Radiotherapy in bone metastasis : the Dutch bone metastasis study Linden, Y.M. van der
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Hele tekst
(2) . 3IMPLE RADIOGRAPHIC PARAMETER PREDICTS FRACTURING I METASTATIC FEMORAL BONE LESIONS :WFUUF.WBOEFS-JOEFO )FSNBO.,SPPO 4BOEFS1%4%JKLTUSB +VEJUI+-PL &E./PPSEJKL +BO8JMMFN)-FFS $PSSJF"..BSJKOFOGPSUIF%VUDI#POF .FUBTUBTJT4UVEZ(SPVQ 3BEJPUIFSBQZBOE0ODPMPHZ .
(3) )NTRODUCTION. !BSTRACT "ACKGROUND AND 0URPOSE *OUIFSBOEPNJ[FE%VUDI#POF.FUBTUBTJT4UVEZPOUIFQBMMJBUJWF FGGFDUPGBTJOHMFGSBDUJPO 4' PG(ZWFSTVTGSBDUJPOTPG(ZPOQBJOGVMCPOFNFUBTUBTFT GSBDUVSFTPDDVSSFEJOQBUJFOUTXJUIGFNPSBMNFUBTUBTFT1VSQPTFPGUIFQSFTFOUTUVEZ XBTUPJEFOUJGZMFTJPOBMSJTLGBDUPSTGPSGSBDUVSJOHBOEUPFWBMVBUFUIFJOGMVFODFPGUIFUSFBUNFOU TDIFEVMF -ATERIAL AND -ETHODS 1SFUSFBUNFOUSBEJPHSBQITPGGFNPSBMNFUBTUBTFTXFSFDPMMFDUFE5ISFF PCTFSWFSTTFQBSBUFMZNFBTVSFEUIFMFTJPOTBOETDPSFESBEJPHSBQIJDDIBSBDUFSJTUJDT 2ESULTS 5FOGSBDUVSFTPDDVSSFEBGUFSNFEJBOXFFLTJO4'QBUJFOUT BOEBGUFSNFEJBO XFFLTJONVMUJQMFGSBDUJPOQBUJFOUT 67 1 *OGFNPSBMNFUBTUBTFT BOBYJBM DPSUJDBMJOWPMWFNFOU NNTJHOJGJDBOUMZQSFEJDUFEGSBDUVSJOH .7 1 5XFMWFPVUPG GSBDUVSFEMFTJPOTBOEPVUPGOPOGSBDUVSFENFUBTUBTFTIBEBOBYJBMDPSUJDBMJOWPMWFNFOU NN OFHBUJWFQSFEJDUJWFWBMVF 8IFODPSSFDUJOHGPSUIFBYJBMDPSUJDBMJOWPMWFNFOU UIFUSFBUNFOUTDIFEVMFXBTOPUQSFEJDUJWFBOZNPSF .7 1 #ONCLUSIONS 'SBDUVSJOHPGUIFGFNVSNPTUMZEFQFOEFEPOUIFBNPVOUPGBYJBMDPSUJDBM JOWPMWFNFOUPGUIFNFUBTUBTJT8FSFDPNNFOEUPUSFBUGFNPSBMNFUBTUBTFTXJUIBOBYJBMDPSUJDBM JOWPMWFNFOU NNXJUIBO4'PG(ZGPSSFMJFGPGQBJO*GUIFBYJBMDPSUJDBMJOWPMWFNFOU NN QSPQIZMBDUJDTVSHFSZTIPVMECFQFSGPSNFEUPNJOJNJ[FUIFSJTLPGQBUIPMPHJDBMGSBDUVSJOH PS JGUIFQBUJFOUµ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¾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¿VFODFPGUIFUSFBUNFOUTDIFEVMFPO UIFPDDVSSFODFPGBGFNPSBMGSBDUVSF5IFSFGPSF BMMGFNPSBMQBUJFOUTBOEGFNP SBMMFTJPOTXJUIJOUIF%#.4XFSFSFWJFXFE5IFPCKFDUJWFPGUIFTUVEZXBTUP EF¾OFBQSBDUJDBMHVJEFMJOFUIBUDBOCFVTFEJOBDMJOJDBMTFUUJOH UPEFDJEF XIJDIGFNPSBMMFTJPOTTIPVMECFUSFBUFEXJUISBEJPUIFSBQZBOEXIJDIXJUI QSPQIZMBDUJDTVSHFSZ. -ATERIAL AND -ETHODS 0ATIENT SELECTION AND FOLLOW UP #FUXFFO.BSDIBOE4FQUFNCFS %VUDIQBUJFOUTXJUIQBJOGVM CPOFNFUBTUBTFTGSPNTPMJEUVNPSTXFSFSBOEPNJ[FECFUXFFOB4'PG(Z O BOEGSBDUJPOT NVMUJQMFGSBDUJPOT .' PG(Z O 1VSQPTFPG.
