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Metastatic Breast Cancer

- Discussion:
     - metastatic breast disease survival averages 34 months;
     - avg life expectancy w/ metastatic disease to bone is > 18 months;

- Radiographs:
    - permeative destructive lesions of bone;
    - permeative destruction of the proximal femur is the most common type of destruction leading to a pathologic fracture;
    - look for subtle changes of bony destruction;
    - permeative destruction of bone is most likely due to metastatic deposits of breast cancer;

- Labs:
    - need to rule out hypercalcemia;

- Biopsy:
    - because disuse osteoporosis may show similar appearance, the x-ray diagnosis
           should be confirmed w/ biopsy, unless the diagnosis has already been confirmed;

- Medical Management:
    - estrogens & antiestrogens:
             - cause hypercalcemia in approx 30% of pts when used to treat breast cancer, which is metastatic to the skeleton;
    - bisphosphonates:
             - pamidronate

- Surgical Fixation:
    - permeative destruction of the proximal femur is the most common type of destruction leading to a pathologic fracture;
    - for pts w/ this type of destruction involving more than 50% of the shaft diameter on any radiographic view, consider prophylactic
           internal fixation of femoral neck & subtrochanteric region;
           - see: technique of femoral IM nailing:
    - wide resection of solitary mets;
           - in the retrospective study by Dürr HR, et al, the authors studied the effect of wide resection on solitary breast ca mets;
                   - of the six patients with radically resected solitary bone lesions, five patients had systemic progression of the disease develop;
                   - for the entire group, the survival rate was 59% after 1 year, 36% after 2 years, 13% after 5 years, and 7% after 10 years;
                   - independent factors that were associated with survival were the extent of the disease and the duration of symptoms from bone metastasis;
                   - the authors noted that wide resection of solitary mets did not improve survival and that patients with solitary bone lesions have a 39% chance of living 5 years

The pattern of vertebral involvement in metastatic vertebral breast cancer.

Human breast cancer: survival from first metastasis. Breast Cancer Study Group.

Surgical Treatment of Bone Metastases in Patients With Breast Cancer   

Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. Protocol 19 Aredia Breast Cancer Study Group.

Metastatic breast cancer: overview of treatment.