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    • br Adverse events Treatment reported toxicities were similar

    2019-06-29


    Adverse events Treatment reported toxicities were similar to those previously reported [23].
    Discussion Several other studies have addressed the same issue using different bisphosphonates. The SABRE study randomised breast cancer patients taking anastrozole with a T-score of between −1 and −2 to risedronate (35mg weekly) or placebo. After 2 years, BMD increased by 2.2% at the LS and by 1.8% at the TH [22]. 3 large, very similar studies (Z-FAST, ZO-FAST and E-ZO-FAST), compared the efficacy of 6 monthly intravenous zoledronic XL413 hydrochloride given either from the start of AI therapy with letrozole or if there was either significant bone loss or the development of a non-traumatic fracture in patients taking letrozole for their breast cancer. In all three studies [20,24–25] immediate zoledronic acid prevented bone loss. The Z-FAST study has recently published the final results after 5 years of treatment [20], and showed that treatment with zoledronic acid resulted in a difference in BMD after 5 years on study at the LS and TH of 8.9% and 6.7% respectively (p<0.0001). These differences appear somewhat greater than we observed with oral ibandronate, but no direct comparison of ibandronate and zoledronic acid is planned to determine whether there are any meaningful differences in the two treatment approaches. The ARIBON study has not evaluated BMD changes after the 5 years of aromatase inhibitor therapy but a degree of recovery of BMD would be expected as was seen in the extended results of the ATAC [26] and IES [27] trials. Although the small number of patients and the fact that some patients on placebo required subsequent bisphosphonate limits our study, some important conclusions can nevertheless be drawn. Firstly a strategy of introducing a bisphosphonate in patients with severe osteopenia can prevent osteoporosis but patients still need to be monitored for changes in bone density. Secondly patients who have relatively stable BMD for the first 2 years of an aromatase inhibitor without a bisphosphonate may require little further treatment or monitoring because the risk of subsequent accelerated bone loss appears to be low. Further research is important to investigate why their bone density is so stable and also how these patients can be prospectively identified. Thirdly patients with osteoporosis at the diagnosis of breast cancer can be safely treated with an aromatase inhibitor provided they are also prescribed a bisphosphonate.
    Introduction Bone metastases are one of the most frequent complications of malignant tumors and they are a relevant source of morbidity. Up to 70% of all tumor patients develop bone metastases [1]. Most of the patients suffer from pain with a reduction of mobility and life quality and therefore have a high risk of concomitant complications [2]. Therapy of bone metastases follows three strategies: pain relief, improvement of mobility and quality of life, and improvement of life expectancy. Therapeutic possibilities comprise local strategies like radiation, surgical therapy and systemic therapy. Surgical therapy needs large approaches and the rate of complications as well as the comorbidity and length of hospital stay are not negligible. Minimal invasive therapy of bone tumor is getting more important [3]. The advantages are obvious. The size of the surgical approach as well as operation time and complication rate are reduced. Comorbidity, quality of life and the time as an inpatient are improved [4]. Therefore further developments in the field of minimal invasive tumor therapy are necessary. Radiofrequency ablation in bone tumor is an upcoming technique which was first described by Rosenthal et al. [5]. It is used to treat multiple benign and malignant diseases. Liver, lung and bone have become the primary target tissue in the thermal ablation therapy [6]. Due to its high efficacy and safety, radiofrequency ablation has become one of the most accepted techniques in hyperthermal ablation therapy [7]. The radiofrequency system consists of a generator and an electrode system. While the generators are highly developed, the electrodes for bone ablation are still the weak point of this technology. They are rigid and ablate in a predefined and mainly oval shaped zone only. Further developments are necessary to develop new ablation system with which a multidirectional ablation is necessary.