| Bone metastasis is one of the most common complications during the advanced stage of cancer. Nearly half of the patients are found to have osseous metastasis after autopsy. The most common tumors which prefer to transfuse to bone are breast cancer, prostatic carcinoma and lung cancer .Patients with bone metastasis can display bone pain ,pathologic fracture,spinal compression and hypercalcinemia which highly reduced their quality of life. So serious bone pain usually results in the visit for diagnosis and theropy. Bone metabolism is a dynamic and continuous process, which is normally maintained in a tightly coupled balance between resorption of old or injured bone and formation of new bone. Once this balance is damaged ,the concentration of corresponding bone markers reflect both resorption and formation,such as Alkaline phosphatase and type I collagen N-telopeptides will change. Managements of bone metastasis include synthetic and odynolysis theropy. Bisphosphonates can palliate bone pain as reported having a remission rate above eighty percent by inhibiting the activity of osteoclast. We analyse retrospectively the clinical character ,relationship between alkaline phosphatase and progression of the disease and the therapeutic efficacy of synthetic theropy and bisphosphonates of three hundreds and five patients with bone metastasis but without hepatopathy and hepatic metastasis in our hospital received from January 2002 to February 2007.Results: 1. The first three solid tumors metastase to bone are lung cance ,breast cancer and prostate cancer ,with the number of patients12- 4(40.7%),48(15.7%) and 35(11.5%),and there is a statistic significance amo- ng them.2. the pathology of majority are adenocarcinoma(48.5%). The number of patients with lung adenocarcinoma is higher than other types(P<0.01). 3. 271(88.9%) patients have multiple bone lesions ,while only 34(11.1%) patients have isolated lesions(P<0.01). And the axial skeleton is more commonly involved than the appendicular skeleton. The predilection sites are dorsal vertebra, pelvis, abdominal vertebra and costal bone by turns. 4. Lung cancer metasizes to bone much faster than prostate cancer , rectal cancer and breast cancer. 5. Bone pain is the chief clinical manifestation,while the incidence of hypercalcinemia is low(0.98%) .6. 71.1 percent of the cases show high sALP concentration. There is no statistic significance of the alkaline phosphatase concentration among the age groups(P>0.05) as among the breast cancer, prostatic carcinoma and lung cancer(P > 0.05).But the level of alkaline phosphatase differs significantly among patients suffering different pain grades (P<0.01) as between patients having less or more than three bone lesions (P<0.01) and with or without skeleton related events. 7. Both synthetic treatment and biophosphanates decided by thephysical status and economy condition can predominantly relieve the pain resulting in the improvement of the patients'locomotor activity,and there is a stastatic significance between the two methods(P<0.01).Discussion: Tumor cells usually transferred to bone by blood. Vertebral venous system rich in blood offers a"soil"for cancer cells ,so the most common skeleton involved in bone metastasis is spine. In our study the corresponding skeletons most frequently involved in breast cancer, prostatic carcinoma and lung cancer are dorsal vertebra,dorsal vertebra and pelvis. So we conclude that the bone position tumors are liable to transfer to is related with the bone nearby the tumor. Along with the development of osseous metastasis , osteoclasts are activated consistently which results in more bone lesions pain ,and skeleton related accidents moreover.At the same time the disbalance between bone resorption and formation aggravates leading to more bone formation , so the level alkali phosphatase secreted by osteoplasts are higher consistently. These explain the results about alkaline phosphatase concentration. Bisphosphonates can stick to the surface of bone trabecula as a protection from lysing effect of osteoclasts ;they can also inhibit the production of prostaglandin and lactic acid which always cause pain in patients;most importantly they can reduce the bone resoption by inhibiting the activity of osteoclasts . So bisphosphonates are recommended as a standard treatment for patients with bone metastasis .But because their antitumor effects are not very clear ,they can not reach the efficiency of combined therapy.Conclusions: The most common tumors which prefer to transfuse to bone marrow are breast cancer, prostatic carcinoma and lung cancer .The pathology of majority are adenocarcinoma. The majority of patients have multiple bone lesions, and the axial skeleton is more commonly involved than the appendicular skeleton. Lung cancer can metasize to bone marrow in a less time,and breast cancer in a longer time. Bone pain is the chief clinical manifestation,while the incidence of hypercalcinemia is low. Most cases have high level serum alkaline phosphatase .The concentration of alkaline phosp- hatase relates with degree of bone pain , extent of bone lesion and skeleton related events , but not with age and original tumor . It can reflect the progression of bone metastasis in some degree. Bisphosphonates can highly reduce the bone pain and improve the life quality of the patients ,but the effectiveness is much better in combination with chemotherapy and radiot- herapy.
|
PDF Full Text Request