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Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sarcomatous proliferation of the fibroblast-like stromal cells in renal cell carcinoma was found in three patients who had apparently tumor-associated hypercalcemia but no evidence of bone metastases. The proliferation of stromal cells was not found in 20 patients who also had renal cell carcinoma without hypercalcemia. Immunoreactive parathormone-like substance was detected in two of the three patients with hypercalcemia, despite high levels of serum calcium. The parathormone assay was not conducted on the third hypercalcemic patient, however. Buffer extract from one of the tumors associated with hypercalcemia was able to elicit an increase of the serum calcium in rats, whereas buffer extract from a tumor not associated with hypercalcemia failed to induce hypercalcemia in rats. Findings suggest that the stromal cells of renal cell carcinoma may play a role in the tumor-associated hypercalcemia. The exact nature of the hypercalcemic agent is uncertain. However, in the case studied it appears that a parathormone-like substance was responsible.
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PMID:Hypercalcemia associated with renal cell carcinoma: probable role of neoplastic stromal cells. 683 61

Seventy-one patients with breast cancer and bone metastases, together with other assessable sites of disease, were monitored by radiologic skeletal survey, bone scanning, pain charts, bone marrow aspirate, serum calcium, alkaline phosphatase and urine hydroxyproline/creatinine ratio. On the basis of UICC criteria of response in nonosseous sites, 37 were classed as responders and 34 as nonresponders. Responding patients with osteolytic disease frequently showed sclerosis, but only at 6-8 months, whereas patients with mixed lytic/sclerotic or sclerotic metastases frequently showed no change or further sclerosis. Nonresponders most frequently showed progressive lysis. Bone scanning showed clear evidence of improvement or deterioration in 7/21 responders and 8/23 nonresponders who showed no definite evidence of progression or response on skeletal radiography. Pain assessment was also useful in these patients. Neither the bone marrow aspirate nor other biochemical tests were useful in assessing response to therapy. This study concludes that bone scanning and pain assessment are both useful in assessment of response of bone metastases to treatment in some patients and incorporation into a standard criteria of response is recommended.
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PMID:Assessment of response of bone metastases to systemic treatment in patients with breast cancer. 686 Oct 98

Although hypercalcemia is a well-known complication of malignant diseases, hypocalcemia seems to be a rather rare one. A 34-yr-old woman with advanced breast cancer who presented hypocalcemia is described. She had generalized multiple osteolytic bone metastases which were progressive in spite of chemo-endocrine and radiation therapy. She was admitted because of severe bone pain and dyspnea caused by bilateral pleural effusion. Laboratory examination on admission showed that the serum calcium was 9.6 mg/dl, serum total protein 5.9 g/dl, serum inorganic phosphorus 4.6 mg/dl, and serum alkaline phosphatase 29.6 King-Armstrong units. The serum calcium gradually fell to 7.0 mg/dl on the 45th hospital day when the serum total protein was 6.8 g/dl and she complained of paresthesia in the extremities. On the 58th day, severe tachycardia and hypotension developed and she died of congestive heart failure on the 67th hospital day. At that time the serum calcium was 5.4 mg/dl. During her hospital course, the plasma parathyroid hormone levels were examined repeatedly and were 0.4, 0.6, 0.6 and 0.7 ng/ml (normal; less than 0.5 ng/ml). Autopsy revealed that cancer invaded the space between the thyroid and the trachea and no parathyroid glands could be found even in the mediastinum. Microscopically the parathyroid glands were replaced completely by the cancer cells. These observations indicate that metastasis of breast cancer to the parathyroid glands caused relative hypoparathyroidism, resulting in hypocalcemia. In addition, congestive heart failure which was refractory to digitalis and diuretics might have been caused by impaired contractility of the myocardium associated with hypocalcemia.
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PMID:A case of advanced breast cancer associated with hypocalcemia. 688 61

