некоторые аспекты состояния костной системы в патологии, критерии дифференциации остеопороза и метастаза рака в кости
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некоторые аспекты состояния костной системы в патологии, критерии дифференциации остеопороза и метастаза рака в кости
- 2. Потенциально заинтересованные специальности Онкология Ортопедия Эндокринология Гинекология Патология костной системы
- 9. Ультраструктура костной ткани Нормальная костная ткань Остеопороз
- 14. Индуцированный стеопороз или метастазы рака простаты, - критерии дифференциации Индуцированный максимальной антиандрогенной блокадой остеопороз Метастатическое поражение Костная боль, разрушение костной ткани
- 16. Наиболее частые локусы метастазирования по данным аутопсии Weigelt B, et al. Nature Reviews Cancer 2005; 5 :591 – 602 Bone Lung Liver
- 18. Механизм стимуляции остеокластов в метастатическом очаге Продукция опухлевыми клетками или иммунными клетками в костях следующих медиаторов: PTHrP (паратиреоподобный протеин) TGF , TGF (трансформирующий фактор роста-факторы ангиогенеза) interleukin-1a,TNF, interleukin-6 TGF- высвобождается при резорбции кости, что иницирует продукцию PTHrP
- 21. Typical regions of metastatic disease Типичные локусы метастатической болезни
- 22. Probability of positive bone scans based on prostate-specific antigen Вероятность положительных данных остеосцинтиграфии в соответствии с данными ПСА
- 23. Radioscintigraphic bone scan: detecting metastases to bone Остеостинциграфия: выявление метастазов в костях
- 24. Сравнительная эффективность бифосфонатов в снижении риска патологических переломов i.v. Bondronat 6mg 1 oral Bondronat 50mg 1 Zoledronate 2 Pamidronate 3 Clodronate 3 0 10 20 30 40 50 Percentage 1 F. Hoffmann-La Roche Ltd. Data on file; 2 Calculated from Coleman et al. SABCS 2002; 3 Pavlakis N, Stockler M. The Cochrane Library 2002 # of events versus placebo
- 26. Клинические аспекты: обнаженная кость, непостоянная боль, потеря зубов
- 27. Клинические аспекты: обнаженная кость,непостоянная боль, потеря зубов
- 28. Осложнение терапии бифосфонатами Infection Loss of segments of jaw bones
- 32. Земля
- 33. Армения
- 34. Ереван
- 35. Мы и наша клиника
Editor's Notes
- Figure 8-1. Typical regions of metastatic disease. A, Localized prostate cancer. B, Regional and para-aortic lymph node metastases. C, Bony metastases. Appropriate management of prostate cancer relies on the sensitive and specific detection of locoregional and distant metastatic disease. The most common sites of prostate cancer metastasis identified in pathologic studies are regional lymph nodes and bone; lung and liver metastases can also be found [10]. Identification of distant soft tissue metastases has traditionally relied on cross-sectional imaging with CT or MRI. Bone scans are the preferred method for detecting lesions in the bone. Contemporary imaging studies include radioimmunoscintigraphy and positron emission tomography. Prostate-specific antigen–producing cells can be detected with high sensitivity by the molecular technique of polymerase chain reaction. Definitive local therapy alone is doomed to failure, however, in those with underlying metastatic disease; thus, timely detection and some form of systemic therapy are required for optimal treatment in these patients. References: [10]. Franks LM, The spread of prostate carcinoma. J Pathol 1956 72 603-611
- Figure 8-2. The probability of positive bone scans as predicted by serum prostate-specific antigen (PSA). Modern techniques of PSA determination and disease staging have greatly reduced the need for routine bone scans in patients diagnosed with clinically localized prostate cancer. If the serum PSA level is less than 10 ng/mL, the probability of detecting bony metastases by bone scan is low [11]. Furthermore, bone scans are not recommended in the post–radical prostatectomy patient with an undetectable PSA level [12] or PSA recurrence less than 30 to 40 ng/mL [13]. References: [11]. Lee CT, Oesterling JE, Using prostate-specific antigen to eliminate the staging radionuclide bone scan. Urol Clin North Am 1997 24 389-394 [12]. Terris MK, Klonecke AS, McDougall IR, Stamey TA, Utilization of bone scans in conjunction with prostate specific antigen levels in the surveillance for recurrence of adenocarcinoma after radical prostatectomy. J Nucl Med 1991 32 1713-1718 [13]. Cher ML, Bianco FJ, Jr, Lam JS, et al. Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol 1998 160 1387-1391
- Figure 8-3. The radioscintigraphic bone scan is the most sensitive imaging method to detect metastases to bone. These lesions typically appear as asymmetric areas of increased tracer uptake, particularly in the axial skeleton. The advantages of bone scintigraphy include its high overall sensitivity, ability to evaluate the entire skeletal system, and relatively low cost. However, bone scans are limited because of the nonspecific information provided. Areas of increased radiotracer uptake can be associated with a number of nonmalignant etiologies, such as trauma, arthritis, and Paget’s disease. (From Manyak [14]; with permission.) References: [14]. Manyak M, Advances in imaging prostate cancer. Advances in Prostate Cancer 1997 1 5-7
- A comparison of the efficacy results from separate studies indicates that risk reductions are comparable between zoledronate and oral and intravenous Bondronat. Both Bondronat and zoledronate reduce the likelihood of a skeletal event to a greater extent than pamidronate and clodronate.
- Pivotal phase III trials in metastatic bone disease demonstrate that compared with placebo both intravenous and oral formulations of Bondronat are equally effective and significantly: Reduce skeletal morbidity Reduce skeletal-related events Reduce bone pain Improve quality of life. Both formulations were also well tolerated and were associated with no renal toxicity and no significant gastrointestinal effects (oral administration only).