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¾MNTPGQBUJFOUTXJUIBGFNPSBMNFUBTUBTJTXFSFDPMMFDUFE3BEJPHSBQIT UBLFOOPNPSFUIBOXFFLTQSJPSUPSBOEPNJ[BUJPOXFSFDPOTJEFSFETVJUBCMF GPSFWBMVBUJPO8JUIPVULOPXMFEHFPGUIFUSFBUNFOUTDIFEVMFPSPVUDPNF BGUFSUSFBUNFOU JFBGSBDUVSFZFTPSOP BMMGFNPSBMMFTJPOTXFSFTFQBSBUFMZ BOBMZ[FECZUISFFFYQFSJFODFEPCTFSWFST BSBEJPMPHJTU BOPSUIPQFEJDTVSHFPO BOEBSBEJBUJPOPODPMPHJTU 5IFGPMMPXJOHSBEJPHSBQIJDBTQFDUTXFSFTDPSFEBQQFBSBODF QSFEPNJOBOU MZPTUFPMZUJDPSQSFEPNJOBOUMZPTUFPCMBTUJD GFBUVSF TPMJUBSZMFTJPO NVMUJQMF MFTJPOT EJGGVTFMFTJPOTJOUIFGFNVS QBUUFSOPGCPOFEFTUSVDUJPO HFPHSBQIJD NPUIFBUFO QFSNFBUJWFQBUUFSO BYJBMMPDBMJ[BUJPO QSPYJNBMGFNVS TIBGU EJTUBMGFNVS BOEUSBOTWFSTFMPDBMJ[BUJPO NPTUMZNFEJBM NPTUMZDFOUSBM NPTUMZ MBUFSBM PSBDPNCJOBUJPOPGNFEJBM DFOUSBMBOEPSMBUFSBM *ODBTFPGEJTDSFQBOU TDPSJOHCFUXFFOUIFPCTFSWFSTUIFZSFFWBMVBUFEUIFSBEJPHSBQITBOESFBDIFE BDPOTFOTVT 5IFPCTFSWFSTNFBTVSFEPOUIFBWBJMBCMFDPOWFOUJPOBMSBEJPHSBQITUIF TJ[FTPGUIFMFTJPOTJONN ¾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¾FME POMZ UIFMFTJPODPOTJEFSFEBUSJTLPGGSBDUVSJOHXBTNFBTVSFEBOETDPSFE*O QBUJFOUTXJUINPSFUIBOMFTJPODPOTJEFSFEBUSJTLPGGSBDUVSJOH CPUIMFTJPOT XFSFTFQBSBUFMZBOBMZ[FEPOMZJGUIFJSMPDBMJ[BUJPOTXFSFBUBNJOJNBMEJTUBODF PGNN 3TATISTICAL ANALYSIS 5IFEBUBCBTFXBTBOBMZ[FEVTJOH4144GPS8JOEPXT 4144*OD $IJDBHP *- 64" 4QFBSNBOµTSBOLDPSSFMBUJPOUFTUTXFSFVTFEUPBOBMZ[FUIFJOUFSPCTFSWFS WBSJBCJMJUZPGTFQBSBUFNFBTVSFNFOUT'JTIFSµT&YBDUUFTUTXFSFVTFEUPDPNQBSF QSPQPSUJPOTGPSCBTFMJOFDIBSBDUFSJTUJDTBOECBTFMJOFTDPSFESBEJPHSBQIJD BTQFDUT.BOO8IJUOFZUFTUTXFSFVTFEUPDPNQBSFRVBOUJUBUJWFBOEPSEFSFE WBSJBCMFTGPSCBTFMJOFDIBSBDUFSJTUJDTBOECBTFMJOFMFTJPOBMNFBTVSFNFOUT 4UVEFOUµTUUFTUTXFSFVTFEUPBOBMZ[FEJGGFSFODFTJOOPSNBMMZEJTUSJCVUFEEBUB GPSCBTFMJOFDIBSBDUFSJTUJDT1SFEJDUJWFWBMVFTPGSJTLGBDUPSTXFSFDBMDVMBUFE ,BQMBO.FJFSDVSWFTBOEMPHSBOLUFTUTXFSFVTFEGPSTVSWJWBMBOBMZTFT ¾HVSF -PHSBOLUFTUTXFSFVTFEUPEFUFSNJOFEJGGFSFODFTJOUJNFUPGSBDUVSFXJUIFOE PGGPMMPXVQPSEFBUIDPOTJEFSFEBTDFOTPSFE#FDBVTFUIFFOEQPJOUPGUIJT TUVEZXBTQSFWFOUJPOPGGSBDUVSFT QBUJFOUTXIPEJFEXJUIPVUBGSBDUVSFXFSF SFHBSEFEBTCFJOHTVDDFTTGVMMZQBMMJBUFE5IFSFGPSF UPHFUBHPPEFTUJNBUFPG UIFQSPCBCJMJUZPGGSBDUVSFCFGPSFEFBUIGPSFBDIOFXQBUJFOUQSFTFOUJOHXJUIB GFNPSBMMFTJPO QBUJFOUTXIPEJFEXJUIPVUBGSBDUVSFXFSFOPUDFOTPSFECVU XFSFDPOTJEFSFEUPIBWFBOVOFWFOUGVMGPMMPXVQVOUJM%FDFNCFS ¾HVSF BOE "$PYQSPQPSUJPOBMIB[BSETNPEFMXBTVTFEGPSVOJBOENVMUJWBSJBUF BOBMZTFT"MMSFQPSUFEQWBMVFTBSFCBTFEPOUXPTJEFEUFTUTXJUI1 UBLFO UPCFTJHOJ¾DBOU. 2ESULTS 2EGISTERED AND RANDOMIZED PATIENTS 0GSFHJTUFSFEQBUJFOUTXIPEJEOPUNFFUUIFFOUSZDSJUFSJB O XFSFFYDMVEFECFDBVTFPGJNQFOEJOHPSBDUVBMGSBDUVSFT.PSFUIBOPG.
