[Response of bone metastases to medical treatment: definition of evaluation criteria and classification trials].
Bone metastases are very frequent. Some are sensitive to the action of anticancer drugs. However, there is as yet an unsolved methodological problem in the evaluation of response to these drugs. The uniquely radiological UICC criteria are quite insufficient, in as much as they appear with a long delay and sometimes give erroneous results. In this work we give a brief review of biological and clinical knowledge about bone metastases, and we attempt to give an array of the possible evaluation criteria and their respective value. We propose as a working hypothesis a classification of responses taking into account the criteria: the urinary hydroxyproline to urinary creatinine ratio, the serum dosage of bone isoenzyme of alkaline phosphatase and propeptide of type III procollagen (P III NP), and as an essential element, an analysis of all available imaging techniques. A visual study of bone scintillation scans must precede that of radiographs and, when possible, it must be associated to computerized scintillation scanning. When metastasis are located to the pelvis, the vertebral column, or the sternum, a CT scan or better, a nuclear magnetic resonance study (IRM), is indispensable in order to have a direct measure of the tumor extension to soft tissues. Furthermore, in the case of isolated metastases, one of these imaging techniques allows a diagnostic biopsy. Finally an analysis of response at the bone level will always be associated with a measure of their duration and an evaluation of metastases to other sites.
Belpomme
D
D
Hôpital Bichat, Paris, France.
Droz
J P
JP
Marie
F N
FN
Namer
M
M
Tan
T N
TN
Pecking
A
A
Rouesse
J
J
Vanel
D
D
Bock
P
P
Cappelaere
P
P
D000135:Acid Phosphatase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000097:blood / Q000145:classification / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D005069:Evaluation Studies as Topic; D006801:Humans; D006909:Hydroxyproline / Q000652:urine; D008279:Magnetic Resonance Imaging; D010147:Pain Measurement; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D000469:Alkaline Phosphatase; D000135:Acid Phosphatase; D006909:Hydroxyproline
Réponse des métastases osseuses aux thérapeutiques médicales: définition des critères d'évaluation et essai de classification.