Identification of Areas for Improvement in the Management of Bone Metastases in Patients with Neuroendocrine Neoplasms
AuthorsLim, Kok Haw Jonathan
McNamara, Mairead G
Hubner, Richard A
Valle, Juan W
AffiliationDepartment of Medical Oncology, The Christie NHS Foundation Trust, Manchester
MetadataShow full item record
AbstractBackground: There is no global consensus on the optimal management of bone metastases (BMs) in neuroendocrine neoplasms (NENs). Objectives: To review current management and outcomes of patients with BMs in NENs, in order to identify areas for improvement. Methods: A retrospective study of all patients with NENs, except Grade 3 lung NENs (April 2002 to March 2018) was conducted. Baseline characteristics, nature of BMs, treatment received and overall survival (OS) were evaluated. Statistical analyses were performed using SPSS version 23.0/STATA v12. Results: Of 1,212 patients, 85 (7%) had BMs; median age 58 years. The majority had a gastro-entero-pancreatic primary (49%, n = 42) followed by lung (25%, n = 21), unknown primary (20%, n = 17), and "others" (6%, n = 5). Two-thirds (n = 57) had G1-2 neuroendocrine tumours, and 41% (n = 35) had functional tumours. Overall, 28% (n = 24) presented with synchronous BMs at first NEN diagnosis, and 55% (n = 47) developed BMs at the same time as other distant metastases. For the subpopulation of patients in whom BMs developed metachronously to other distant metastases (45%, n = 38), median time to development of BMs was 14.0 months. BMs were "widespread" in 61% (n = 52). Although only 22% (n = 19) reported symptoms at initial diagnosis of BMs, most (78%) developed symptoms at some time during the follow-up period (pain/hypercalcaemia 64%, skeletal-related events 20%). BMs were mainly managed with analgesia (44%, n = 37). Radiotherapy and bisphosphonates were used in 34% (n = 29) and 22% (n = 19) respectively. Surgery was rarely performed (2%, n = 2). Median OS from identification of BMs was 31.0, and 18.9 months from development of BMs-related symptoms. Conclusions: In this cohort study, most patients with BMs developed symptoms. The utility of radiotherapy and/or bisphosphonates should be prospectively and systematically explored further for its potential impact on patients' quality of life and survival outcomes. Keywords: Bisphosphonates; Bone metastases; Hypercalcaemia; Palliative radiotherapy; Skeletal-related events; Survival.
CitationLim KHJ, Raja H, D'Arienzo P, Barriuso J, McNamara MG, Hubner RA, et al. Identification of Areas for Improvement in the Management of Bone Metastases in Patients with Neuroendocrine Neoplasms. Neuroendocrinology. 2020;110(7-8):688-96.
- Knowns and unknowns of bone metastases in patients with neuroendocrine neoplasms: A systematic review and meta-analysis.
- Authors: Garcia-Torralba E, Spada F, Lim KHJ, Jacobs T, Barriuso J, Mansoor W, McNamara MG, Hubner RA, Manoharan P, Fazio N, Valle JW, Lamarca A
- Issue date: 2021 Mar
- Bone Metastases in Neuroendocrine Neoplasms: From Pathogenesis to Clinical Management.
- Authors: Altieri B, Di Dato C, Martini C, Sciammarella C, Di Sarno A, Colao A, Faggiano A, NIKE Group.
- Issue date: 2019 Sep 8
- Prognosis of renal cell carcinoma with bone metastases: Experience from a large cancer centre.
- Authors: Ruatta F, Derosa L, Escudier B, Colomba E, Guida A, Baciarello G, Loriot Y, Fizazi K, Albiges L
- Issue date: 2019 Jan
- The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice.
- Authors: Alexandraki KI, Pizanias M, Uri I, Thomas D, Page T, Kolomodi D, Low CS, Adesanya O, Tsoli M, Gross DJ, Randeva H, Srirajaskanthan R, Grozinsky-Glasberg S, Kaltsas G, Weickert MO
- Issue date: 2019 Jun
- Clinicopathological features and prognosis of gastroenteropancreatic neuroendocrine neoplasms in a Chinese population: a large, retrospective single-centre study.
- Authors: Zhang M, Zhao P, Shi X, Zhao A, Zhang L, Zhou L
- Issue date: 2017 Jul 13