Radiotherapy in bone metastasis : the Dutch bone metastasis study Linden, Y.M. van der
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(2) . )NTRODUCTION AND OUTLINE.
(3) )NTRODUCTION -ECHANISMS OF METASTASIS *OHFOFSBM BMMNBMJHOBOUUVNPSTIBWFUIFQPUFOUJBMUPNFUBTUBTJ[F)PXFWFS GSFRVFODZPGNFUBTUBTJTBOETQFFEPGPOTFUBGUFSUIFQSJNBSZEJBHOPTJTEJGGFS CFUXFFOUIFWBSJPVTQSJNBSZUVNPST8IFOUIFQSJNBSZUVNPSHSPXTBOECF DPNFTWBTDVMBSJ[FE BOHJPHFOFTJT JOWBTJPOPGBEKBDFOUTUSVDUVSFTNBZPDDVS XJUIQFOFUSBUJPOPGCMPPEWFTTFMTBOEMZNQIBUJDT.FUBTUBTJTJTUIFTVCTFRVFOU QSPDFTTJOXIJDIBUVNPSDFMMMFBWFTUIFQSJNBSZUVNPS USBWFMTUPBEJTUBOUTJUF JOUIFCPEZWJBUIFIBFNBUPHFOPVTPSUIFMZNQIBUJDDJSDVMBUPSZTZTUFNBOE FTUBCMJTIFTBTFDPOEBSZUVNPSJOMZNQIOPEFT WFTTFMTPSIPTUUJTTVF5IF NFUBTUBTJTHSPXTBOEWBTDVMBSJ[FT ¾OBMMZMFBEJOHUPGVSUIFSNFUBTUBTJTGSPN NFUBTUBTFT *OCPOF UVNPSHSPXUIVTVBMMZTUBSUTJOUIFNFEVMMBJSZDBWJUZ BOEGSFRVFOU MZUIFOHSPXTJOUPUIFDPSUFY.BOZJOUSJOTJDCJPMPHJDBMBOENJDSPFOWJSPONFO UBMGBDUPSTQMBZBSPMF *OUIFCPOFNBSSPX TQFDJ¾DHSPXUIGBDUPSTTVDIBT JOTVMJOMJLFHSPXUIGBDUPS *(' BOEUSBOTGPSNJOHHSPXUIGBDUPS 5(' GBDJM JUBUFBOETUJNVMBUFUIFQSPMJGFSBUJPOPGUVNPSDFMMT$ZUPLJOFTTVDIBTJOUFS MFVLJO *- ° *-BOEUVNPSOFDSPTJTGBDUPS 5/' ũBMTPDPOUSJCVUF 5VNPS DFMMTBDUJWBUFUIFOPSNBMCPOFGPSNJOHDFMMT UIFPTUFPDMBTUTBOEPTUFPCMBTUT MFBEJOHUPCPUICPOFEFTUSVDUJPOBOEOFXCPOFGPSNBUJPOUIBUDBVTFTBCFSSBOU CPOFHSPXUI5IFPTUFPDMBTUTOPSNBMMZSFTPSCCPOFEVSJOHUIFQIZTJPMPHJD QSPDFTTPGCPOFSFNPEFMJOHBOESFQBJS8IFOUIFSFJTBNBSLFEJODSFBTFPGPT UFPDMBTUGPSNBUJPOBOEBDUJWJUZDBVTFECZUVNPSQSPEVDUTPTUFPMZTJTPDDVST 'PMMPXJOHPTUFPMZTJTUIFSFNBZCFBTVCTFRVFOUPTUFPCMBTUJDSFTQPOTF XJUI PTUFPCMBTUTTZOUIFTJ[JOHBOPTUFPJENBUSJY CVUUIJTJTPGUFOCMVOUFEBOE TPNFUJNFTBCTFOU 8JUICPOFNFUBTUBTFT UVNPSDFMMTUFOEUPNFUBTUBTJ[FUPUIFCFTUWBTDV MBSJ[FEQBSUTPGUIFCPEZ%JWJTJPOPGCPOFNFUBTUBTFTPWFSUIFTLFMFUPOJT NPTUMZJOUIFSFECPOFNBSSPXPGUIFBYJBMTLFMFUPO BOEJOUIFQSPYJNBMFOET PGUIFMPOHCPOFT UIFSJCT BOEUIFWFSUFCSBMDPMVNO#POFNFUBTUBTFTJOUIF EJTUBMFYUSFNJUJFTBSFSBSF 5IFSBEJPHSBQIJDBQQFBSBODFPGBCPOFMFTJPOJTPGUFOUZQJDBMGPSDFSUBJOQSJ NBSZUVNPST-ZUJDCPOZMFTJPOTBSFNPTUDPNNPOBOEQSFTFOUJOCSFBTU MVOH UIZSPJE SFOBMBOEHBTUSPJOUFTUJOBMNBMJHOBODJFTBOEJONFMBOPNB-FTTPGUFO NFUBTUBTFTGSPNTPMJEUVNPSTDBVTFBOJODSFBTFJOPTUFPCMBTUBDUJWJUZ MFBEJOH UPFYDFTTCPOFGPSNBUJPO TDMFSPTJT #FDBVTFUIFQSPDFTTPGTZOUIFTJTPGDPMMB HFOBOEPUIFSCPOFQSPUFJOTJTBDDFMFSBUFEVOOBUVSBMMZ UIFOFXMZGPSNFECPOF JTJNNBUVSFBOEJODPNQMFUFMZNJOFSBMJ[FE.FUBTUBTFTGSPNQSPTUBUFDBODFS FTQFDJBMMZ CVUBMTPUIPTFGSPNCSFBTU MVOH DBSDJOPJEBOENFEVMMPCMBTUPNB UVNPSTHJWFSJTFUPUIFTFTDMFSPUJDMFTJPOT .
