Breast to bone

[Guest guest]

Robyn,

You are probably thinking of hyperthermia, that

is, heat. There are newer hyperthermia

strategies for breast cancer with bone mets. To whit:

From <http://www.medscape.com/news>Medscape Medical News

High-Intensity Ultrasound Ablation Possible Treatment for Bone Tumors

Roxanne

May 27, 2010 ­ High-intensity focused ultrasound

appears to be effective for ablating primary bone

tumors, and could contribute to existing

chemotherapy and limb-salvaging surgical

regimens, according to Chinese researchers.

They found that long-term survival rates for

patients with stage IIb disease were

substantially better in patients who underwent

the complete regimen of high-intensity focused

ultrasound and chemotherapy than in those who did

not finish the chemotherapy cycles or who underwent partial ablation only.

The study appears in the June issue of Radiology.

As a local treatment, the authors note,

high-intensity focused ultrasound can be used to

treat malignant tumors, and a high rate of

complete tumor ablation can be achieved.

This looks like a promising way to treat bone

tumors, said Levon N. Nazarian, MD, a professor

of radiology and vice chair of education at

Jefferson University in Philadelphia, Pennsylvania.

" The technology has existed in the United States

for quite a few years, and is similar to that

used to treat uterine fibroids and, more

recently, tumors in the liver, " said Dr.

Nazarian, who was not involved in the study.

However, there will be some hurdles in the United

States before it is approved for use in bone tumors, he added.

In an interview, Dr. Nazarian pointed out that

bone tumors are often treated in referral

centers. " There is potential for these centers to

see this technique as a less invasive way of

treating bone tumors, " he said, " and to possibly adopt this technique. "

Because the technology is already available, it

could be used off-label to treat bone tumors, but

the idea would be to get approval from the US

Food and Drug Administration for this indication,

Dr. Nazarian explained. " Unfortunately, it often

takes a long time to go from the literature to

clinical use, as it has to go through clinical

trials, which can be lengthy and expensive. "

Possible Limb-Saving Technique?

Globally, limb-salvaging treatment has become a

routine method of treating bone cancer in

carefully selected patients, write the authors.

However, amputation remains the treatment of

choice for primary bone malignancies in China,

because of a shortage of well-trained orthopedic

oncologists and late diagnoses. Therefore, new techniques are needed.

" There has been a general consensus that

ultrasound energy cannot enter bone at an

intensity sufficient for therapeutic ablation, "

write lead author Wenzhi Chen, MD, and colleagues

from the Clinical Center for Tumor Therapy,

Second Affiliated Hospital of Chongqing Medical

University in China. " Thus, we questioned whether

high-intensity focused ultrasound ablation

therapy could be effectively applied to bone tumors.

The authors sought to address that question by

evaluating the effectiveness of

ultrasonography-guided high-intensity focused

ultrasound ablation in the treatment of patients

with primary bone malignancies. The cohort

consisted of 80 patients ­ 60 with stage IIb

disease and 20 with stage III disease (Enneking

staging system). Treatment options consisted of

either chemotherapy plus ultrasound ablation or

ablation alone. The choice of treatment depended on the type of cancer.

High-intensity focused ultrasound ablation (60 to

20 W of ultrasound energy) plus chemotherapy was

performed in 62 patients with osteosarcoma, 1

patient with periosteal osteosarcoma, and 3 patients with Ewing's sarcoma.

The chemotherapeutic regimen used included

cisplatin, adriamycin, methotrexate, and

ifosfamide. Chemotherapy was administered in 3 to

5 cycles before ultrasound ablation was

performed; another 4 to 6 cycles were given after the ablation.

The remaining patients were diagnosed with

chondrosarcoma, giant cell bone cancer,

periosteal sarcoma, or an unknown malignancy, and

were treated with high-intensity focused

ultrasound ablation only because these

malignancies are insensitive to chemotherapy.

Follow-up imaging showed that in 69 patients, the

tumors had been completely ablated; greater than

50% tumor ablation was observed in the remaining 11 patients.

Best Survival in Patients Who Completed Full Regimen

Overall survival rates for the entire cohort was

89.8% for 1-year, 72.3% for 2-year, 60.5% for

3-year, 50.5% for 4-year, and 50.5% for 5-year

survival. The authors also then calculated

disease-free survival for 54 patients with stage

IIb disease who completed the full regimen of

high-intensity focused ultrasound ablation

treatment; it was 100% for 1-year, 84.0% for

2-year, 73.5% for 3-years, 62.8% for 4-year, and 62.8% for 5-year survival.

Survival Rates Categorized by Disease Stage

Survival Rates Stage IIb, % Stage III, %

1 year 93.3 79.2

2 years 82.4 42.2

3 years 75.0 21.1

4 years 63.7 15.8

5 years 63.7 15.8

The survival rates at different intervals were

significantly different between the 2 disease

stages (P < .001), and survival was significantly

higher among patients who completed the full

treatment protocol than among those who did not

(P < .001). For example, patients with stage IIb

disease who achieved complete tumor ablation and

the full 9 cycles of chemotherapy had a 5-year

survival rate of 86.4%. But patients who did not

complete the full chemotherapy protocol had a 5-year survival rate of 35.9%.

