Multidisciplinary approach to the problem of bone metastases of breast cancer. Evaluation of treatment results

Bone metastases of breast cancer are the most common site of dissemination and represent 30-40% of all first metastases. The symptoms and deficits produced-disabling pain, fracture, hypercalcemia, spinal cord or nerve root compression, or reduced marrow function - are much different from those associated with metastases in other sites. Recognition of bone metastases does not exclude long life expectancy (many years) in some patients.
There are many reasons to reevaluate management strategies in this group of patients. Bone pain secondary to metastasis is the most common pain syndrom requiring treatment in cancer patients. Patients with predominant bone metastases have longer duration of survival than patients with predominantly visceral metastases. Patients with bone metastases have more severe symptoms and become symptomatic earlier in the clinical course than patients with liver and lung metastases. Complications of bone metastases are common (occurring in up to one third of patients who develop first metastases in bones) and produce high morbidity. There is an increasing incidence of bone metastases because of longer patient survival as a result of more effective treatment of primary tumors and other metastases. These patients require integrated treatment and proper medical care. That involves application of many treatment methods including radiotherapy, chemotherapy, hormonotherapy, surgery, bisphosphonates, pain relieving treatment and paliative care.
The study presents the results of follow up of 92 patients treated for bone metastases of breast cancer. Two groups of patients with different prognosis were selected. The first one (44 women) included patients with metastases confined to the bone, the second (48 patients) - metastases to the bone and to parenchymatous organs. The primary status of cancerous process was similar in both groups. Most of them were patients with the second stage of advancement according to TNM. The most common histopathological diagnosis with both groups was carcinoma ductale infiltrans.
The evaluated problems were: the degree of pain relief according to analogue pain scale VAS, the level of reduction of the amount of applied pain killers, causing mobility in patients who have so far been confined to be and the level of treatment failure.
On the basis of follow up of this group of patients, the following conclusions may be drawn:
1. Among patients with bone metastases who received, as constituents of oncological treatment radiotherapy, chemotherapy, hormonotherapy, oral bisphosphonates and pain killers, the patients who benefited most were those with dissemination confined to osseous system. The intensity of pain was significantly decreased (by approximately 50%) and a few bedridden patients became mobile.
2. In the subgroup of patients with individual metastases, especially to flat bones, when the patients were not irradiated, but received chemotherapy or hormonotherapy and oral bisphosphonates, the intensity of pain became four times smaller and the amount of pain killers used became four times smaller as well.
3. Cases of treatment failure were caused by another dissemination of the disease but integrated attitude towards treatment of bone metastases in these patients leads to improvement in their life quality, diminishing both pain symptoms and complications connected with bone metastases.