(5) &)'52% . &)'52% . &)'52% . -EASUREMENTS OF METASTATIC LESIONS IN THE FEMUR IN MM LARGEST AXIAL LENGTH OF THE ENTIRE LESION , LESION
(6) LARGEST TRANSVERSE EXTENSION OF THE LESION 7 LESION
(7) LARGEST AXIAL CORTICAL INVOLVEMENT , CORT -EASUREMENTS OF THE FEMUR IN MM LARGEST TRANSVERSE WIDTH OF THE BONE 7 TOT
(8) MAXIMAL THICKNESS OF CORTEX WITHOUT LESIONAL INVOLVEMENT # TOT AND MAXIMAL THICKNESS OF CORTEX WITH LESIONAL INVOLVEMENT # LESION. 3URVIVAL IN PATIENTS WITH FEMORAL METASTASES TREATED WITHIN THE $UTCH "ONE -ETASTASIS 3TUDY FOR THE TREATMENT SCHEDULE SINGLE FRACTION OF 'Y 3& VERSUS FRACTIONS OF 'Y -&. 0ROBABILITY OF FRACTURING IN FEMORAL METASTASES FOR TH TREATMENT SCHEDULE SINGLE FRACTION OF 'Y 3& VERSUS OF 'Y -& IN PATIENTS TREATED WITHIN THE $UTCH "ONE -ETASTASIS 3TUDY . 3URVIVAL . . , LESION. . . -& X 'Y . , CORT # LESION. 0ROBABILITY OF FRACTURING . . . . . 3& X . -& X . 3& X 'Y . 7 LESION . . 4IME FROM RANDOMIZATION WEEKS. . . 4IME FROM RANDOMIZATION WEEKS. # TOT 7 TOT. UIFTFQBUJFOUT O IBEGFNPSBMNFUBTUBTFT5IFQBUJFOUDIBSBDUFSJTUJDTPG UIFSFHJTUFSFEQBUJFOUTIBWFCFFOSFQPSUFEFMTFXIFSF *OTIPSU OPNBKPSEJG GFSFODFTXFSFOPUFECFUXFFOSFHJTUFSFEBOESBOEPNJ[FEQBUJFOUTGPSTFY BHF ,BSOPGTLZ1FSGPSNBODF4DBMF JOJUJBMQBJOTDPSF QSJNBSZUVNPSPSUSFBUNFOU TJUF0GUIFSBOEPNJ[FEQBUJFOUT QBUJFOUTXFSFFOUFSFEJOUPUIFUSJBM XJUIBGFNPSBMNFUBTUBTJT8IFOUIFSBEJPHSBQITXFSFFWBMVBUFE QBUJFOUT UVSOFEPVUUPIBWFBOBDFUBCVMBSNFUBTUBTJTBOEXFSFUIFSFGPSFOPUJODMVEFE JOUIJTBOBMZTJT0GUIFSFNBJOJOHQBUJFOUT QBUJFOUT SFDFJWFEB4' BOEQBUJFOUT SFDFJWFE.' !VAILABILITY OF RADIOGRAPHS AND NUMBER OF FEMORAL LESIONS 'SPNUIFQBUJFOUTXJUIBGFNPSBMMFTJPOBMMBWBJMBCMFSBEJPHSBQITXFSF DPMMFDUFEJOIPTQJUBMTUISPVHIPVUUIF/FUIFSMBOET5IFSBEJPHSBQITPG.'QB UJFOUTXFSFNJTTJOHBOEDPVMEUIFSFGPSFOPUCFFWBMVBUFE'SPNUIFSFNBJOJOH QBUJFOUTUIFGPMMPXJOHJNBHJOH¾MNTXFSFBWBJMBCMFSBEJPUIFSBQZ TJNVMBUJPO¾MNT "1EJSFDUJPO DPOWFOUJPOBMSBEJPHSBQIT "1SBEJP HSBQIT NVMUJEJSFDUJPOBMSBEJPHSBQIT $5 PS.3*TDBOTBOECPOF TDJOUJHSBNT5IFSBEJPUIFSBQZTJNVMBUJPO¾MNTXFSFDIFDLFEGPSHFPHSBQIJDBM NJTTFTBMMMFTJPOTXFSFBEFRVBUFMZUSFBUFEXJUIJOUIFSBEJBUJPO¾FMET*O QBUJFOUTUIFMFTJPOXBTPOMZWJTJCMFPOB$5TDBO .3*TDBOPSCPOFTDJOUJHSBN 'JWF4'QBUJFOUTBOE.'QBUJFOUTIBEUXPMFTJPOTDPOTJEFSFEBUSJTLPGGSBDUVS JOH .'QBUJFOUIBEUISFFMFTJPOT*OUIFTFQBUJFOUT UIFMFTJPOTXFSFMPDBUFE JOEJGGFSFOUQBSUTPGUIFGFNVSXJUIBNJOJNBMEJTUBODFPGNN"MMMFTJPOT. XFSFJODMVEFEJOUIFBOBMZTJT*OUPUBM JOQBUJFOUTXJUIBWBJMBCMFSBEJP HSBQIT MFTJPOTXFSFTDPSFEPOSBEJPHSBQIJDBTQFDUTBOEMFTJPOTXFSF NFBTVSFE. 0ATIENT CHARACTERISTICS
