Patterns of bone metastases and bisphosphonate use in renal cancer patients in Leeds, UK
Year: 2008
Session type: Poster / e-Poster / Silent Theatre session
1St James' Institute of Oncology, Leeds, UK, 2Cancer Research UK Academic Unit of Oncology, Leeds, UK
Abstract
Background
Renal cancer commonly results in bony metastases and it is estimated that around 30% of patients with metastases will have skeletal involvement. Skeletal-related events (SREs) such as hypercalcaemia, bone pain, pathological fractures and spinal cord compression and, indeed, skeletal morbidity rate is higher in these patients than in other cancer types. Bisphosphonates (BP) have been shown to reduce SREs in this group of patients but their use is inconsistent in clinical practice. We audited our metastatic renal cancer practice with the aim of identifying patterns of bone disease and BP use.
Method
A search was conducted of the Patient Pathway Manager electronic database using the terms ‘renal cancer’, ‘bone’ and ‘metastases’ in proximity as far back as electronic records were available (1998). This yielded 607 patients of which 272 had renal cell cancer with bone metastases. We then extracted information from clinical records regarding distribution of metastases, SRE’s and bisphosphonate use from 2002, when BP became indicated in the treatment of renal cancer bone metastases.
Results
We identified 181 male patients and 73 female patients with renal cancer and bone metastases. The median was 61.8 (range- 29-80). 144 (56.6%) had bone metastases at presentation. 62 patients (24%) had multiple sites of bone metastases. Of the remaining 192 patients, 153 had metastases in the axial skeleton, 36 in long bones, 1 in the skull and 2 in other sites. From 2002, 47.3% of patients received bisphosphonates including Pamidronate (n=36), Zoledronic acid (n=32) and Clodronate (n=4). Indications included hypercalcaemia (n=26 pts), prevention (n=26) and pain (n=16). Further SREs included the need for radiotherapy in 87.5% of patients, fractures in 24%, spinal cord compression in 23.5% and orthopaedic surgery in 23.5%.
Conclusion
Despite the large number of SREs, use and dose schedule of bisphosphonates was inconsistent in this patient group. With recent advances in renal cancer treatments, more focus needed to optimise the management of bone metastases.
Background
Renal cancer commonly results in bony metastases and it is estimated that around 30% of patients with metastases will have skeletal involvement. Skeletal-related events (SREs) such as hypercalcaemia, bone pain, pathological fractures and spinal cord compression and, indeed, skeletal morbidity rate is higher in these patients than in other cancer types. Bisphosphonates (BP) have been shown to reduce SREs in this group of patients but their use is inconsistent in clinical practice. We audited our metastatic renal cancer practice with the aim of identifying patterns of bone disease and BP use.
Method
A search was conducted of the Patient Pathway Manager electronic database using the terms ‘renal cancer’, ‘bone’ and ‘metastases’ in proximity as far back as electronic records were available (1998). This yielded 607 patients of which 272 had renal cell cancer with bone metastases. We then extracted information from clinical records regarding distribution of metastases, SRE’s and bisphosphonate use from 2002, when BP became indicated in the treatment of renal cancer bone metastases.
Results
We identified 181 male patients and 73 female patients with renal cancer and bone metastases. The median was 61.8 (range- 29-80). 144 (56.6%) had bone metastases at presentation. 62 patients (24%) had multiple sites of bone metastases. Of the remaining 192 patients, 153 had metastases in the axial skeleton, 36 in long bones, 1 in the skull and 2 in other sites. From 2002, 47.3% of patients received bisphosphonates including Pamidronate (n=36), Zoledronic acid (n=32) and Clodronate (n=4). Indications included hypercalcaemia (n=26 pts), prevention (n=26) and pain (n=16). Further SREs included the need for radiotherapy in 87.5% of patients, fractures in 24%, spinal cord compression in 23.5% and orthopaedic surgery in 23.5%.
Conclusion
Despite the large number of SREs, use and dose schedule of bisphosphonates was inconsistent in this patient group. With recent advances in renal cancer treatments, more focus needed to optimise the management of bone metastases.