Of the 69 patients who had completely ablated

tumors, only 5 (7%) experienced local tumor

progression after a mean follow-up of 36.8

months. Upon multivariate analysis, the authors

found that tumor stage (P = .00) and completed

treatment (P = .01) were associated with

survival, whereas age, sex, and tumor histology

were not independent factors for survival.

The most common adverse event, other than mild

local pain, was skin toxicity (21%), followed by

peripheral nerve damage (12%). Overall, 40

adverse events were recorded, and 14 patients

experienced complications that required surgical intervention.

" The results of this study demonstrate that

[ultrasonography]-guided focused ultrasound can

render complete bone tumor responses, " the

authors conclude, adding that further studies are

needed to ascertain which patient subgroup(s)

would be best suited for this noninvasive treatment.

The study was funded by the Key Laboratory of

Ultrasonic Medical Engineering of

Chongqing–National and Provincial Key Laboratory,

and grants from the Ministry of Science and

Technology of China and the National Natural Science Foundation of China.

Radiology. 2010;255: 967-978.

<http://www.ncbi.nlm.nih.gov/pubmed/20501734>Abstract

------------------------

If the cancer has gone to the spine or the hip

joint I would consider ultrasound with conformal

radiation and sensitizers such as Lonidamine,

metronidazole, and tocopherol succinate. You

would also want to consider cementoplasty if the bone mets are lytic.

There are many factors that would go into an IPT

decision -- I have posted on this. Ozone is not

a great performer for this use. I would not rely

on homeopathics nor on graviola. Certain diets

can help out, but it would depend on the grade of the cancer.

At 03:29 PM 5/29/2010, you wrote:

>

>, Is your practice open? I have breast

>cancer with many mets to bones. I was thinking

>about getting ipt. The clinic told me that

>hypothermia is the best for bones. They do

>multiple things. What do you think of ipt in

>this situation plus hypothermia plus ozone

>therapy, plus homepathics and more? What do you think of graviola?

>

>Thanks, Robyn

[Guest guest]

,

What is conformal radiation,? lonadimine? ,metronidazole?, and tocopherol

succinate? cementoplasty? Where do you get these things? Are you suggesting

full dose chemo. I read your former posts on Ipt, but I dont know what to do.

I think the place I am considering is very experienced.

Thanks, Robyn

________________________________

From: VGammill <vgammill@...>

Sent: Sat, May 29, 2010 5:47:12 PM

Subject: [ ] Breast to bone

Robyn,

You are probably thinking of hyperthermia, that

is, heat. There are newer hyperthermia

strategies for breast cancer with bone mets. To whit:

From <http://www.medscape.com/news>Medscape Medical News

High-Intensity Ultrasound Ablation Possible Treatment for Bone Tumors

Roxanne

May 27, 2010 ­ High-intensity focused ultrasound

appears to be effective for ablating primary bone

tumors, and could contribute to existing

chemotherapy and limb-salvaging surgical

regimens, according to Chinese researchers.

They found that long-term survival rates for

patients with stage IIb disease were

substantially better in patients who underwent

the complete regimen of high-intensity focused

ultrasound and chemotherapy than in those who did

not finish the chemotherapy cycles or who underwent partial ablation only.

The study appears in the June issue of Radiology.

As a local treatment, the authors note,

high-intensity focused ultrasound can be used to

treat malignant tumors, and a high rate of

complete tumor ablation can be achieved.

This looks like a promising way to treat bone

tumors, said Levon N. Nazarian, MD, a professor

of radiology and vice chair of education at

Jefferson University in Philadelphia, Pennsylvania.

" The technology has existed in the United States

for quite a few years, and is similar to that

used to treat uterine fibroids and, more

recently, tumors in the liver, " said Dr.

Nazarian, who was not involved in the study.

However, there will be some hurdles in the United

States before it is approved for use in bone tumors, he added.

In an interview, Dr. Nazarian pointed out that

bone tumors are often treated in referral

centers. " There is potential for these centers to

see this technique as a less invasive way of

treating bone tumors, " he said, " and to possibly adopt this technique. "

Because the technology is already available, it

could be used off-label to treat bone tumors, but

the idea would be to get approval from the US

Food and Drug Administration for this indication,

Dr. Nazarian explained. " Unfortunately, it often

takes a long time to go from the literature to

clinical use, as it has to go through clinical

trials, which can be lengthy and expensive. "

Possible Limb-Saving Technique?

Globally, limb-salvaging treatment has become a

routine method of treating bone cancer in

carefully selected patients, write the authors.

However, amputation remains the treatment of

choice for primary bone malignancies in China,

because of a shortage of well-trained orthopedic

oncologists and late diagnoses. Therefore, new techniques are needed.