Quantitative bone histology was studied in 23 patients with malignant hypercalcemia (MH) due to carcinoma (16) or immunoproliferative disease (7). Plasma calcium was 3.37 +/- 0.47 (mean +/- SD) mmol/liter. Bone resorbing surface (RS) was measured using a sensitive histochemical stain to identify osteoclasts. In the MH patients with carcinoma, the RS was 3.1 +/- 2.6% compared to 1.0 +/- 0.3% in controls (P less than 0.02). In the myeloma patients it was 2.3 +/- 1.7%, and in normocalcemic patients with malignant disease 0.8 +/- 1.1%. RS did not correlate with serum PTH, and several high RS values were associated with undetectable PTH. RS correlated with forming surface (FS) in MH patients (r = 0.44, P less than 0.05) and controls (r = 0.68, P less than 0.005), but there was a greater RS relative to FS in MH patients than in controls (P less than 0.005). "Excess" RS in the MH patients was calculated by subtracting the RS accounted for by the measured FS, using the relationship defined by the controls. Bone loss, as reflected in urinary calcium excretion, correlated weakly with excess RS (r = 0.44, P less than 0.05) but was high even when excess RS was zero. Thus, the histological findings do not account for the bone loss, and additional resorption around bone metastases is likely; the results of this study are consistent with a humoral substance produced by the malignant tissue causing generalized bone resorption in addition to bone dissolution around metastases.
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PMID:Quantitative bone histology in the hypercalcemia of malignant disease. 713 Mar 37

Among 470 patients with metastatic breast cancer treated with tamoxifen, ten patients (2.3%) developed hypercalcemia. All patients with hypercalcemia had osteolytic or mixed lytic and blastic bone metastases. Hypercalcemia developed after a median period of seven days (range 4-11 days) of tamoxifen administration. Hypercalcemia was treated with conventional measures and serum calcium levels normalized in nine patients, either with a brief interruption of tamoxifen therapy or in spite of continued treatment. Four patients experienced partial remissions with continued tamoxifen therapy. These results indicate that hypercalcemia is a potentially serious complication of tamoxifen therapy but is generally short-lived, and can be controlled with supportive measures, thus allowing continued tamoxifen administration.
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PMID:Tamoxifen-induced hypercalcemia in breast cancer. 726 Aug 71

Two cases of laryngeal carcinoma are presented which, upon initial evaluation, were noted to have asymptomatic hypercalcemia with no evidence of bone metastases. Exploration of the parathyroid glands at the time of definitive surgery revealed parathyroid pathology in both cases. Calcium levels returned to normal postoperatively in both cases. We conclude that in patients with head and neck cancer with hypercalcemia and no evidence of bone metastases, parathyroid pathology should be considered. Exploration of the parathyroid glands at the time of definitive surgery or as a separate procedure may prove rewarding.
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PMID:Primary hyperparathyroidism and laryngeal carcinoma: a cause of associated hypercalcemia. 730 May 42

Osseous deposits secondary to advanced carcinoma of the prostate are a common feature of the disease. These deposits are most often seen in the lumbar spine and pelvis and cause severe and intractable pain, often requiring large quantities of strong analgesia for alleviation of pain. Relief of pain can be achieved by external irradiation of these deposits, but this relief may not be permanent and the disease may be so widespread that it is impracticable to treat all the deposits by irradiation. Deposits from carcinoma of the prostrate are usually multiple and all may cause pain at the same time. A method of delivering the radiation to all the deposits at the same time has been sought. Previous studies have shown that radioactive phosphorus (P32) can be used to obtain this localisation of radioactivity at sites of osseous activity. In this study 24 patients with bone metastases from carcinoma of the prostate were treated with radiophosphorus and methyl testosterone, or radiophosphorus with parathormone and calcium. An overall response rate of 58% shows this to be an effective palliative treatment. The results suggest there is a greater response when P32 is used in conjunction with parathormone and calcium, than with methyl testosterone.
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PMID:Carcinoma of the prostate: the treatment of bone metastases by radiophosphorus. 730 44

The analgesic properties of 89Sr were investigated in 17 patients with multiple painful bone metastases. 89Sr is a radioisotope, the metabolism of which in the body is comparable to that of calcium. It is a pure beta emitter and its half-life is 51 days. When injected intravenously it is captured by bone, especially at locations where the turnover is increased. Each patient received 1--2 mCi of 89Sr. Bone scans and hematological investigations were performed before, and 2 months after, treatment. No significant changes were found. Shealy's method was used to assess pain, initially twice a week and then at more prolonged intervals. One patient suffering from multiple myeloma showed a spectacular improvement and 6 others responded favourably. Improvement generally occurred within 3--7 days, but was sometimes delayed for up to 3 weeks. Relief lasted for up to several months. Five patients had an increase of pain during the 24 hours immediately after treatment. An average of 28% of the administered radioactive dose was found in the urine collections during the first 48 hours. Although the treatment was not successful in every case, the use of 89Sr as a long acting analgesic in multiple bone metastases should be considered more frequently, especially as there are no side effects.
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PMID:[Use of strontium-89 in the analgesic treatment of bone metastases]. 744 9

