasis. New findings that SPECT of 18F-FDG, a positron emitter, has been revealed to have a great potential in the management of cancer patients, will give a great impact on Nuclear Oncology.
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PMID:[Current status of nuclear oncology in Japan]. 852 36

Today nuclear medicine is expected to be the most sensitive approach to measure in vivo physiology, biochemistry and metabolism. Since in most of the pathophysiological process, the alternation of the organ function occurs much earlier than morphological changes. To achieve quantitatively this measurement improvements in instrumentation (SPECT, PET) and radiopharmaceuticals are essential. Nuclear physicians and researchers in many institutions and industries are continuing to provide new radiopharmaceuticals, instruments and methodologies. Nuclear medicine is defined as topographic physiological chemistry, not anatomical orientation, marking it possible to evaluate the biochemical and physiological abnormalities at the cellular level, so that it could guide to treat the patients more effectively and predict the response to the treatments. The future developement of nuclear medicine depends on an infrastructure of physics, mathematics and chemical biology. Another important role of nuclear medicine is the application of radiopharmaceuticals emitting beta-ray for the treatment of diseases, especially malignant neoplasms. At present we have several options; thyroid cancer and thyrotoxicosis with I-131, neuroblastoma and pheochromocytoma with I-131-MIBG, and bone pain palliation in patients with bone metastases with Sr-89. The expansion of this field is crucial for nuclear medicine, and we believe this could happen more extensively than expected.
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PMID:[Future prospects for nuclear medicine]. 872 45

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.
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PMID:Strontium-89 therapy and imaging with bremsstrahlung in bone metastases. 929 93

Radionuclides used for cancer patients are produced by cyclotron or nuclear reactor. Thyroid cancer patients with lung and/or bone metastasis have been successfully treated with 131I for more than 50 years. But for the diagnosis of cancer patients, 99mTc is superior to 131I, and many 99mTc labeled compounds have been developed, such as for the diagnosis of bone metastasis, liver and kidney diseases and so on. Recently PET studies using 18F-labeled FDG have been widely performed and excellent results are reported in many cancer patients such as lung, colorectal, malignant lymphoma, malignant melanoma and so on. Radionuclides with beta emitter are suitable for the therapy of various cancers. 131I labeled anti-CD-20 monoclonal antibodies and 131I-MIBG are used for the therapy of lymphoma and pheochromocytoma, respectively. For the palliation of metastatic bone pain, 89Sr, 153Sm or 186Re is promising, because these radionuclides can be administered on an outpatients basis.
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PMID:[Progress of nuclear oncology]. 1047 78

The association between primary hyperparathyroidism and nonmedullary thyroid malignancies is well known. There is also, however, some evidence for an association between secondary hyperparathyroidism (SHPT) and thyroid cancer. We report three patients in whom invasive papillary thyroid carcinoma (PTC) was diagnosed before (one case) or at the time of (two cases) parathyroidectomy for SHPT. Three women (ages 23, 54, and 64 years) presented with bone pain and pruritus typical of SHPT. All three patients had biopsy-proven parathyroid bone disease and elevated parathormone levels (664, 1674, and 2051 pg/mL). All underwent subtotal parathyroidectomy and total thyroidectomy without complications. Pathology revealed diffuse parathyroid hyperplasia with multifocal invasive papillary thyroid carcinoma (two cases) and follicular variant of papillary thyroid carcinoma (one case). Two cases were associated with metastatic disease to local lymph nodes. The patients received adjuvant radioactive 131I, and remained tumor free 24 to 36 months after surgery with complete resolution of SHPT. We conclude: 1) PTC may accompany SHPT, 2) PTCs associated with SHPT may be locally aggressive although usually they are early tumors, 3) surgeons need to have an index of suspicion for thyroid tumor when operating on patients with SHPT, and 4) routine removal of the thymus as part of the operation for SHPT may have a secondary benefit in diagnosing PTC in the occasional patient.
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PMID:Secondary hyperparathyroidism: evidence for an association with papillary thyroid cancer. 1137 34