(4) .EWER APPLICATIONS OF #4 AND -2) MAY BE USEFUL FOR OBTAINING WHOLE BODY IMAGES IN A R EASONABLE TIME
(5) BUT THE COST OF CENTRAL AXIAL SKELETAL IMAGING REMAINS HIGH . !LTHOUGH THE RANGES OF SENSITIVITY AND SPECIl CITY VALUES FOR 33 VARY
(6) IN MOST REPORTS 33 IS REGARDED AS A HIGHLY SENSITIVE BUT POORLY SPECIl C MODALITY. . %STIMATES ARE BASED ON -EDICARE FEE SCHEDULES FOR (ARRIS #OUNTY
(7) 4EXAS
(8) 53! ,OW LESS THAN MODERATE TO HIGH MORE THAN 6ALUES ARE GIVEN IN 53 DOLLARS. . . 33 SKELETAL SCINTIGRAPHY
(9) 82 PLAIN RADIOGRAPHY
(10) #4 COMPUTED TOMOGRAPHY
(11) -2) MAGNETIC RESONANCE IMAGING
(12) 0%4 POSITRON EMISSION TOMOGRAPHY
(13) 30%#4 SINGLE PHOTON EMISSION COMPUTED TO. 4ERMS ARE DEl NED AS FOLLOW WHOLE BODY THE ENTIRE BODY IS STUDIED AT ONE TIME WITH ONE IMAGE REGIONAL LARGE ANATOMIC AREA STUDIED AT ONE TIME WITH ONE IMAGE AND LOCAL FOCAL OR SM STUDIED AT ONE TIME WITH ONE IMAGE. . . -ODERATE (IGH (IGH 30%#4. (OT SPOTS. 3AME AS 33 ,OCAL .O. 3AME AS 33. (IGH (IGH 6ARIES 0%4. (OT SPOTS. ,ESION ONLY IN THE CORTEX 7HOLE BODY .O. !FTER CHEMOTHERAPY. -ODERATE CERVICAL SPINE THORACIC SPINE LUMBAR SPINE WITHOUT CONTRAST (IGH (IGH ,OW OR HIGHER ,ESION ONLY IN INTENSITY SIGNAL ON THE CORTEX 44 SCANS 2EGIONAL -2). 9ES. %DEMA. -ODERATE THORACIC ABDOMINAL WITHOUT CONTRAST .UMERICAL SPECIl CITY VALUES NOT ADDRESSED (IGH ,YTIC
(14) SCLEROTIC
(15) MIXED FOR BONE
(16) HIGHER ATTENUATION FOR MARROW ,OCALREGIONAL #4. 9ES. ,YSISSCLEROSIS NOT AT 4RAUMA
(17) TRESHOLD FOR INm AMMATION
(18) DETECTION BENIGN TUMOR HEALING. ,OW .UMERICAL SPECIl CITY VALUES NOT ADDRESSED ,OW 4RAUMA
(19) INm AMMATION
(20) BENIGN TUMOR HEALING ,YTIC
(21) SCLEROTIC
(22) MIXED ,OCALREGIONAL WHOLE BODY 82. 9ES. "ONE MARROW ONLY ,YSISSCLEROSIS NOT AT TRESHOLD FOR DETECTION /STEOPENIA. ,OW 6ARIES 6ARIES 33. (OT SPOTS. 2APIDPURE OSTEOLYTIC PROGRESSION 7HOLE BODY .O. 4RAUMA
(23) INm AMMATION
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(138) (OSKIN 0*
(139) %ASTON $
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(145) (OSKIN 0*
(146) %ASTON $
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(149) 9ARNOLD *2 0ROSPECTIVE RANDOMISED TRIAL OF SINGLE AND MULTIFRACTION RADIOTHERAPY SCHEDULES IN THE TREATMENT OF PAINFUL BONY METASTASES 2ADIOTHER /NCOL .
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(151) 0RICE 0
(152) %ASTON $
(153) 2EGAN *
(154) !USTIN $
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(158) !NDERSSON -
(159) "ANNING !-
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(164) 7ALTER +
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(190) 4ORIYAMA 3
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