Impact of Prior Cancer on the Prognosis of Patients with Chondrosarcoma: A Population-Based Study of the SEER Database.

Background: Patients with prior cancer are generally exempt from cancer experiments. This research aims to describe the prevalence, clinical features, and effects of past malignancy among patients with chondrosarcoma. Methods: Chondrosarcoma patients diagnosed between 2010 to 2015 were collected from the SEER database. The propensity score matching method was used to reconcile the disparity in baseline attributes. Kaplan-Meier analysis was employed to explore the outcomes of prior cancer on overall survival. The proportional hazards assumption was used to certain whether the covariate matched the Cox regression model. The potential outliers were estimated by deviance residuals type. Results: A total of 1,721 unique individuals were collected, of those 284 (16.50%) patients had a history of cancer, with prostate cancer being commonly documented (n = 49, 17.25%). Approximately half of the previous tumors are diagnosed within 5 years before the diagnosis of chondrosarcoma. Chondrosarcoma patients with prior cancers have a lower survival rate than those without prior malignancy (P < .001). A multivariable Cox analysis reveals that past cancer is a distinct risk factor for lifespan (hazard ratio = 2.489, P < .001). Conclusion: This study initially discovered that chondrosarcoma patients with past cancer have a bad prognosis. Different types of past cancer have varying effects on survival. We urgently propose that cancer trial exclusion criteria be set specifically by cancer classification, rather than accepting the unchangeable criterion for default.

Risk Factors for Hepatic Toxicity of High-dose Methotrexate in Patients With Osteosarcoma.

BACKGROUND/AIM: High-dose methotrexate (HD-MTX) is widely used to treat osteosarcoma. However, some patients develop hepatic toxicity, leading to dose modification and delays in the scheduled chemotherapy. The present study aimed to identify the risk factors of hepatotoxicity in patients with osteosarcoma. PATIENTS AND METHODS: We conducted a retrospective study of patients with osteosarcoma treated with HD-MTX between January 2014 and June 2020 at the National Cancer Center Hospital, Japan. The risk factors for MTX-induced hepatotoxicity (≥grade 3) were identified using multivariate logistic regression analysis. RESULTS: The final analysis included 88 courses of 36 patients. Hepatotoxicity occurred in 51 (58.0%) of the 88 courses. Female sex, MTX dose (>10.2 g/m2), and serum calcium concentration (>9.3 mg/dl) were identified as risk factors for HD-MTX-induced hepatotoxicity. CONCLUSION: Identifying the risk factors of HD-MTX-induced hepatotoxicity may contribute to improvements in the safety and management of HD-MTX therapy.

[Update and interpretation of 2021 National Comprehensive Cancer Network (NCCN) "Clinical Practice Guidelines for Bone Tumors"].

The incidence of primary malignant bone tumors is low, and clinical cognition is insufficient. The establishment of diagnostic criteria is of great significance for prognosis of tumors. National Comprehensive Cancer Network (NCCN) regularly publishes "Clinical Practice Guidelines for Bone Tumors" to summarize the latest treatment progress of bone tumors. In the latest version of the guidelines released in November 2020, surgery is the main treatment for chondrosarcoma, chordoma, and giant cell tumor of bone, which can be combined with radiotherapy or targeted therapy. Ewing's sarcoma and osteosarcoma are treated by surgery combined with chemotherapy. Immunotherapy can be used to treat high-grade undifferentiated pleomorphic sarcoma. For recurrent tumors, surgery combined with radiotherapy, chemotherapy, and/or targeted therapy can be used for control. The guidelines provide a reference for the standard treatment of bone tumors.

Rural patients are at risk for increased stage at presentation and diminished overall survival in osteosarcoma.