(9) SURVIVAL AND OCCURRENCE OF FRACTURES 3& VERSUS -& #FUXFFOUIF4'QBUJFOUTBOE.'QBUJFOUTOPNBKPSEJGGFSFODFTJOBHF TFY QBJOTDPSFBUUJNFPGSBOEPNJ[BUJPO ,BSOPGTLZ1FSGPSNBODF4DBMF PSQSJNBSZ UVNPSXFSFGPVOE UBCMF .FEJBOGPMMPXVQXBTNPOUITJOCPUIHSPVQT SBOHFNPOUIT .FEJBOUJNFGSPNSBOEPNJ[BUJPOUPUIFTUBSUPGSBEJP UIFSBQZXBTEBZTJO4'QBUJFOUT SBOHFEBZT WFSTVTEBZTJO.'QBUJFOUT SBOHFEBZT *OUPUBM 4'BOE.'QBUJFOUTSFDFJWFEBTFDPOEJSSBEJBUJPO CFDBVTFPGDPOUJOVJOHPSSFDVSSJOHQBJO WT SFTQFDUJWFMZ 1 'JHVSFTIPXTUIFPWFSBMMTVSWJWBMPGUIFUSFBUNFOUHSPVQT4'BOE.'QBUJFOUT IBEBNFEJBOTVSWJWBMPGXFFLT $*XFFLT BOEXFFLT $* XFFLT SFTQFDUJWFMZ 1 %VSJOHGPMMPXVQ GSBDUVSFT PDDVSSFEJO4'QBUJFOUTWTGSBD UVSFT JO.'QBUJFOUT 1 'JHVSFTIPXTUIFQSPCBCJMJUZPGB GSBDUVSFCFGPSFEFBUIJOCPUIUSFBUNFOUHSPVQT EFNPOTUSBUJOHUIBU4'QBUJFOUT IBEBIJHIFSDIBODFUPFYQFSJFODFBQBUIPMPHJDBMGSBDUVSFUIBO.'QBUJFOUT .FEJBOUJNFUPGSBDUVSJOHBGUFSSBOEPNJ[BUJPOXBTXFFLTJO4'QBUJFOUT SBOHFXFFLT BOEXFFLTJO.'QBUJFOUT SBOHFXFFLT #FDBVTF 4'QBUJFOUTXFSFUSFBUFETPPOFSBGUFSSBOEPNJ[BUJPOUIBO.'QBUJFOUT UIF NFEJBOUJNFUPGSBDUVSJOHGSPNUIFTUBSUPGSBEJPUIFSBQZXBTTUVEJFE.
(10) 4!",% #(!2!#4%2)34)#3 !4 4)-% /& 2!.$/-)3!4)/. /& 0!4)%.43 7)4( ! -%4!34!4)# &%-/2!, "/.% ,%3)/. 0%2 42%!4-%.4 3#(%$5,% 3).',% &2!#4)/. 63 -5,4)0,% &2!#4)/.3 X 'Y . . 3$. . !GE -EAN. . . . . +ARNOFSKYp -EAN. 3$. . . . . . . 0RIMARY TUMOUR "REAST ,UNG 0ROSTATE /THER. . . X 'Y . LESIONS. 0 VALUE . 'ENDER -ALE &EMALE. 0AIN SCOREo -EAN. X 'Y . . 4!",% 2!$)/'2!0()# !30%#43 !.$ ,%3)/.!, -%!352%-%.43 /& 4(% &%-/2!, ,%3)/.3 &/2 4(% 42%!4-%.4 3#(%$5,%3 3).',% &2!#4)/. 6%2353 -5,4)0,% &2!#4)/.3. . . 3$ STANDARD DEVIATION o 0AIN SCORE AT RANDOMISATION
(11) MINIMAL SCORE OF ON AN nPOINT SCORE FROM NO PAIN TO WORST IMAGINABLE PAIN p +ARNOFSKY 0ERFORMANCE 3CALE CONDITIONAL SCORE
(12) RANGING FROM NORMAL SITUATION