Skeletal metastases from thyroid cancer are poorly responsive to medical or radioiodine treatment. Bone destruction in skeletal metastases results from osteoclast-induced bone resorption. Therefore, a new approach in the therapy of bone metastases consists in using aminobisphosphonates, such as pamidronate, which are potent inhibitors of osteoclastic activity. In the present study, 10 thyroid cancer patients with painful osteolytic bone metastases were administered pamidronate (90 mg, as a 2 hour intravenous infusion) monthly for 12 consecutive cycles. Bone pain, quality of life, performance status, analgesic consumption and disease staging were evaluated before and during the trial. The patients who had been administered pamidronate showed a significant decrease in bone pain (P = 0.0052). Performance status improved nearly significantly (P = 0.051), while the quality of life showed a remarkable amelioration. However, no significant decrease in analgesic consumption was recorded. Partial radiographic response of bone lesions was observed in 2/10 patients. The side effects of pamidronate were mild and transient. In conclusion, monthly infusion of pamidronate is a well-tolerated treatment that induces significant relief from bone pain and improves the quality of life of thyroid cancer patients with symptomatic and osteolytic bone metastases.
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PMID:Pamidronate improves the quality of life and induces clinical remission of bone metastases in patients with thyroid cancer. 1140 9

Bone is the second most frequent target of distant metastases in patients with differentiated thyroid cancer, and such forms carry a very poor prognosis. The impact of (131)I therapy in this setting is controversial. We describe the diagnostic circumstances and outcome of patients with bone metastases recently managed in two institutions. Among 921 consecutive thyroid cancer patients who had total thyroidectomy and (131)I ablation between January 2000 and December 2004 and who were subsequently monitored, bone metastases had been diagnosed in 16 patients. In three cases, the bone metastases were non-functioning (negative (131)I uptake) . These patients were treated with surgery and radiotherapy but progressed rapidly. The other 13 patients had functioning (positive (131)I uptake) bone metastases. In five of them, thyroid cancer was revealed by signs of distant involvement (bone pain, n = 4; dyspnea, n = 1). The bone metastases progressed in these five patients, despite local therapy and multiple courses of (131)I. The bone metastases in the remaining eight patients were discovered on the post-surgery (131)I therapy scan. Complementary radiological studies were negative except in one patient in whom one of the metastases (a 5 mm lesion of the right humerus) was visible on magnetic resonance imaging (MRI). Six of these patients showed a good response to (131)I therapy, with (131)I uptake and Tg levels becoming undetectable or showing a sharp fall. One patient refused (131)I therapy; bone metastases became visible on MRI within 1 year and the Tg level rose tenfold. The disease progressed in one patient despite (131)I therapy. Post-surgical (131)I ablation can contribute to early detection of bone metastases at a time when the Tg level may be only moderately elevated, when other radiological studies are negative, and when the disease is potentially curable by (131)I therapy.
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PMID:Bone metastases of differentiated thyroid cancer: impact of early 131I-based detection on outcome. 1791 9

Patients with differentiated thyroid cancer generally have a good prognosis and high cure rates; however, subgroups of patients exist who develop progressive disease with significant morbidity and mortality. We analyzed the clinical outcome of patients with follicular thyroid cancer and distant metastases to define their presentation, impact of therapy and clinical outcome. A group of 44 patients with follicular thyroid cancer which had metastasized to the lungs or the skeleton was identified. All patients were treated at M.D. Anderson Cancer Center between 1965 and 1994. The group included 26 women and 18 men, with a median age of 56 years (range, 23 to 80 years). The primary tumor was limited to the thyroid in most cases. At the time of writing 13 patients were alive with metastatic disease a median of 43 months (range, 4 to 230 months) after diagnosis, while 27 patients died of thyroid cancer a median of 83 months (range, 4 to 238 months) after diagnosis. Bone pain was the chief complaint in almost all the 24 patients in whom distant metastases were present at diagnosis. In the 20 patients who initially presented with localized disease, distant metastases to the skeleton and/or lungs were detected after a median interval of 53 months (range, 8 to 216 months). Symptomatic spinal cord compression occurred in 13 patients and preceded their death by 4 to 34 months. Radioiodine uptake was seen in most bone metastases but in only about half of metastatic foci in the lungs. Radiotherapy was palliative and useful for bone metastases. We conclude that patients with follicular thyroid cancer and distant metastases have a distinct clinical profile that includes prominent skeletal and pulmonary involvement and substantial morbidity and mortality. Intensive multimodality therapy is required to optimize the clinical outcome.
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PMID:Follicular thyroid cancer. 2154 53


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