BACKGROUND: There is an undefined relationship between access to regional referral centers and whether the eventual oncologic outcomes are influenced by distance, travel time, or residence in a rural community. METHODS: We used the Surveillance, Epidemiology and End Results (SEER) Program Database to capture all cases of high-grade osteosarcoma from 1990 to 2014 in Iowa, Utah, and New Mexico. Using univariate, Kaplan Meier survival analysis, and multivariate Cox proportional hazards modeling we analyzed patient and tumor characteristics. RESULTS: A total of 476 patients met the study criteria. There was an increased incidence of metastases for patients residing in a county with a greater than 2 -h drive to the nearest comprehensive cancer center (p = 0.021). Individuals residing in "rural" counties and "very rural" counties showed decreased 5-year survival (p = 0.007 and 0.003, respectively) when compared to those living in areas of higher population density. A multivariate regression analysis showed that the presence of metastasis (HR = 2.78 [95% CI: 1.88-4.10], p < 0.0001) and rural status (HR = 1.58 [95% CI: 1.03-2.43], p = 0.037) were risk factors for mortality when controlling for size of the tumor. CONCLUSION: The travel time to the nearest comprehensive center was associated with an increased incidence of metastasis on presentation in patients with osteosarcoma. Metastasis and rural status were independent risk factors for mortality. This investigation suggests that individuals living in rural counties may experience barriers to presentation, treatment, or surveillance that are not present in areas with a higher population density.

Pathological complete response may underestimate distant metastasis in locally advanced rectal cancer following neoadjuvant chemoradiotherapy and radical surgery: Incidence, metastatic pattern, and risk factors.

AIM: To evaluate the pattern of tumor relapse of pathological complete response (pCR) patients with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME), and to identify predictive factors of distant metastasis in pCR patients after nCRT. METHOD: This was a retrospective analysis of 118 LARC patients who achieved a pCR following nCRT and TME from 2008 to 2015. Clinicopathological and therapeutic parameters were evaluated as possible predictors of distant metastasis-free survival (DMFS), and COX regression analysis was performed. RESULTS: After a median follow-up of 57 months, the 5-year overall and disease-free survival rates were 94.7% and 88.1%, respectively. Overall, 6 patients (5.1%) died, no local recurrence occurred, 13 patients (11%) developed distant metastases, including lung (n = 5), liver (n = 2), bone (n = 3), lung and brain (n = 1), peritoneal (n = 1), and spleen (n = 1) metastasis. On univariate analysis, tumor distance from the anal verge (HR = 0.706, P = 0.039), acellular mucin pools (HR = 6.687, P = 0.002), and MUC1 expression (HR = 8.280, P < 0.001) were independently associated with DMFS. COX regression demonstrated that MUC1 expression (HR = 3.812, P = 0.041) remained to be an independent predictor of DMFS in pCR patients. CONCLUSION: Distant metastasis still remained a major concern in pCR patients following nCRT and TME. Tumor distance from the anal verge, acellular mucin pools, and MUC1 expression were associated with distant metastasis in patients with pCR. MUC1 staining remained to be an independent risk factor for DMFS. Such information could facilitate treatment decision in these patients, such as adjuvant chemotherapy and follow-up.

Miscorrelation of Functional Outcome and Sociooccupational Status of Childhood, Adolescent, and Young Adult Generation With Bone and Soft Tissue Sarcoma Patients.

Few studies have examined the relationship between functional outcome and sociooccupational or psychological status in adolescent and young adults (AYA) generation and childhood sarcoma patients. We retrospectively analyzed clinical (prognostic and functional) and sociooccupational outcomes in 50 patients; 22 children aged under 14 years and 28 AYAs generation (15 to 29 y). There were 35 cases of bone sarcomas and 15 of soft tissue sarcomas. Limb-sparing surgery was performed in 30 of 37 extremity cases. The most prevalent problems among patients were as follows: limited activities; drop-out or delayed studies among high school and college students; limitation in job searching; and changes in social relationships. These problems were unaffected by limb-sparing. Regression analysis between functional and sociooccupational disability showed that the correlation coefficient was significant (P=0.005) in all limb-salvaged patients, but there was no significant correlation among osteosarcoma patients (P=0.07). These findings suggest that quality of life is a multidimensional measure: it depends on physical status, spiritual health, and social well-being of both patients and family members. To overcome the disadvantages of this type of disease, it is essential to provide comprehensive care at the earliest convenience using multidimensional approaches.

Population-based validation of the National Cancer Comprehensive Network recommendations for baseline imaging workup of cutaneous melanoma.

