Bone metastases are common in many advanced solid tumours, being breast, prostate, thyroid, lung, and renal cancer the most prevalent. Bone metastases can produce skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, need of bone irradiation or need of bone surgery, and hypercalcaemia. Patients with bone metastases experience pain, functional impairment and have a negative impact on their quality of life. Several imaging techniques are available for diagnosis of this disease. Bone-targeted therapies include zoledronic acid, a potent biphosfonate, and denosumab, an anti-RANKL monoclonal antibody. Both reduce the risk and/or delay the development of SREs in several types of tumours. Radium 233, an alpha-particle emitter, increases overall survival in patients with bone metastases from resistant castration prostate cancer. Multidisciplinary approach is essential and bone surgery and radiotherapy should be integrated in the treatment of bone metastases when necessary. This SEOM Guideline reviews bone metastases pathogenesis, clinical presentations, lab tests, imaging techniques for diagnosis and response assessment, bone-targeted agents, and local therapies, as radiation and surgery, and establishes recommendations for the management of patients with metastases to bone.
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2016 Jan 28 [Epub ahead of print]
C Grávalos, C Rodríguez, A Sabino, M Á Seguí, J A Virizuela, A Carmona, J Cassinello, D Isla, C Jara, M Martín
Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. ., Hospital Universitario de Salamanca, Salamanca, Spain., Grupo ONCOAVANZE, Seville, Spain., Corporació Sanitària Parc Taulì, Sabadell, Spain., Complejo Hospitalario Regional Virgen Macarena, Seville, Spain., Hospital Universitario J.M. Morales Meseguer, Murcia, Spain., Hospital Universitario de Guadalajara, Guadalajara, Spain., Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain., Hospital Universitario Fundación Alcorcón, Madrid, Spain., Hospital Universitario Gregorio Marañón, Madrid, Spain.