Journal Reading

Spinal bone
metastases in
colorectal cancer: a
retrospective
analysis of
Tilman Bostel, Robert Foster, Ingmar Schlampp, Tania Sprave, Thomas Bruckner stability
National Center for Radiation Oncology, Germany
prognostic factors
and survival after
palliative
dr. Lon Hitman Rizal radiotherapy
BACKGROUND
– CRC is one of the most common cancers worldwide
– Poor prognosis
– 5 year survival rate: 10%
– Most common bone metastasis: vertebral collumn
– The aims of analysis: assess bone lesion resulting from CRC in terms of stability,
fracture before and after RT, survival, and predictive factors for stability and
survival.
METHODS

– 94 patients
– With bone metastases of thoracic and lumbar resulting from CRC
– February 2000 – July 2014
– Department of Radiation Oncology at Heidelberg University Hospital
– Cancer registry of the National Center of Tumour Disease
– Patients underwent regular examination follow up CT imaging
– Diagnosis based on CT,MRI,or scintigraphy findings
METHODS
– Stability of each vertebral body
was assessed according to Taneichi
bone stability score
– Also based on follow up CT at 3
and 6 month after radio theraphy
– Classifiying osteolytic metastatic in
vertebral bodies as stable or
unstable
– Statistics analysis using SAS Software 9.3
– P value p<0,05
– Bone survival defined as time between first day of RT until death from any
cause
– Survival was plotted according to Kaplan-Meier method
DISCUSSION
– Major problems patients with bone metastasis :
1. Reduce quality of life
2. Drug resistant pain symptoms
3. Manifest or impending fracture
4. Tumor induced hypercalcemia and neurological complication.
– Taneichi scoring system is an tool for classification of spinal metastasis regarding
risk of pathological fracture or bone instability.
– 63% had unstable bone metastasis and after 6 months only 9% reached
reossification and stabilization with palliative RT
– Stabilization rate relative poor
– Chemotheraphy and or bisphosphonate therapy improved bone survival
– Limited study: retrospective and limited number of patients
– Selection criteria for the application of chemotherapy and bisphosphonates
were retrospectively not available
– Palanned analysis of prognostic factors fos stabilization of initially unstable bone
metastases was not possible
– Taneichi score limitation : patients with bone metastases from CRC outside the
thoracic and lumbar spine were not considred.
CONCLUSION

– Bone metastases due to CRC :

1. Poor bone survival
2. Low recalcification rates
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