The aim of the current study is to assess the performance of some of the imaging scans recommended in the National Comprehensive Cancer Network Guidelines as part of baseline staging for cutaneous melanoma, regarding the detection of lung, brain, bone, and liver metastases. Surveillance, Epidemiology and End Results database (2010-2015) was used to extract the data, and cases with cutaneous melanoma and complete information about TN stages and sites of distant metastases were explored. Performance parameters assessed in the current study included positive predictive value (PPV), negative predictive value, sensitivity, specificity, number needed to investigate (NNI), and accuracy. A total of 109 971 patients were included in the analysis. If all stage III patients in the study cohort are to be staged through routine imaging, PPV (for the recognition of lung metastases) will be 2.9% and NNI to detect one case of lung metastasis will be 34. Likewise, PPV (for the recognition of bone metastases) will be 1.8% and NNI to detect one case of bone metastasis will be 55. Moreover, PPV (for the recognition of liver metastases) will be 1.8% and NNI to detect one case of liver metastasis will be 55. Excluding stage III patients with clinically node-negative/sentinel node-positive disease would improve PPV and decrease NNI for the three metastatic sites. Adherence to current National Comprehensive Cancer Network guidelines for cutaneous melanoma imaging for baseline staging results in low rates of failure to detect asymptomatic lung, liver, brain, or bone metastases.

Population-based validation of the National Cancer Comprehensive Network recommendations for breast cancer staging.

OBJECTIVE: The aim of the current study is to evaluate the performance characteristics of the National Comprehensive Cancer Network (NCCN) staging recommendations for breast cancer with regard to the detection of lung, bone, and liver metastases. METHODS: Surveillance, epidemiology, and end points (SEER) database (2010-2015) was accessed, and patients with breast cancer and complete information about T stage and clinical N stage, ER status, Her2 status, and metastatic sites were extracted. Performance characteristics evaluated for the current study included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), number needed to investigate (NNI), and accuracy. RESULTS: A total of 239,196 patients were included in the analysis. For the overall cohort, the required PPV (for the recognition of lung metastases) is 10.6% and NNI to detect one case of lung metastasis is 9.4. Likewise, PPV (for the recognition of bone metastases) is 18.6% and NNI to detect one case of bone metastasis is 5.3. Moreover, PPV (for the recognition of liver metastases) is 7.6% and NNI to detect one case of liver metastasis is 13.1. When changing the threshold for baseline imaging to includeT2N1 patients, a better balance between sensitivity and specificity among ER+/Her2- patients (> 92% for both sensitivity and specificity for the three metastatic sites) was observed. On the other hand, the proposed change improved sensitivity while it lowers significantly the specificity among Her2+ and triple negative subtypes (specificity < 84% for Her2+ disease for the three metastatic sites; specificity < 87% for triple negative disease for the three metastatic sites). CONCLUSION: The current NCCN recommendations for breast cancer staging have an excellent NPV and miss only few patients with lung, liver, or bone metastases. Future studies incorporating the subtype of breast cancer as a determinant of staging pathway is needed.

Prostate cancer bone metastases on staging prostate MRI: prevalence and clinical features associated with their diagnosis.

PURPOSE: Bone lesions on prostate MRI often raise concern about metastases. This study aimed to evaluate the prevalence of bone metastases on staging prostate MRI and evaluate associations between their MRI features and clinical/pathologic characteristics. METHODS: Retrospective, IRB-approved study of 3765 patients undergoing prostate MRI for newly diagnosed PCa between 2000 and 2014. The reference standard to calculate the prevalence of bone metastases was bone biopsy and/or ≥1-year follow-up after MRI. In a subsample of 228 patients, the MRI characteristics of bone lesions were recorded by two radiologists independently. Associations between MRI and clinical/pathologic findings, including National Comprehensive Cancer Network (NCCN) risk categories, were calculated. RESULTS: 57/3765 patients (1.5%, 95% CI 1.2-2.0%) had bone metastases. No patient with NCCN low-risk PCa (Gleason < 7, PSA < 10 ng/mL, cT1-2a) had bone metastases. In the subsample, ≥1 bone lesion was present on MRI in 74% (95% CI 0.67-0.79) and 72% (95% CI 0.66-0.78) of patients (R1 and R2). Larger lesion diameter (OR 1.33/1.19; p < 0.001 for both readers) and the absence of intralesional fat (OR 0.07/0.11; p = 0.004/0.002 for R1/R2) were significantly associated with bone metastases. CONCLUSION: Bone lesions are common in prostate MRI, but only rarely represent metastases. MRI should be interpreted in the context of clinical features that influence the likelihood of metastatic disease.

