title: The incidence and clinical impact of bone metastases in non-small cell lung cancer.
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) is the leading global cause of cancer death. While bone metastases (BM) commonly cause morbidity, bone-targeted agent (BTA) use is variable. We investigated the incidence and impact of BM among unselected NSCLC patients.
  
  
  METHODS
  A retrospective chart review of all NSCLC patients seen at a single institution from January 2007 to January 2008 was performed. Various clinical and pathology data were collected. In BM patients, skeletal related events (SRE), interventions and outcomes were recorded.
  
  
  RESULTS
  We identified 383 patients; median age 68 (IQR 60-76); 54% female. Initially 156 patients (41%) were treated with curative intent of whom 91 subsequently relapsed; 227 (59%) were considered palliative from time of diagnosis, including 22 with early stage disease not amenable to radical therapy. Of 296 patients with advanced NSCLC, common metastatic sites were: lung/pleura (80%), mediastinal nodes (69%), bone (39%), brain (30%), and liver (24%). Of 118 patients with BM, 69 (59%) had ≥1 SREs (range 1-18). Common SREs were radiotherapy (63%), pathologic fractures (22%), spinal cord compression (6%) or surgery to bone (5%). Opioid analgesia was required in 69% of BM patients, only 6% of patients with BM received BTA. Overall survival (OS) in pts with mNSCLC was 7.3 months (IQR 3.1-20.5). Pts with BM had significantly shorter OS compared to those without BM (5.8 versus 10.2 months, p=0.03).
  
  
  CONCLUSIONS
  BM are common in patients with advanced NSCLC and associated with shorter survival. In this cohort, despite SREs occurred in many patients, BTA were rarely used.
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuchuk
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Iryna
authors.initials: I
authors.lastname: Kuchuk
authors.affiliation: Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Elham
authors.initials: E
authors.lastname: Sabri
authors.affiliation: Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, & Department of Medicine, University of Ottawa, Ottawa, Canada. Electronic address: pwheatleyprice@toh.on.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Wheatley-Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: BTA; Bone metastases; NSCLC; SRE