(13) NO COMPLAINTS TO DEATH. BEEJUJPOBMMZ4'QBUJFOUTFYQFSJFODFEBGSBDUVSFBUBNFEJBOPGXFFLTGSPN UIFEBZUIFSBEJBUJPOXBTEFMJWFSFE SBOHFXFFLT DPNQBSFEUPNFEJBO XFFLTGPS.'QBUJFOUT SBOHFXFFLT 5IFTFSFTVMUTTVHHFTUUIBU.' QPTUQPOFEUIFPDDVSSFODFPGBQBUIPMPHJDBMGSBDUVSF ,ESIONAL CHARACTERISTICS AND MEASUREMENTS 3& VERSUS -& 5PFWBMVBUFUIFWBSJBCJMJUZCFUXFFOUIFPCTFSWFST 4QFBSNBOµTSBOLDPSSFMBUJPO DPFG¾DJFOUTGPSUIFTFQBSBUFNFBTVSFNFOUTXFSFDBMDVMBUFE SBOHJOHGSPN GPS-MFTJPO GPS-DPSU GPS8MFTJPO GPS8UPU GPS$UPUBOEGPS$MFTJPO7BSJBCJMJUZPGNFBTVSJOHXBT BDDFQUBCMFBOEKVTUJ¾FEDPNCJOJOHUIFNFBTVSFNFOUTJOUPPOFPVUDPNF 5BCMFMJTUTUIFMFTJPOBMDIBSBDUFSJTUJDTBOENFBTVSFNFOUTGPS4'WFSTVT.' MFTJPOT#FUXFFOUIFSBOEPNJ[BUJPOHSPVQTOPTJHOJ¾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¾DBOUMZMBSHFS8UPU BOE8MFTJPO5IFBYJBMNFBTVSFNFOUT-MFTJPOBOE-DPSUBOEUIFDPSUJDBM. X 'Y . LESIONS. 0 VALUE . 2ADIOGRAPHIC FEATURE 3OLITARY -ULTIPLE $IFFUSE. . . 2ADIOGRAPHIC APPEARANCE /STEOBLASTIC /STEOLYTIC . . . 2ADIOGRAPHIC PATTERN 'EOGRAPHIC -OTH EATEN 0ERMEATIVE . . . !XIAL LOCALIZATION 0ROXIMAL 3HAFT $ISTAL. . . 4RANSVERSE LOCALIZATION -EDIAL #ENTRAL ,ATERAL #OMBINATION. . . . . . . ,ENGTH MEDIAN AND RANGE IN MM. , LESION , CORT . . . 7IDTH MEDIAN AND RANGE IN MM 7 TOT 7 LESION . . . #ORTEX MEDIAN AND RANGE IN MM. # TOT # LESION . . . 2ADIOGRAPHIC ASPECTS WERE SCORED IN LESIONS IN PATIENTS OF WHOM RADIOGRAPHS COULD BE COLLECTED CONVENTIONA RADIOGRAPHS
(14) #4 SCANS
(15) -2) SCANS ANDOR BONE SCINTIGRAMS. ,ESIONAL MEASUREMENTS ON ONLY CONVENTIONAL RADIOGRAPHS OF LESIONS IN MM SEE &IGURE LARGEST AXIAL LENGTH ENTIRE LESION , LESION
(16) LARGEST TRANSVERSE EXTENSION OF THE LESION 7 LESION AND LARGEST AXIAL CORTICAL INVOLVEMENT , CO -EASUREMENTS OF THE FEMUR IN MM LARGEST TRANSVERSE WIDTH OF THE BONE 7 TOT
(17) MAXIMAL THICKNESS OF CORTEX WITHO LESIONAL INVOLVEMENT # TOT AND MAXIMAL THICKNESS OF CORTEX WITH LESIONAL INVOLVEMENT # LESION. NFBTVSFNFOUT$UPUBOE$MFTJPOXFSFOPUTJHOJ¾DBOUMZEJGGFSFOUCFUXFFO MFTJPOTJOUIFUXPUSFBUNFOUHSPVQT 0ATIENT CHARACTERISTICS AND SURVIVAL FRACTURES VERSUS NO FRACTURES #FUXFFOUIFQBUJFOUTUIBUFYQFSJFODFEBGSBDUVSFBOEUIFQBUJFOUTUIBU SFNBJOFEGSFFGSPNGSBDUVSJOHOPNBKPSEJGGFSFODFTFYJTUFEGPSBHF TFY QBJO TDPSFBUUJNFPGSBOEPNJ[BUJPO ,BSOPGTLZ1FSGPSNBODF4DBMFPSQSJNBSZUV NPS4JYGSBDUVSFTXFSFSFQPSUFEJOBUPUBMPGQBUJFOUTXJUICSFBTUDBODFS JOQBUJFOUTXJUIQSPTUBUFDBODFS JOQBUJFOUTXJUIMVOH DBODFS BOEJOQBUJFOUTXJUIPUIFSQSJNBSZDBODFST 1 .FEJBOGPMMPXVQXBTNPOUITGPSQBUJFOUTXJUIPSXJUIPVUBQBUIPMPHJDBM GSBDUVSF.FEJBOPWFSBMMTVSWJWBMGPSQBUJFOUTXJUIBGSBDUVSFXBTXFFLT $*XFFLT BOEXFFLTGPSQBUJFOUTXJUIPVUBGSBDUVSF $*.