Do Patients After Chondrosarcoma Treatment Have Age-appropriate Bone Mineral Density in the Long Term?

BACKGROUND: In long-term survivors of osteosarcoma and Ewing sarcoma treated with the addition of radio- and chemotherapy, low bone mineral density (BMD) and fractures have been observed, presumably resulting from these adjuvants. Because patients with chondrosarcoma usually are not treated with conventional adjuvant treatment, observation of low BMD in patients with chondrosarcoma presumably would be the result of other mechanisms. However, BMD in patients with a history of chondrosarcoma has not been well characterized. QUESTIONS/PURPOSES: The aim of our study was to address the following questions: (1) Do long-term survivors of chondrosarcoma have normal BMD and, if not, which factors contribute to low BMD? (2) Is there a greater risk of fracture and does the Fracture Risk Assessment Tool (FRAX(®)) score reflect fracture likelihood? METHODS: All known patients with a history of chondrosarcoma treated at our institution before 2006 were identified. Of 127 patients believed to be alive at the time of this study, 30 agreed to participate in this study (11 females, 19 males; mean age at surgery, 39 ± 12 years; mean followup, 12 ± 5 years). With the data available, the 30 participants were not different from the 97 nonparticipants in terms of age, sex, BMI, tumor grade, tumor location (axial versus appendicular, lower extremity versus elsewhere), and use of any treatment known to influence osteopenia (chemotherapy, lower extremity surgery). BMD was measured and history of fractures was assessed using a questionnaire. The patients´ BMD measurements in this study were sex- and age-matched with a normative sex- and age-categorized reference population reported by Kudlacek et al. Associations were tested by univariate regressions and ANOVAs of all measures of BMD and eligible oncologic and demographic factors. RESULTS: Eighteen of 30 (60%) patients had a pathologic BMD according to the WHO dual-energy x-ray absorptiometry definition, 15 (50%) had osteopenia, and three (10%) had osteoporosis. T-scores in the study cohort were lower than reference values for the femur neck (mean difference, 0.64; 95% CI, 0.27-1.01; p < 0.0015), but not for the spine (mean difference, 0.39; 95% CI, -0.06 to 0.84; p = 0.09). Thirteen patients (45%) reported a history of fractures not distinguishing between low and high impact. The incidence of fractures was 2.8 greater than expected from a comparison with a published microcensus survey of the Austrian population. No effect of the FRAX(®) score on fracture risk could be identified (p = 0.057). CONCLUSIONS: Long-term survivors of chondrosarcoma appear to be at greater risk for having low BMD develop than the healthy population. Although these results are preliminary and based on a very small sampling of patients, if they can be confirmed in larger studies, BMD assessment by dual-energy x-ray absorptiometry might be considered as these patients are followed posttreatment by sarcoma care units. The reasons for low BMD still must be elucidated. LEVEL OF EVIDENCE: Level IV, prognostic study.

[Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience]. / La concordance du diagnostic histopathologique des sarcomes osseux et des tissus mous entre deux centres anticancéreux de l'Europe de l'Est et de l'Ouest : une expérience de collaboration.

