title: Radiotherapy in conjunction with intravenous infusion of 180 mg of disodium pamidronate in management of osteolytic metastases from breast cancer: clinical evaluation, biochemical markers, quality of life, and monitoring of recalcification using assessments of gray-level histogram in plain radiographs.
abstract: OBJECTIVE
  To evaluate the clinical improvement and radiographically monitor the effect of local radiotherapy in conjunction with disodium pamidronate (DP) on metastatic osteolytic disease.
  
  
  METHODS
  Thirty-three patients with osteolytic metastasis from advanced breast cancer received radiotherapy with a 6-MV linear accelerator up to a dose of 30 Gy (3 Gy/fraction, 5 d/wk) combined with 24 monthly sessions of a 180-mg DP infusion. Conventional X-rays were obtained during the first six sessions of DP treatment, retaining the same settings for each exposure. The analysis of the image attributes was based on measuring the first-order statistics of the mean value and energy of gray-level histograms in the osteolytic region.
  
  
  RESULTS
  The 6-month measurements compared with baseline showed statistically significant differences (p < 0.01, Wilcoxon test) in energy of gray-level histogram (-10.8%), mean value of gray-level histogram (+9.5%), pain score (-5.8 points), Eastern Cooperative Oncology Group status (-2.4 points), urine hydroxyproline/creatinine ratio (-41.7%), urine calcium/creatinine ratio (-58.8%), and bone alkaline phosphatase (-42.4%). Quality of life as determined by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (version 3) also improved. During follow-up, 88% of patients had complete and 12% partial responses (International Union Against Cancer radiologic criteria). On multivariate analysis, greater changes in the mean value of the gray-level histogram and negative nodal status were predictors for a reduction in the number of skeletal complications after therapy. Flu-like syndrome occurred in 13 patients (39%) and was well managed with mild antipyretics.
  
  
  CONCLUSIONS
  Image-processing in plain radiographs offers an objective way to assess recalcification. The image-processing indexes, along with the measurements of performance status, quality of life, and biochemical markers, improved significantly. Local radiotherapy combined with long-term high-dose DP up to 180 mg is tolerable and has a high therapeutic response.
authors.affiliation: Department of Radiology, Areteion University Hospital, Athens, Greece.vko@eortc.be
authors.forename: Vassilis
authors.initials: V
authors.lastname: Kouloulias
authors.forename: George
authors.initials: G
authors.lastname: Matsopoulos
authors.forename: John
authors.initials: J
authors.lastname: Kouvaris
authors.forename: Costas
authors.initials: C
authors.lastname: Dardoufas
authors.forename: Andrew
authors.initials: A
authors.lastname: Bottomley
authors.forename: Maria
authors.initials: M
authors.lastname: Varela
authors.forename: Nikos
authors.initials: N
authors.lastname: Uzunoglu
authors.forename: Christos
authors.initials: C
authors.lastname: Antypas
authors.forename: Anna
authors.initials: A
authors.lastname: Metafa
authors.forename: Antzela
authors.initials: A
authors.lastname: Moulopoulos
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Sandilos
authors.forename: Lambros
authors.initials: L
authors.lastname: Vlahos
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D000077268:Pamidronate; D011788:Quality of Life; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates; D000077268:Pamidronate