(18) ,% 2!$)/'2!0()# !30%#43 !.$ ,%3)/.!, -%!352%-%.43 /& &%-/2!, ,%3)/.3 &/2 4(% /54#/-% &2!#452% 9%3 /2 ./ &RACTURE NO . LESIONS. 56 o (2 #). . . . n n . . . . . . . . n n . . AL LOCALIZATION XIMAL FT AL. . . . NSVERSE LOCALIZATION DIAL TRAL RAL MBINATION . . . . GTH MEDIAN AND RANGE IN MM. SION ORT . . . DTH MEDIAN AND RANGE IN MM. OT ESION. . . TEX MEDIAN AND RANGE IN MM. OT SION . . . n n . 0ROBABILITY OF FRACTURING . IOGRAPHIC PATTERN GRAPHIC H EATEN MEATIVE . 0 VALUE. . IOGRAPHIC FEATURE TARY TIPLE USE. IOGRAPHIC APPEARANCE EOBLASTIC EOLYTIC. &RACTURE YES . LESIONS. &)'52% 0ROBABILITY OF FRACTURING IN FEMORAL METASTASES FOR AN AXIAL CORTICAL INVOLVEMENT , CORT ) MM VERSUS , CORT MM IN PATIENTS TREATED WITHIN THE $UTCH "ONE -ETASTASIS 3TUDY. . . . ,CORT MM . ,CORT ) MM . . 4IME FROM RANDOMIZATION WEEKS. . n n n . ADIOGRAPHIC ASPECTS WERE SCORED IN LESIONS IN PATIENTS OF WHOM RADIOGRAPHS COULD BE COLLECTED CONVENTIONAL RADIOGRAPHS
(19) 4 SCANS
(20) -2) SCANS ANDOR BONE SCINTIGRAMS ,ESIONAL MEASUREMENTS ON ONLY CONVENTIONAL RADIOGRAPHS OF LESIONS IN MM SEE &IGURE LARGEST AXIAL LENGTH OF THE ENTIRE LESION LESION
(21) LARGEST TRANSVERSE EXTENSION OF THE LESION 7 LESION AND LARGEST AXIAL CORTICAL INVOLVEMENT , CORT -EASUREMENTS OF THE FEMUR N MM LARGEST TRANSVERSE WIDTH OF THE BONE 7 TOT
(22) MAXIMAL THICKNESS OF CORTEX WITHOUT LESIONAL INVOLVEMENT # TOT AND MAXIMAL ICKNESS OF CORTEX WITH LESIONAL INVOLVEMENT # LESION 56 UNIVARIATE ANALYSIS
(23) (2 HAZARD RATIO CALCULATED WITH #OX PROPORTIONAL HAZARDS MODEL
(24) #) CONl DENCE INTERVALS. XFFLT 1 1BUJFOUTXIPSFNBJOFEGSFFGSPNGSBDUVSJOHEVSJOHGPMMPXVQ XFSFOPUSFUSFBUFENPSFPGUFOUIBOQBUJFOUTXIPEFWFMPQFEBGSBDUVSF WT SFTQFDUJWFMZ 1 5IFSFGPSF BIJHIFSUPUBMEPTFPGJSSBEJBUJPOEVFUP NPSFSFUSFBUNFOUXBTOPUBWBMJEFYQMBOBUJPOGPSOPOGSBDUVSJOHPGMFTJPOT ,ESIONAL CHARACTERISTICS AND MEASUREMENTS FRACTURES VERSUS NO FRACTURES *OUBCMFUIFSBEJPHSBQIJDBTQFDUTBOEMFTJPOBMNFBTVSFNFOUTBSFMJTUFEGPS GSBDUVSFEWTOPOGSBDUVSFEMFTJPOT3BEJPHSBQIJDGFBUVSF BQQFBSBODF QBUUFSO PGEFTUSVDUJPO BYJBMPSUSBOTWFSTFMPDBMJ[BUJPOPGUIFMFTJPOTXBTOPUEJGGFSFOU CFUXFFOGSBDUVSFEBOEOPOGSBDUVSFEMFTJPOT.PTUGSBDUVSFEBOEOPOGSBD UVSFEMFTJPOTXFSFTPMJUBSZ PTUFPMZUJDMFTJPOT MPDBUFEQSPYJNBMMZJOUIFGFNVS "MUIPVHIGSBDUVSFEMFTJPOTNPSFPGUFOIBEBQFSNFBUJWFSBEJPHSBQIJDQBUUFSO . UIJTXBTOPUQSFEJDUJWFGPSGSBDUVSJOH 1 .PTUGSBDUVSFEMFTJPOTXFSF MPDBUFENFEJBMMZ PSXFSFBDPNCJOBUJPOPGNFEJBM DFOUSBMBOEPSMBUFSBM 1 5IFMBSHFTUBYJBMMFOHUIPGUIFFOUJSFMFTJPO UIFUSBOTWFSTF NFBTVSFNFOUT8UPUBOE8MFTJPOBOEUIFDPSUJDBMNFBTVSFNFOUT$UPUBOE $MFTJPOXFSFOPUTJHOJ¾DBOUMZEJGGFSFOUCFUXFFOGSBDUVSFEBOEOPOGSBDUVSFE MFTJPOT5IFBYJBMDPSUJDBMJOWPMWFNFOU-DPSUXBTUIFPOMZQBSBNFUFSJOUIF VOJWBSJBUFBOBMZTJTTJHOJ¾DBOUMZQSFEJDUJWFGPSGSBDUVSJOH 1 .FEJBO -DPSUGPSGSBDUVSFEMFTJPOTXBTNNWTNNGPSOPOGSBDUVSFEMFTJPOT $VUPGGQPJOUTGPSUIFBYJBMDPSUJDBMJOWPMWFNFOUXFSFDIPTFOUPEFUFSNJOFB NPSFPCKFDUJWFQSFEJDUPSGPSGSBDUVSJOH"DVUPGGQPJOUPGNNTJHOJ¾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¾DBOUMZ.
