Dear Holly,
I am puzzled as well. It could be that the mets are not big enough to judge which treatment might be best. Maybe radiation at this point would do collateral damage without enough benefit to outweigh the risk?
Here are some of the issues on treating mets (from the article on WebCafe);
Will further treatments improve my quality of life?
Will benefits outweigh risk and discomfort?
Will further treatments add to survival?
What feels most comfortable to me?
Do I feel I can manage the side effects of each treatment option? What kind of support will I have from family or friends? Outside agencies?
Many studies cite the addition of 2-3 months to a person's life as justification enough for aggressive chemotherapy. Ask your doctor how many patients he's treated with the same therapy and how the patients did. Palliation of symptoms alone is still a valid goal in metastatic cancer.
Because the needs of metastatic patients are highly individual and many of the treatments are still experimental, there are no standard guidelines available to either the patient or the doctor. In some cases the decision is determined by whose opinion you seek — a surgeon will recommend surgery, an oncologist chemotherapy or a radiation oncologist radiation therapy. Often, the patient and family must decide on the course of treatment. .
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Bone Metastasis
Aside from causing pain in up to 70% of people afflicted, the most serious implication of bone metastasis is that they increase the possibility of "pathological fractures", so named because they are due to problems within the bone itself rather than to external factors.
Metastatic bone lesions can be described as osteolytic, osteoblastic and mixed. The osteolytic lesions are most common where the destructive processes outstrip the laying down of new bone. Osteoblastic lesions result from new bone growth that is stimulated by the tumor. Microscopically, most lesions are mixed.
Treatment for bone metastasis is normally palliative. An assessment of the risk of pathological fracture must be made by an experienced orthopaedic surgeon. Lesions that do not represent a risk for fracture may be treated with radiation or by appropriate chemotherapy directed at the tumor.
Where a weight-bearing bone, such as the leg is involved, your doctor may suggest an operation to support the bone and prevent a break. This procedure will involve reinforcing the bone with internal splints and may help relieve pain and prevent a break. The goals of surgery are to preserve stability and function of the musculoskeletal system as well as alleviate pain.
The ribs, pelvis and spine are usually first affected. Pain, which resembles ordinary low back pain or a disease such as arthritis, is usually the first sign. Standing up on the bone may compress it, causing more pain than when lying down.
Another risk from bone metastasis is hypercalcemia (a higher concentration of calcium compounds in the bloodstreatm). This condition can cause a number of symptoms, including dehydration, loss of appetite, nausea, thirst, fatigue, muscle weakness, kidney problems, restlessness, confusion and even death.
For an article with everything you wish you never needed to know about bone metastases:
www.emedicine.com/radio/topic88.htm#section~mri
Zometa for bone metastases/hypercalcemia
Bisphosphonates work by slowing down the actions of bone cells.
Bisphosphonates (clodronate, pamidronate, aredia, zometa), a family of drugs used to treat osteoporosis and the bone pain caused by some types of cancer, have been investigated in large trials for breast and prostate cancer with good results at relieving bone pain and perhaps even slowing destructive processes.
Zometa, the youngest and easiest to use of the bisphosphonates, was first approved for the treatment of hypercalecemia. In February, 2002, The FDA approved Zometa (Zoledronic Acid) for patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy. The trials that led to the approval of Zometa mark the first time any bisphosphonate has demonstrated efficacy in treating bone complications in patients with prostate cancer, lung cancer and other solid tumors (including bladder tumors). see;
www.zometa.com/index.html
One potential potential side effect of Zometa included kidney damage, which can also occur with other bisphosphonates.
blcwebcafe.org/metatcc.asp