Skip to main content

Advertisement

Log in

A prospective analysis of CT density measurements of bone metastases after treatment with zoledronic acid

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The objective was to prospectively determine CT density changes in bone metastases, before and after intravenous zoledronic acid for a maximum period of 12 months.

Patients and methods

Twenty-three consecutive patients presented with bone metastases and underwent therapy with zoledronic acid from December 2004. All patients underwent CT of the chest, abdomen, and pelvis. Bone density, measured in Hounsfield units (HU), was determined by segmenting lesions in the same anatomical area of the metastasis sites on the axial images of the sequential series of CT examinations. The effects of zoledronic acid were evaluated by calculating absolute and relative increases in bone density.

Results

The patients presented with multiple metastases in 65% of the cases. When compared with the baseline, all groups demonstrated a significant increase in bone density, which significantly (p < 0.01) correlated with the number of zoledronic acid administrations. There was increased bone density of at least 100% in 57%, and an increase of at least 50% in 87% of the patients. This increase was significant in both lytic and sclerotic metastases after 3 months of therapy. No significant bone density difference was found in normal-appearing bone.

Conclusion

Bone density measured by CT increases at metastatic sites after zoledronic acid treatment, regardless of the type of metastasis, in contrast to apparently normal bone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol 2004; 22(14): 2942–2953.

    Article  PubMed  Google Scholar 

  2. Hayward JL, Carbone PP, Heusen JC, et al. Assessment of response to therapy in advanced breast cancer. Br J Cancer 1977; 35: 292–298.

    PubMed  CAS  Google Scholar 

  3. Mundy GR. Mechanisms of bone metastasis. Cancer 1997; 80(8 Suppl): 1546–1556.

    Article  PubMed  CAS  Google Scholar 

  4. Shih LY, Shih HN, Chen TH. Bone resorption activity of osteolytic metastatic lung and breast cancers. J Orthop Res 2004; 22(6): 1161–1167.

    Article  PubMed  CAS  Google Scholar 

  5. Kozlow W, Guise TA. Breast cancer metastasis to bone: mechanisms of osteolysis and implications for therapy. J Mammary Gland Biol Neoplasia 2005; 10(2): 169–180.

    Article  PubMed  Google Scholar 

  6. Kido DK, Gould R, Taati F, Duncan A, Schnur J. Comparative sensitivity of CT scans, radiographs and radionuclide bone scans in detecting metastatic calvarial lesions. Radiology 1978; 128(2): 371–375.

    PubMed  CAS  Google Scholar 

  7. O’Connor SD, Yao J, Summers RM. Lytic metastases in thoracolumbar spine: computer-aided detection at CT—preliminary study. Radiology 2007; 242(3): 811–816.

    PubMed  Google Scholar 

  8. Body JJ. Clinical trials in metastatic breast cancer to bone: past–present–future. Can J Oncol 1995; 5(1): 16–27.

    PubMed  Google Scholar 

  9. Hortobagyi GN, Theriault RL, Porter L, et al. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 1996; 335: 1785–1791.

    Article  PubMed  CAS  Google Scholar 

  10. Berenson JR, Lichtenstein A, Porter L, et al. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. N Engl J Med 1996; 334: 488–493.

    Article  PubMed  CAS  Google Scholar 

  11. Purohit OP, Anthony C, Radstone CR, Owen J, Coleman RE. High-dose intravenous pamidronate for metastatic bone pain. Br J Cancer 1994; 70: 554–558.

    PubMed  CAS  Google Scholar 

  12. Paterson AHG, Powles TJ, Kanis JA, et al. Double blind controlled trial of clodronate in patients with bone metastases from breast cancer. J Clin Oncol 1993; 11: 59–65.

    PubMed  CAS  Google Scholar 

  13. Lahtinen R, Laakso M, Palva I, et al. for the Finnish Leukaemia Group. Randomised, placebo-controlled multicenter trial of clodronate in multiple myeloma. Lancet 1992; 340: 1049.

    Article  PubMed  CAS  Google Scholar 

  14. Saad F, Lipton A. Zoledronic acid is effective in preventing and delaying skeletal events in patients with bone metastases secondary to genitourinary cancers. BJU Int 2005; 96(7): 964–969.

    Article  PubMed  CAS  Google Scholar 

  15. Brown JE, Cook RJ, Major P, Lipton A, Saad F, Smith M, Lee KA, Zheng M, Hei YJ, Coleman RE. Bone turnover markers as predictors of skeletal complications in prostate cancer, lung cancer, and other solid tumors. J Natl Cancer Inst 2005; 97(1): 59–69.

    Article  PubMed  CAS  Google Scholar 

  16. Luckman SP, Hughes DE, Coxon FP. Nitrogen containing bisphosphonates inhibit the mevalonate pathway and prevent post-translational prenylation of GTP-binding proteins, including ras. J Bone Miner Res 1998; 13: 581–589.

    Article  PubMed  CAS  Google Scholar 

  17. Vassiliou V, Kalogeropoulou C, Christopoulos C, Solomou E, Leotsinides M, Kardamakis D. Combination of ibandronate and radiotherapy for the treatment of bone metastases: clinical evaluation and radiologic assessment. Int J Radiat Oncol Biol Phys 2007; 67(1): 264–272.