(25) TNBMMFS NNWTNNGPS"1WTNVMUJEJSFDUJPOBMSFTQFDUJWFMZ 1 EFNPOTUSBUJOHUIBU"1¾MNTDPVMECFVTFESFMJBCMZUPNFBTVSF-DPSU #FUXFFO4'BOE.'QBUJFOUTUIFQFSDFOUBHFPGMFTJPOTXJUI-DPSU NNXBT OPUEJGGFSFOU WT SFTQFDUJWFMZ 1 4VCTFRVFOUMZ XFQFSGPSNFE BNVMUJWBSJBUFBOBMZTJTXJUIUIFWBSJBCMFTUIBUQSFEJDUFEGSBDUVSJOHJOUIF VOJWBSJBUFBOBMZTJTSBOEPNJ[BUJPOUSFBUNFOUTDIFEVMFBOE-DPSU NN 8IFODPSSFDUJOHGPS-DPSU NN XFDPVMEOPUEFNPOTUSBUFUIFUSFBUNFOU TDIFEVMFUPCFBTJHOJ¾DBOUQSFEJDUPSGPSGSBDUVSJOH 1 )3 $* °. "OBYJBMDPSUJDBMJOWPMWFNFOU NNSFNBJOFEQSFEJDUJWFGPSGSBDUVSJOH JOUIFNVMUJWBSJBUFBOBMZTJT 1 )3 $*°. . $ISCUSSION *OUIJTTUVEZPOGSBDUVSFSJTLTJOGFNPSBMNFUBTUBUJDMFTJPOT XFEFNPOTUSBUFE UIFBYJBMDPSUJDBMJOWPMWFNFOUPGUIFMFTJPOUPCFTJHOJ¾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¾YBUJPOT5IFSFGPSF OPJOGPSNB UJPOPOUIFOBUVSBMDPVSTFPGUIFTFMFTJPOTXJUIPVU¾YBUJPOXBTBWBJMBCMF#F DBVTFNPTUQBUJFOUTIBWFMJNJUFEMJGFFYQFDUBODJFT JUJTQPTTJCMFUIBUBMBSHF QSPQPSUJPOPGUIFMFTJPOTXPVMEIBWFOFWFSQSPHSFTTFEJOUPBGSBDUVSF5IF QSFTFOUTUVEZIBTUIFNBKPSBEWBOUBHFUIBUBMMSFWJFXFEGFNPSBMQBUJFOUTXFSF SBOEPNJ[FEJOUPBQSPTQFDUJWFSBEJPUIFSBQZUSJBMXJUIBEFRVBUFGPMMPXVQPO TVSWJWBMBOEEFWFMPQNFOUPGGSBDUVSFT'PVSUFFOPGUIFSBOEPNJ[FEQBUJFOUT XJUIBGFNPSBMMFTJPOEFWFMPQFEBQBUIPMPHJDBMGSBDUVSFEVSJOHGPMMPXVQ8F EFNPOTUSBUFEUIFBYJBMDPSUJDBMJOWPMWFNFOUPGUIFMFTJPOUPCFTJHOJ¾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
(26) UIBUUIFTFFYQFDUFEIJHISJTLBOEBMSFBEZGSBDUVSFEMFTJPOTXFSFMBSHFSUIBO PSBUMFBTUBTMBSHFBTUIFFYQFDUFEMPXSJTLMFTJPOTUIBUXFSFSBOEPNJ[FEJOUP UIF%#.45IFSFGPSF XFCFMJFWFUIFVTFPG-DPSUBTBHVJEFMJOFGPSUSFBUNFOU JTBQQMJDBCMFUPBMMGFNPSBMMFTJPOT4FDPOEMZ UIFTDPSJOHBOENFBTVSJOH PGUISFFPCTFSWFSTXFSFDPNCJOFEJOUPPOFPVUDPNFUPTJNVMBUFBNVMUJ EJTDJQMJOBSZTFUUJOHJOXIJDIDMJOJDJBOTKPJOUIFJSJOEJWJEVBMFYQFSJFODF5IF JOUFSPCTFSWFSWBSJBCJMJUZPGUIFNFBTVSFNFOUTXBTSFBTPOBCMFBOEKVTUJ¾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¾DBUJPOBGUFSSBEJPUIFSBQZ $IFOH FUBMSFUSPTQFDUJWFMZTUVEJFECPOFNFUBTUBTFTJOCSFBTUDBODFSQBUJFOUT 'PSJNQFOEJOHGSBDUVSJOHUIFZUPPLDSJUFSJBUIBU#FBMTBOE)BSSJOHUPOTVHHFTU FEGPSQSFEJDUJOHGSBDUVSJOH BMFTJPO NNJOEJBNFUFSBOEPSBOZMFTJPO. XJUIBDJSDVNGFSFOUJBMEFTUSVDUJPOPGUIFDPSUFY 5IJSUZOJOFFYQFDUFE JNQFOEJOHGFNPSBMMFTJPOTEJEOPUCSFBLEVSJOHGPMMPXVQBGUFSBSBEJBUJPO EPTFPGUP(Z*OQBUJFOUTFWJEFODFPGSFPTTJ¾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µTDPOEJUJPO JTMJNJUFE SBEJPUIFSBQZVTJOHNVMUJQMFGSBDUJPOTTIPVMECFHJWFOUPQPTUQPOF UIFPDDVSSFODFPGBGSBDUVSF*GUIFBYJBMDPSUJDBMJOWPMWFNFOU NN QSPQIZMBDUJDTVSHFSZTIPVMEBMXBZTCFDPOTJEFSFE BDDFQUJOHBSFMBUJWFMZ IJHIQFSDFOUBHFPGTVSHJDBMJOUFSWFOUJPOTUPQSFWFOUEJTBCMJOHQBUIPMPHJDBM GSBDUVSJOHPGUIFGFNVS. 2EFERENCE ,IST. 'Y SINGLE FRACTION RADIOTHERAPY FOR THE TREATMENT OF METASTATIC SKELETAL PAIN RANDOMIZED COMPARISON WITH A MULTIFRACTION SCHEDULE OVER MONTHS OF PATIENT FOLLOW UP "ONE 0AIN 4RIAL 7ORKING 0ARTY 2ADIOTHER /NCOL "ARNES %!