INTRODUCTION: This study aims to assess the degree of concordance of histological diagnosis of bone and soft tissue sarcomas between a Comprehensive Cancer Center (CCC) of Eastern Europe - not specialized in this area of pathology - and an important CCC of Western Europe, which is one of the coordinators of a clinical reference network in sarcoma pathology. The goal is to have an overview of the sarcomatous pathology in a region of Eastern Europe and to discover diagnostic discrepancies between the two centers, while determining their cause. MATERIALS AND METHODS: The initial diagnosis was compared with the revised diagnosis on 110 specimens from 88 patients with bone or soft tissue sarcomas from East-European CCC, in a one-year period of time. RESULTS: Complete diagnostic agreement was observed in 55 cases (62.5%), a partial agreement in 23 cases (26.1%) and a major disagreement in 10 cases (11.4%). Major discrepancies of the histological type was observed in only 3 cases (3.4%): one case of discordance benign/malignant and 2 cases of discordance mesenchymal/non mesenchymal. Minor histological discrepancies - not affecting the management of the patient - were observed in 18 cases (20.4%). A major discordance in grading - potentially changing the management of the patient - was noted in 7 cases (7.9%), and a minor discrepancy in 5 cases (5.7%). DISCUSSIONS: Some histological types were clearly overdiagnosed, like "adult fibrosarcomas" and "malignant peripheral nerve sheet tumors" (MPNST), mostly converted after the audit into "undifferentiated spindle cell sarcomas" or other types of sarcomas. Some "unclassified" sarcomas and "undifferentiated pleomorphic sarcomas" could be re-classified with the aid of an extensive panel of antibodies. Overall, immunohistochemistry was responsible, but not in exclusivity, for half of the minor discrepancies, and for 2 out of 3 cases of major histological discrepancies. Otherwise, the main cause of discrepancies was the difficulties in the interpretation of the morphology. Molecular biology was decisive in one case. Most grading discrepancies resulted from the appreciation of the mitotic index. CONCLUSIONS: The profile of the sarcomatous pathology in the northwest region of Romania does not appear to differ significantly from other parts of Europe or the world, but a prospective epidemiological study would be necessary to confirm this assessment. The expansion of immunohistochemical antibody panel, the over-specialization of pathologists and, in the future, the establishment of a national network of referral centers in sarcoma pathology, are required for a high level of histological diagnosis in Eastern Europe. A periodic external audit, continuing this trans-European collaboration between the two centers, would be beneficial for monitoring progress.

How I do it: managing bone health in patients with prostate cancer.

Urologists have two scenarios where they have to address bone loss or increased risk of fractures in men with prostate cancer. In the first setting, a patient who has been started on androgen deprivation therapy may develop cancer-treatment-induced bone loss. In the second setting, a patient's prostate cancer may have metastasized to the bone. This article describes six steps to manage bone health in patients diagnosed with prostate cancer in a community practice.

Prevalence of pain and analgesic use in men with metastatic prostate cancer using a patient-reported outcome measure.

PURPOSE: Contemporary tumor-directed therapies for metastatic castration-resistant prostate cancer (mCRPC) are approved to prolong life, but their effects on symptoms such as pain are less well understood as a result of the lack of analytically valid assessments of pain prevalence and severity, clinically meaningful definitions of therapeutic benefit, and methodologic standards of trial conduct. This study establishes pain characteristics in the mCRPC population using a PRO measure. MATERIALS AND METHODS: Patients with prostate cancer participated in an anonymous survey at five US comprehensive cancer centers in the Prostate Cancer Clinical Trials Consortium that incorporated the Brief Pain Inventory (BPI), analgesic use, and interference with daily activities. Prevalence and severity of cancer-related pain and analgesic use were tabulated according to castration-resistant status and exposure to docetaxel chemotherapy. RESULTS: Four hundred sixty-one patients with prostate cancer participated, of whom 147 had mCRPC involving bone (61% [89 of 147] docetaxel exposed, 39% [58 of 147] docetaxel naive). Pain of any level was more common among docetaxel-exposed versus docetaxel-naive patients with mCRPC (70% [62 of 89] v 38% [22 of 58], respectively; P<.001). BPI score≥4 was reported by 38% (34 of 89) of docetaxel-pretreated and 24% (14 of 58) of docetaxel-naive patients with mCRPC; 40% of these patients with pain intensity≥4 reported no current narcotic analgesic. CONCLUSION: Pain prevalence and severity were higher in patients with prior docetaxel exposure. Analgesics were underutilized. These results provide a method for estimating accruals along the disease continuum, and for enabling design of trials appropriately powered to assess pain.

Lesiones tumorales y pseudotumorales de la mano de niños: estudio retrospectivo de casos / Tumor and pseudotumoral lesions of the hand in children: a retrospective review

Tumor lesions of the hand in children have different features than those found in adults. Objective: To identify the type and behavior of tumors and pseudotumors in hands of patients younger de 16 years of age. Material and Method: A retrospective and descriptive study of patients younger 16 years of age, operated (in a period of 10 years), with the diagnosis of tumor in any segment of the hand, through clinical records revision, images and anatomopathologic study was done. Patients operated because of an acute infection, or foreign body reaction were not included. Results: The 77 children studied had 82 lesions located in fingers, metacarpal zone and wrist: 50 percent of them were synovial cyst, 26 percent were of soft tissue origin (mostly of vascular origin). Three tumors affected the axis or growth of a finger and two condromas presented as a fracture in a pathologic bone. One myofibroma, one osteobastoma and 6 synovial cyst relapsed and were reoperated. No malignant lesions were found. Conclusion: Tumoral and pseudotumoral lesions of the hand in children are less frequent than in adults. Usually they are benign, although some of them have a tendency to relapse or may affect the physis to the phalanx or metacarpals.

