Monitoring Therapeutic Response in Skeletal Metastases Using Dual-Energy X-Ray Absorptiometry: A Prospective Feasibility Study in Breast Cancer Patients

• Published in: Cancer investigation Vol. 17; no. 8; pp. 566 - 574
• Main Authors: Shapiro, Charles L., Keating, Jennifer, Angell, Jennifer E., Janicek, Milos, Gelman, Rebecca, Hayes, Daniel, LeBoff, Meryl S.
• Format: Journal Article
• Language: English
• Published: New York, NY Informa UK Ltd 1999; Informa Healthcare
• Subjects: Absorptiometry, Photon - methods; Absorptiometry, Photon - standards; Adult; Aged; Biological and medical sciences; Bone Density; Bone Neoplasms - drug therapy; Bone Neoplasms - secondary; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Feasibility Studies; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Middle Aged; Prospective Studies; Reference Values; Sensitivity and Specificity; Treatment Outcome; Tumors; Antineoplastic agent; Human; Diseases of the osteoarticular system; Metastasis; Malignant tumor; Density; Inorganic element; Mammary gland diseases; Chemotherapy; Bone mass; Treatment; Dual energy absorptiometry; Tumor progression; Female; Mammary gland; Bone; Quantitative analysis
• ISSN: 0735-7907; 1532-4192
• DOI: 10.3109/07357909909032841

Abstract
Response to systemic therapy in breast cancer patients with lytic skeletal metastases manifests as a shift from increased bone resorption to new bone formation. We hypothesized that dual-energy x-ray absorptiometry (DXA) could be used to pro-spectively quantitate changes in bone mineral density (BMD) in metastatic skeletal lesions in breast cancer patients receiving systemic therapy. Nine metastatic breast cancer patients with one or more assessable lytic skeletal metastases receiving systemic therapy were prospectively evaluated with DXA, skeletal radiographs, computed tomography (CT), and radionuclide bone scans at baseline (t = 0 months, 2 months, and 6 months). The median (range) percentage change in BMD in skeletal lesions among patients responding to systemic therapy was 10.7% (0.1-21.85), 5.0% (-1.3-234, and 16.7% (-2.0-50.8) at 0-2, 2-6, and 0-6 months, respectively. Changes in BMD between 0-2, and 0-6 months were significant (Wilcoxin signed rank test; p = 0.013 and p = 0.017, respectively). The percentage change in BMD skeletal lesions between 0-2 and 2-6 months correlated with the changes imaged on skeletal x-rays (Spearman rank order correlation coeficient (Rs,] = 0.511, p = 0.011) and CTs (Rs, = 0.416, p = 0.046) but less so with bone scans (Rs, = 0.293, p = 0.189). It is technically feasible to use DXA to prospectively monitor changes in lytic skeletal metastases in breast cancer patients receiving systemic therapy. The BMD of skeletal metastases increases in patients responding to treatment and was significantly correlated with the changes imaged on skeletal x- rays and CTs. Additional studies of DXA to evaluate response in skeletal metastasis are warranted.