" There has been a general consensus that

ultrasound energy cannot enter bone at an

intensity sufficient for therapeutic ablation, "

write lead author Wenzhi Chen, MD, and colleagues

from the Clinical Center for Tumor Therapy,

Second Affiliated Hospital of Chongqing Medical

University in China. " Thus, we questioned whether

high-intensity focused ultrasound ablation

therapy could be effectively applied to bone tumors.

The authors sought to address that question by

evaluating the effectiveness of

ultrasonography-guided high-intensity focused

ultrasound ablation in the treatment of patients

with primary bone malignancies. The cohort

consisted of 80 patients ­ 60 with stage IIb

disease and 20 with stage III disease (Enneking

staging system). Treatment options consisted of

either chemotherapy plus ultrasound ablation or

ablation alone. The choice of treatment depended on the type of cancer.

High-intensity focused ultrasound ablation (60 to

20 W of ultrasound energy) plus chemotherapy was

performed in 62 patients with osteosarcoma, 1

patient with periosteal osteosarcoma, and 3 patients with Ewing's sarcoma.

The chemotherapeutic regimen used included

cisplatin, adriamycin, methotrexate, and

ifosfamide. Chemotherapy was administered in 3 to

5 cycles before ultrasound ablation was

performed; another 4 to 6 cycles were given after the ablation.

The remaining patients were diagnosed with

chondrosarcoma, giant cell bone cancer,

periosteal sarcoma, or an unknown malignancy, and

were treated with high-intensity focused

ultrasound ablation only because these

malignancies are insensitive to chemotherapy.

Follow-up imaging showed that in 69 patients, the

tumors had been completely ablated; greater than

50% tumor ablation was observed in the remaining 11 patients.

Best Survival in Patients Who Completed Full Regimen

Overall survival rates for the entire cohort was

89.8% for 1-year, 72.3% for 2-year, 60.5% for

3-year, 50.5% for 4-year, and 50.5% for 5-year

survival. The authors also then calculated

disease-free survival for 54 patients with stage

IIb disease who completed the full regimen of

high-intensity focused ultrasound ablation

treatment; it was 100% for 1-year, 84.0% for

2-year, 73.5% for 3-years, 62.8% for 4-year, and 62.8% for 5-year survival.

Survival Rates Categorized by Disease Stage

Survival Rates Stage IIb, % Stage III, %

1 year 93.3 79.2

2 years 82.4 42.2

3 years 75.0 21.1

4 years 63.7 15.8

5 years 63.7 15.8

The survival rates at different intervals were

significantly different between the 2 disease

stages (P < .001), and survival was significantly

higher among patients who completed the full

treatment protocol than among those who did not

(P < .001). For example, patients with stage IIb

disease who achieved complete tumor ablation and

the full 9 cycles of chemotherapy had a 5-year

survival rate of 86.4%. But patients who did not

complete the full chemotherapy protocol had a 5-year survival rate of 35.9%.

Of the 69 patients who had completely ablated

tumors, only 5 (7%) experienced local tumor

progression after a mean follow-up of 36.8

months. Upon multivariate analysis, the authors

found that tumor stage (P = .00) and completed

treatment (P = .01) were associated with

survival, whereas age, sex, and tumor histology

were not independent factors for survival.

The most common adverse event, other than mild

local pain, was skin toxicity (21%), followed by

peripheral nerve damage (12%). Overall, 40

adverse events were recorded, and 14 patients

experienced complications that required surgical intervention.

" The results of this study demonstrate that

[ultrasonography]-guided focused ultrasound can

render complete bone tumor responses, " the

authors conclude, adding that further studies are

needed to ascertain which patient subgroup(s)

would be best suited for this noninvasive treatment.

The study was funded by the Key Laboratory of

Ultrasonic Medical Engineering of

Chongqing–National and Provincial Key Laboratory,

and grants from the Ministry of Science and

Technology of China and the National Natural Science Foundation of China.

Radiology. 2010;255: 967-978.

<http://www.ncbi.nlm.nih.gov/pubmed/20501734>Abstract

------------------------

If the cancer has gone to the spine or the hip

joint I would consider ultrasound with conformal

radiation and sensitizers such as Lonidamine,

metronidazole, and tocopherol succinate. You

would also want to consider cementoplasty if the bone mets are lytic.

There are many factors that would go into an IPT

decision -- I have posted on this. Ozone is not

a great performer for this use. I would not rely

on homeopathics nor on graviola. Certain diets

can help out, but it would depend on the grade of the cancer.

At 03:29 PM 5/29/2010, you wrote:

>

>, Is your practice open? I have breast

>cancer with many mets to bones. I was thinking

>about getting ipt. The clinic told me that

>hypothermia is the best for bones. They do

>multiple things. What do you think of ipt in

>this situation plus hypothermia plus ozone

>therapy, plus homepathics and more? What do you think of graviola?

>

>Thanks, Robyn