Las características de las tumoraciones de las manos en niños son diferentes a las de los adultos. Objetivo: Identificar el tipo de comportamiento de los tumores y seudotumores en manos de menores de 16 años. Material y Método: Estudio retrospectivo y descriptivo de pacientes menores de 16 años, operados (en un período de 10 años), con el diagnóstico de tumoración en algún segmento de de la mano, mediante la revisión de fichas, imagenología y estudio anatomopatológico. No se incluyó a los pacientes que fueron operados por infección aguda o reacción evidente a cuerpo extraño en la mano. Resultados: Los 77 niños estudiados tenían 82 lesiones, ubicadas en dedos, metacarpo y muñeca; de las cuales el 50 por ciento fueron quistes sinoviales, 26 por ciento tumoración de origen óseo (principalmente osteocondromas y condromas) y 24 por ciento tumoración de partes blandas (generalmente de origen vascular). Tres tumores afectaron el eje o el crecimiento del dedo y dos condromas debutaron con fractura en hueso patológico. Un miofibroma, un osteoblastoma y 6 quistes sinoviales recidivaron y necesitaron nuevas cirugías. No hubo lesiones malignas. Conclusiones: Las lesiones tumorales y seudotumorales de la mano en niños son menos frecuente que en adultos. Habitualmente son benignas aunque, algunas dan problemas por su tendencia a recidivar o porque pueden afectar la fisis de las falanges o metacarpianos.

Sarcoma.

Sarcomas comprise a heterogeneous group of mesenchymal neoplasms. They can be grouped into 2 general categories, soft tissue sarcoma and primary bone sarcoma, which have different staging and treatment approaches. This review includes a discussion of both soft tissue sarcomas (malignant fibrous histiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma, dermatofibrosarcoma protuberans, angiosarcoma, Kaposi sarcoma, gastrointestinal stromal tumor, aggressive fibromatosis or desmoid tumor, rhabdomyosarcoma, and primary alveolar soft-part sarcoma) and primary bone sarcomas (osteosarcoma, Ewing sarcoma, giant cell tumor, and chondrosarcoma). The 3 most important prognostic variables are grade, size, and location of the primary tumor. The approach to a patient with a sarcoma begins with a biopsy that obtains adequate tissue for diagnosis without interfering with subsequent optimal definitive surgery. Subsequent treatment depends on the specific type of sarcoma. Because sarcomas are relatively uncommon yet comprise a wide variety of different entities, evaluation by oncology teams who have expertise in the field is recommended. Treatment and follow-up guidelines have been published by the National Comprehensive Cancer Network (www.nccn.org).

Malignant tumors in two ancient populations: An approach to historical tumor epidemiology.

The actual increase in the rate of malignant tumors has been ascribed to a higher life expectancy and the influence of various environmental factors. Herein, we present data on the frequency of malignant tumors in paleopathologically well-defined historic populations. Thereby, we looked for malignant growth affecting the skeleton in three study populations of 905 individuals that have been excavated from the necropoles of Thebes-West and Abydos, Upper Egypt covering the time period between 3200 and 500 BC and 2547 individuals that have been buried in a Southern German ossuary dating from between AD 1400 and 1800. The tissue preservation of both the Egyptian and Southern German material was excellent. All available specimens were subjected to a very careful macroscopic examination; isolated findings were also radiologically investigated. In parallel, anthropological data, such as gender and age at death, were recorded. We identified 5 cases of malignant tumors affecting the skeleton in the Egyptian material and 13 cases affecting the skeletal material from Southern Germany. In most instances, multiple osteolytic lesions with slight osteoblastic reaction are strongly suggestive for metastatic carcinoma. Few cases with poorly reactive osteolyses were most compatible with plasmacytoma. Relative tumor frequencies on an age- and sex-adjusted population basis (using a mathematic model of skeletal involvement of malignant tumors in a well-defined English study population from AD 1901 to 1905) indicated that the tumor rates were not statistically different between ancient Egyptian, the historical Southern German and the recent English reference population. These observations indicate that malignant tumors were present in spatially and temporarily different populations over the last 4000 years with an age- and gender-adjusted frequency not different from Western industrial populations of c. 100 years ago. Therefore, we conclude that the current rise in tumor frequencies in present populations is much more related to the higher life expectancy than primary environmental or genetic factors.

