4.6 Review

Knowns and unknowns of bone metastases in patients with neuroendocrine neoplasms: A systematic review and meta-analysis

Journal

CANCER TREATMENT REVIEWS
Volume 94, Issue -, Pages -

Publisher

ELSEVIER SCI LTD
DOI: 10.1016/j.ctrv.2021.102168

Keywords

Neuroendocrine neoplasms; Bone metastases; Skeletal-related events; Bisphosphonates; Radiotherapy; Surgery

Categories

Funding

  1. Christie Charity
  2. Wellcome Imperial 4i Clinical PhD Fellowship

Ask authors/readers for more resources

The systematic review and meta-analysis revealed that BM prevalence in NENs patients is 18.4%, with mainly osteoblastic and multifocal characteristics, pain being the most common symptom. Various treatment modalities are used with limited evidence available for their efficacy.
Objective: This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs), inform diagnosis and treatment and standardise management between institutions. Methods: PubMed, Medline, EMBASE and meeting proceedings were searched for eligible studies reporting data on patients with BMs and NENs of any grade of differentiation and site; poorly-differentiated large/small cell lung cancer were excluded. Data were extracted and analysed using STATA v.12. Meta-analysis of proportions for calculation of estimated pooled prevalence of BM and calculation of weighted pooled frequency and weighted pooled mean for other variables of interest was performed . Results: A total of 149 studies met the eligibility criteria. Pooled prevalence of BMs was 18.4% (95% CI 15.4?21.5). BMs were mainly metachronous with initial diagnosis of NEN (61.2%) and predominantly osteoblastic; around 61% were multifocal, with a predisposition in axial skeleton. PET/CT seemed to provide (together with MRI) the highest sensitivity and specificity for BM detection. Almost half of patients (46.4%) reported BMrelated symptoms: pain (66%) and skeletal-related events (SREs, fracture/spinal cord compression) (26.2%; weightedweighted mean time-to-SRE 9.9 months). Management of BMs was multimodal [bisphosphonates and bone-modifying agents (45.2%), external beam radiotherapy (34.9%), surgery (14.8%)] and supported by little evidence. Overall survival (OS) from the time of diagnosis of BMs was long [weighted mean 50.9 months (95% CI 40.0?61.9)]. Patients with BMs had shorter OS [48.8 months (95% CI 37.9?59.6)] compared to patients without BMs [87.4 months (95% CI 74.9?100.0); p = 0.001]. Poor performance status and BM-related symptoms were also associated with worse OS. Conclusions: BMs in patients with NENs remain underdiagnosed and undertreated. Recommendations for management of BMs derived from current knowledge are provided. Prospective studies to inform management are required.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available