381P - Pathological fractures in breast cancer patients with bone metastases

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Supportive Care
Breast Cancer, Metastatic
Presenter Marcus Vetter
Citation Annals of Oncology (2014) 25 (suppl_4): iv116-iv136. 10.1093/annonc/mdu329
Authors M. Vetter1, D.J. Huang2, U. Güth3
  • 1Medical Oncology, Universitätsspital Basel, 4031 - Basel/CH
  • 2Gyenecology, University Hospital, Basel/CH
  • 3Gynecology, Canton Hospital, Winterthur/CH

Abstract

Aim

This study evaluates the clinical course of breast cancer patients with bone metastases (BM) who developed pathological fractures (PF).

Methods

The study is based on data of the Basel Breast Cancer Database (Basel, Switzerland). The cases of 363 patients who developed distant metastatic disease in a 22-year period (1990-2011) were analyzed. From these, 254 patients (70.0%) were diagnosed with BM.

Results

In 36 patients (14.2% of the patients who had BM), a total of 45 pathologic fractures occurred. These patients had a median age of 62 years (range: 44-89 years) at the time when the fracture occurred. 32 patients had one event, three patients had two events, and a further two patients developed four fractures. At 53.3%, the femur was the most frequent location. In 32 of the 45 events (71.1%), the patients underwent surgery; in five cases (11.1%), the patients received only radiotherapy for pain relief and for prevention of further fractures. In eight cases (17.8%), the fractures were neither stabilized by surgery, nor did the patients receive radiotherapy. The median survival after pathologic fractures was 5 months (range: 1 week – 49 months). Of the patients who suffered pathological fractures, in 14 cases (38.9%) BM were first diagnosed by this event. In 12 of these cases, the median distant recurrence-free survival was 31 months (10-131 months).

Conclusions

Pathological fractures usually do not occur like a bolt from the blue. In the vast majority of cases, fractures are preceded by bone pain or other symptoms. During regular follow-up visits both in the adjuvant and palliative situation, oncologists should carefully ask for bone symptoms. If the patients report such symptoms, these should not be misdiagnosed as age- or therapy-dependent changes. Radiologic examinations reveal bones which are prone to fractures and efforts can be made to spare the patients pathological fractures. The majority of patients with BM will respond to a low course of radiotherapy with good pain relief and only a small proportion of these patients will appear in the trauma department with a pathological fracture requiring stabilization. Our data shows that in approximately 40% of cases with pathological fractures, early symptoms of impending fractures were missed and BM were first diagnosed by a pathological fracture.

Disclosure

All authors have declared no conflicts of interest.