    PubMed  CAS  Google Scholar 

  18. Fromiguè O, Kheddoumi N, Body JJ. Bisphosphonates antagonize bone growth factors effects on human breast cancer cells survival. Br J Cancer 2003; 89: 178–184.

    Article  PubMed  CAS  Google Scholar 

  19. Rosen LS, Gordon D, Kaminski M, et al. Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial. Cancer J 2001; 7: 377–387.

    PubMed  CAS  Google Scholar 

  20. Body JJ, Coleman RE, Piccart M. Use of bisphosphonates in cancer patients. Cancer Treatment Rev 1996; 22: 265–287.

    Article  CAS  Google Scholar 

  21. Ibrahim A, Scher N, Williams G, et al. Approval summary for zoledronic acid for treatment of multiple myeloma and cancer bone metastases. Clin Cancer Res 2003; 9(7): 2394–2399.

    PubMed  CAS  Google Scholar 

  22. Rosen LS, Gordon D, Kaminski M, et al. Long-term efficacy and safety of zoledronic acid compared with pamidronate disodium in the treatment of skeletal complications in patients with advanced multiple myeloma or breast carcinoma: a randomized, doubleblind, multicenter, comparative trial. Cancer 2003; 98: 1735–1744.

    Article  PubMed  CAS  Google Scholar 

  23. Body JJ. Zoledronic acid: an advance in tumour bone disease and a new hope for osteoporosis. Expert Opin Pharmacother 2003; 4: 567–580.

    Article  PubMed  CAS  Google Scholar 

  24. Kohno N, Aogi K, Minami H, et al. Zoledronic acid significantly reduces skeletal complications compared with placebo in Japanese women with bone metastases from breast cancer: a randomized, placebo-controlled trial. J Clin Oncol 2005; 23: 3314–3321.

    Article  PubMed  CAS  Google Scholar 

  25. Lipton A. Bisphosphonates and breast carcinoma: present and future. Cancer 2000; 88(12 Suppl): 3033–3037.

    Article  PubMed  CAS  Google Scholar 

  26. Huber S, Ulsperger E, Gomar C, Koderhold G, Czembirek H. Osseous metastases in breast cancer: radiographic monitoring of therapeutic response. Anticancer Res 2002; 22(2B): 1279–1288.

    PubMed  CAS  Google Scholar 

  27. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649–655.

    Article  PubMed  CAS  Google Scholar 

  28. Reinbold WD, Wannenmacher M, Hodapp N, Adler CP. Osteodensitometry of vertebral metastases after radiotherapy using quantitative computed tomography. Skeletal Radiol 1989; 18(7): 517–521.

    Article  PubMed  CAS  Google Scholar 

  29. Chow E, Holden L, Rubenstein J, et al. CT evaluation of breast cancer patients with osteolytic bone metastases undergoing palliative radiotherapy: a feasibility study. Radiother Oncol 2004; 70(3): 291–294.

    Article  PubMed  Google Scholar 

  30. Quattrocchi CC, Piciucchi S, Sammarra M, et al. Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions. Radiol Med 2007, in press.

  31. Clarke NW, McClure J, George NJ. Morphometric evidence for bone resorption and replacement in prostate cancer. Br J Urol 1991; 68(1): 74–80.

    Article  PubMed  CAS  Google Scholar 

  32. Garnero P, Buchs N, Zekri J, Rizzoli R, Coleman RE, Delmas PD. Markers of bone turnover for the management of patients with bone metastases from prostate cancer. Br J Cancer 2000; 82(4): 858–864.

    Article  PubMed  CAS  Google Scholar 

  33. Yi B, Williams PJ, Niewolna M, Wang Y, Yoneda T. Tumor-derived platelet-derived growth factor-BB plays a critical role in osteosclerotic bone metastasis in an animal model of human breast cancer. Cancer Res 2002; 62(3): 917–923.

    PubMed  CAS  Google Scholar 

  34. Roodman GD. Mechanisms of bone metastases. N Engl J Med 2004; 351(2): 195–196.

    Article  CAS  Google Scholar 

  35. Martini G, Gozzetti A, Gennari L, Avanzati A, Nuti R, Lauria F. The effect of zoledronic acid on serum osteoprotegerin in early stage multiple myeloma. Haematologica 2006; 91(12): 1720–1721.

    PubMed  CAS  Google Scholar 

  36. Pan B, Farrugia AN, To LB, Findlay DM, Green J, Lynch K, Zannettino AC. The nitrogen-containing bisphosphonate, zoledronic acid, influences RANKL expression in human osteoblast-like cells by activating TNF-alpha converting enzyme (TACE). J Bone Miner Res 2004; 19(1): 147–154.

    Article  PubMed  CAS  Google Scholar 

  37. Shapiro CL, Keating J, Angell JE, Janicek M, Gelman R, Hayes D, LeBoff MS. Monitoring therapeutic response in skeletal metastases using dual-energy x-ray absorptiometry: a prospective feasibility study in breast cancer patients. Cancer Invest 1999; 17(8): 566–574.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlo C. Quattrocchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quattrocchi, C.C., Santini, D., Dell’Aia, P. et al. A prospective analysis of CT density measurements of bone metastases after treatment with zoledronic acid. Skeletal Radiol 36, 1121–1127 (2007). https://doi.org/10.1007/s00256-007-0388-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-007-0388-1

Keywords

Navigation