A new emergency in oncology: Bone metastases in breast cancer patients (Review).
Ibrahim T, Mercatali L, Amadori D.
Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola I-47014, Italy.
Oncol Lett. 2013 Aug;6(2):306-310. Epub 2013 Jun 4.
Breast cancer (BC) is the most common tumour in females and as a result, the management of such patients is a major public health issue. A high percentage of BC patients develop bone metastases (BMs), occasionally even several years following the initial diagnosis. BMs are responsible for high morbidity and a reduced quality of life with the onset of various clinical complications defined as skeletal-related events (SREs), including pathological fractures, spinal cord compression, hypercalcaemia, bone marrow infiltration and severe bone pain, requiring palliative radiotherapy. Such complications reduce functional independence and quality of life, decrease survival rates and increase healthcare costs. The current treatment for metastatic BC aims to achieve meaningful clinical responses, an improved quality of life, long-term remission, prolonged survival and in a small percentage of cases, a complete cure. The treatment of this malignancy has become progressively complex, including well-known antitumour agents or bone-targeted molecules aimed at preventing bone complications and improving patient quality of life and the treatment outcome of a multidisciplinary programme. The importance of a multi disciplinary approach in the management of BMs is also widely accepted. The major complication of BMs are SREs which are responsible for reducing prognoses and patient quality of life and are correlated with high rates of hospitalisation with the subsequent social and economic consequences. For these reasons, it is crucial to prevent where possible or to identify and treat SREs promptly in an attempt to mitigate the ever-increasing clinical and economic burden.
KEYWORDS: bone metastases, breast cancer, multidisciplinary approach, skeletal-related events
Metástasis óseas dolorosas
Painful boney metastases.
Smith HS, Mohsin I.
Department of Anesthesiology, Albany Medical College, Albany, New York, USA.
Korean J Pain. 2013 Jul;26(3):223-41. doi: 10.3344/kjp.2013.26.3.223. Epub 2013 Jul 1.
Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with “triple opioid therapy”, bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics.
KEYWORDS: boney metastases, breakthrough, cancer, pain, triple opioid therapy
Los posibles objetivos terapéuticos para el dolor óseo inducido por la metástasis del cáncer.
The potential therapeutic targets to bone pain induced by cancer metastasis.
Wu J, Wei Y, Shi J, Chen F, Huang G, Chen J, Xia J.
J Can Res Ther [serial online] 2013 [cited 2013 Dec 5];9:135-41.
About 75-90% of patients with advanced metastatic cancer experience significant cancer pain. Bone cancer pain is one of the most common pains experienced by patients with advanced breast, prostate, or lung cancer. It is characterized by significant skeletal remodeling, fractures, pain, and anemia, all of which reduce the functional status, quality of life, and survival of the patient. Recent years have seen great progress toward alleviating bone pain with the identification of a range of chemicals as well as receptors modulating cancer pain progression. However, the complicated interactions among these factors and, sometimes, the contradicting effects of the same factor in different pathways make it difficult to spot individual effective targets. The sheer quantity of the chemicals involved and the limited understanding from animal models are the constraints in the development of effective therapies for cancer bone pain. In this review, key targets will be discussed along the pain transduction pathway, including peripheral pain sensation, spinal cord transduction pathway, and the central nervous system, to offer a logical and systematic study for the development of combined anti-bone pain treatments.
Keywords: Bone metastasis, nervous system, pain transduction pathway, therapeutic target
Anestesiología y Medicina del Dolor