Treatment of metastatic bone disease in breast cancer: bisphosphonates.

Like other metastases, bone metastases in breast cancer patients are not only a sign of the incurable nature of the underlying disease, but are also associated with specific complications. In particular, bone pain and pathological fractures impair the quality of life of those affected. Any treatment concept must, therefore, place the highest priority on preventing or reducing skeletal complications. There are two treatment options--local and systemic. Local therapy includes radiotherapy as well as surgical and orthopedic measures. The four pillars of systemic treatment are hormone therapy, chemotherapy, antiresorptive therapy with bisphosphonates, and treatment with centrally and/or peripherally acting analgesics. A precondition for successful treatment is close cooperation between medical/clinical oncologists, radiotherapists, surgeons/orthopedists, gynecologists, pain specialists, and endocrinologists (in the presence of a hypercalcemic syndrome). Patients with breast cancer associated solely with osseous metastasis may live for a number of years. It is, therefore, all the more important to start appropriate therapeutic measures early. Bisphosphonates play a particularly valuable role, since their main effect lies in the prevention of skeletal complications. Rather than replacing antineoplastic therapy, this class of substances supplements other treatments. Once started, bisphosphonate therapy should be given for the remainder of the patient's life, even in the event of osseous progression.

[Treatment of tumor osteopathy in cancer of the prostate]. / Tratamiento de la osteopatía tumoral en el cáncer de próstata.

Some 40% of patients with prostate cancer present with disseminated disease at the time of diagnosis and up to 80% of the total will develop bone dissemination during the disease. The aging of the population and the elevated incidence of prostate cancer (13% of malignancies in males) bring the figure of prostate cancer diagnosed in Europe to 85,000 new cases every year. To begin with, a comment on the overall aspects of bone metastasis from prostate cancer such as incidence, development mechanisms, distribution, prognosis and clinical outcome is made placing special emphasis on the grading and the evaluation of major therapeutical regimes for this kind of patients. Bone metastasis are the most frequent cause of pain due to cancer and are also the cause of immobilization, pathological fractures, bone marrow affectation, medullary compression and sometimes hypercalcemia. It is obvious that any comprehensible therapeutical approach must be multidisciplinary.

Effect of systemic adjuvant treatment on first sites of breast cancer relapse.

Adjuvant systemic treatment for resectable breast cancer changes the natural history of the disease but provides only a small and delayed effect on survival. Evaluation of the types of first relapse avoided by available treatments may explain why effects on mortality are small and appear late during follow-up. In randomised clinical trials done by the International Breast Cancer Study Group (IBCSG) between 1978 and 1985, 2108 patients with node-positive disease received more-effective treatments (6 or more cycles of cyclophosphamide, methotrexate, fluorouracil and prednisone; with or without tamoxifen, or tamoxifen and prednisone alone), and 722 patients received less-effective treatments (no treatment or a single cycle of chemotherapy). 3 main categories of first site of relapse were defined and evaluated by cumulative incidence analysis: local or regional, and distant soft tissue, bone, and viscera. The more-effective treatments reduced the cumulative incidence of first relapse in local or regional and distant soft tissue sites at 10 years from 36% to 18% (p = 0.0001); first relapse in bone and viscera was not altered by the more-effective treatments. These results were similar for premenopausal and postmenopausal women, and for patients with oestrogen-receptor-positive or oestrogen-receptor-negative tumours. Adjuvant systemic treatments in current use improve patient outcome mainly by reducing the incidence of first local or regional and distant soft-tissue relapses, while first recurrences in bone or viscera are influenced much less. More intensive treatments at present being tested in clinical trials might affect bone and visceral relapses and have a greater and earlier influence on survival.

Osteochondroma in a British neolithic skeleton.

The skeletal remains of past populations provide an important source of information on the natural history of disease. Relatively few cases of bone tumours have been reported in archaeological material. This paper describes one of the oldest occurrences of osteochondroma to have been identified in a human skeleton.