(27) 0ALMER *,
(28) "RUERA % 0REVALENCE OF SYMPTOM CONTROL AND PALLIATIVE CARE ABSTRACTS PRESENTED AT THE !NNUAL -EETING OF THE !MERICAN 3OCIETY FOR 4HERAPEUTIC 2ADIOLOGY AND /NCOLO )NT * 2ADIAT /NCOL "IOL 0HYS "ATES 4 ! REVIEW OF LOCAL RADIOTHERAPY IN THE TREATMENT OF BONE METASTASES AND CORD COMPRESSION )NT * 2ADIAT /NCOL "IOL 0HYS "EALS 2+
(29) ,AWTON '$
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(31) ,AMONT (AVERS 7
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(34) 3HEA " "ONE METASTASIS AND REHABILITATION #ANCER 3UPPL #HENG $3
(35) 3EITZ #"
(36) %YRE (* .ONOPERATIVE MANAGEMENT OF FEMORAL
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(39) /UDKERK -
(40) 7IGGERS 4 0REDICTION OF PATHOLOGICAL SUBTROCHANTERIC FRACTURES DUE TO METASTATIC LESIONS !RCH /RTHOP 4RAUMA 3URG .
(41) $IJKSTRA 3
(42) 7IGGERS 4
(43) VAN 'EEL ".
(44) "OXMA ( )MPENDING AND ACTUAL PATHOLOGICAL FRACTURES IN PATIENTS WITH BONE METASTASES OF THE LONG BONES ! RETROSPECTIVE STUDY OF SURGICALLY TREATED FRACTURES %UR * 3URG &IDLER - 0ROPHYLACTIC INTERNAL lXATION OF SECONDARY NEOPLASTIC DEPOSITS IN LONG BONES "R -ED * &IDLER - )NCIDENCE OF FRACTURE THROUGH METASTASES IN LONG BONES !CTA /RTHOP 3CAND 'AZE -.
(45) +ELLY #'
(46) +ERR '2
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(48) 3PRINGlELD $3
(49) (AYES 7# 0REDICTING PATHOLOGIC FRACTURE RISK IN THE MANAGEMENT OF METASTATIC BONE DEFECTS #LIN /RTHOP (OSKIN 0*
(50) 0RICE 0
(51) %ASTON $
(52) ET AL ! PROSPECTIVE RANDOMIZED TRIAL OF 'Y OR 'Y SINGLE DOSES IN THE TREATMENT OF METASTATIC BONE PAIN 2ADIOTHER /NCOL *ANJAN .! 2ADIATION FOR BONE METASTASES CONVENTIONAL TECHNIQUES AND THE ROLE OF SYSTEMIC RADIOPHARMACEUTICALS #ANCER 3UPPL *ENSEN -0
(53) +AROLY 0
(54) "RAVER 3 4HE MEASUREMENT OF CLINICAL PAIN INTENSITY A COMPARISON OF SIX METHODS 0AIN +EENE *3
(55) 3ELLINGER $3
(56) -C"EATH !!
(57) %NGBER 7$ -ETASTATIC BREAST CANCER IN THE FEMUR ! SEARCH FOR THE LESION AT RISK OF FRACTURE #LIN /RTHOP ,ODWICK '3 )N 4HE "ONES AND *OINTS
(58) AN ATLAS OF TUMOR RADIOLOGY 9EAR "OOK -EDICAL 0UBLISHERS )NC
(59) #HICAGO
(60) PP -ENCK (
(61) 3CHULZE 3
(62) ,ARSEN % -ETASTASIS SIZE IN PATHOLOGIC FEMORAL FRACTURES !CTA /RTHOP 3CAND -ILLER &
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(67) PP .IELSEN /3
(68) "ENTZEN 3-
(69) 3ANDBERG %
(70) 'ADEBERG ##
(71) 4IMOTHY !2 2ANDOMIZED TRIAL OF SINGLE DOSE VERSUS FRACTIONATED PALLIATIVE RADIOTHERAPY OF BONE METASTASES 2ADIOTHER /NCOL /SZARAN :
(72) 9ALMAN $
(73) !NACAK 9
(74) %SASSOLOAK -
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(76) -URRAY *! 3URGICAL TREATMENT FOR SECONDARY NEOPLASTIC FRACTURES ! RETROSPECTIVE STUDY OF NINETY SIX PATIENTS * "ONE *OINT 3URG !M 0RICE 0
(77) (OSKIN 0*
(78) %ASTON $
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(80) 0ALMER 3'
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