Clodronate (clodronic acid, dichloromethylene bisphosphonate) is a bisphosphonate which has demonstrated efficacy in patients with a variety of diseases of enhanced bone resorption including Paget's disease, hypercalcaemia of malignancy and osteolytic bone metastases. In addition, early reports demonstrating potential efficacy of clodronate in the treatment of osteoporosis suggest a possible role in this debilitating disease. Short term intravenous administration (usually 300 mg/day for 5 days) or longer courses of oral clodronate (usually 1600 mg/day for 6 months) effectively reduced bone pain and/or improved mobility in most patients with Paget's disease, and these effects persisted for up to 12 months after discontinuing clodronate. When administered intravenously (300 mg/day for up to 12 days) to patients with malignant hypercalcaemia, serum calcium levels declined significantly within 2 days of starting treatment and approximately 70 to 95% of patients became normocalcaemic. While there is less experience with oral administration, clodronate (800 to 3200 mg/day) achieved normocalcaemia in the majority of patients, usually within 1 week, and serum calcium levels remained significantly reduced from baseline for up to 6 months with continued treatment. Clodronate is clearly superior to placebo and, based on a retrospective analysis, appears to produce greater and more sustained reductions in serum calcium levels than calcitonin in patients with malignant hypercalcaemia. The few available prospective comparative trials showed that clodronate is at least as effective as etidronate, but comparisons with alendronate and pamidronate produced results of questionable clinical relevance because of low bisphosphonate dosages used in these trials. Nevertheless, single intravenous doses of clodronate 600 mg or alendronate 7.5 mg (both agents repeated on day 3 if necessary) were comparable in efficacy, whereas a single intravenous dose of pamidronate 30 mg was more effective than a single intravenous dose of clodronate 600 mg. Normocalcaemic patients with osteolytic bone metastases due to advanced breast cancer experienced significant reductions in the number of episodes of hypercalcaemia and terminal hypercalcaemia, incidence of vertebral fractures and overall rate of morbid events, including the need for radiotherapy to treat bone-related pain, following treatment with clodronate 1600 mg/day for 3 years in a large placebo-controlled study. A similar large placebo-controlled trial in patients with multiple myeloma demonstrated that clodronate 2400 mg/day orally for 2 years significantly reduced progression of osteolytic bone lesions. Follow-up data from clinical trials revealed that the effects on development of fractures and hypercalcaemia persisted for at least 12 months after the drug was discontinued.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clodronate. A review of its pharmacological properties and therapeutic efficacy in resorptive bone disease. 752 33

Bone metastases are a common cause of morbidity in patients with breast cancer. In an open, phase II, non-comparative trial to investigate the effects of repeated infusions of pamidronate (Aredia) on pain, mobility, analgesic consumption, bone healing and bone metabolism, 69 patients with breast cancer and bone metastases received pamidronate 60 mg intravenously in 250 ml normal saline over 1 or 4 hours every 2 weeks for a total of 13 infusions, until either progressive disease or a serious adverse event. Improvement in pain score was seen in 33 of 54 evaluable patients (61%) as measured by a linear analogue pain scale, and in 28 of 56 evaluable patients (50%) as measured on a 6-point pain scale: 18 (30%) of 60 evaluable patients showed reduction in a 6-point analgesic score, while 28 patients (50%) showed some improvement in mobility, as assessed by a questionnaire. Sclerosis appeared in > 25% of bone lesions in 2 patients and in < 25% of bone lesions in 12 patients. Urinary calcium/creatinine ratios fell dramatically during therapy. One patient developed symptomatic hypocalcemia, 1 showed deterioration in pre-existing renal insufficiency. Fever occurred in 19% of patients, and less than 20% developed flu-like symptoms. We conclude that intravenous infusions of pamidronate at a dose of 60 mg every 2 weeks produces a marked reduction in pain in patients with extensive bone metastases from breast cancer.
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PMID:Role of pamidronate in the management of bone metastases from breast cancer: results of a non-comparative multicenter phase II trial. Aredia Multinational Cooperative Group. 753 92


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