448P - Bone metastases in patients with neuroendocrine neoplasms: a survey of natural history and clinical management

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Neuroendocrine Cancers
Endocrine Cancers
Presenter Nicola Fazio
Citation Annals of Oncology (2017) 28 (suppl_5): v142-v157. 10.1093/annonc/mdx368
Authors N. Fazio1, P. Maisonneuve2, A.M. Frezza3, T. Ibrahim4, A. La Salvia5, S. Tafuto6, S. Pusceddu7, R. Marconcini8, F. Silvestris9, D. Campana10, D. Santini11, A. Faggiano12, S. Massironi13, L. De Marinis14, G. Rubini15, E. Merola16, L. Antonuzzo17, V. Amoroso18, I. Puliafito19, F. Spada1
  • 1Unit Of Gastrointestinal Medical Oncology And Neuroendocrine Tumors, European Institute of Oncology, 20141 - Milan/IT
  • 2Epidemiology, European Institute of Oncology, Milan/IT
  • 3Adult Mesenchymal Tumour And Rare Cancer Medical Oncology Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milan/IT
  • 4Osteoncology And Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola/IT
  • 5Oncologia Medica, Ospedale S. Luigi, Orbassano/IT
  • 6Medical Oncology, Istituto Nazionale Tumori – I.R.C.C.S - Fondazione Pascale, 80131 - Napoli/IT
  • 7Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milan/IT
  • 8Oncology Department, Azienda Ospedaliera Universitaria S.Chiara, 56100 - Pisa/IT
  • 9Sicenze Biomediche Ed Oncologia Umana, Università di Bari, Bari/IT
  • 10Oncologia Medica, Policlinico S. Orsola, Bologna/IT
  • 11Department Of Oncology, Campus Bio-Medico di Roma, 128 - Roma/IT
  • 12Endocrinologia, Policlinico di Napoli, Naples/IT
  • 13Gastroenterologia, Policlinico, Milan/IT
  • 14Endocrinologia, Policlinico Gemelli, Rome/IT
  • 15Medicina Nucleare, Università di Bari, Bari/IT
  • 16Gastroenterologia, Ospedale S Andrea, Roma/IT
  • 17Medical Oncology, Azienda Ospedaliera Careggi, 50139 - Firenze/IT
  • 18Oncologia Medica, Spedali Civili, Brescia/IT
  • 19Oncologia Medica, Istituto Oncologico del Mediterraneo, Viagrande/IT



Bone metastases (BM) in neuroendocrine neoplasms (NEN) represent a poorly defined issue.


This is a nationwide survey among Italian institutions dealing with NEN patients. Characteristics of BM, clinical management, skeletal related events (SREs) and disease outcome were recorded.


We analysed 321 patients with histological diagnosis of NEN and BM collected from 18 Italian Centers. Mean age was 59 y.o. (range 13-86). Primary sites were 47% gastroenteropancreatic (GEP), 36% lung, 4% Paraganglioma/Pheocromocytoma (Par/Pheo), 7% unknown, 5% others. The vast majority (72%) of NEN were already metastatic at diagnosis and the liver represented the second most frequent site of metastasis (in 77% of patients) during follow-up, in addition to BM. Bone was the first metastatic site in 41% of cases. Neoplasms were low/intermediate grade in 80% and high grade in 20%. SREs occurred in 32% of cases, mainly in lung and others. Median time to SRE was 4 months. It strictly correlated with the high grade, irrespective of the primary site. Bisphosphonates were administered in 32% of patients. Median survival from BM diagnosis was 65 months (range 45-78) in the whole population, with Par/Pheo at the best and high grade GEP at the worst limit. SRE, high grade (or in alternative high Ki-67) and prior lung metastases resulted significantly associated with worse overall survival at the multivariable analysis. After adjustment for tumor grade, survival of patients with GEP and lung NENs were similar.


This is one of the largest series of NEN patients with BM reported so far. This survey mirrors the Italian real clinical practice in this setting, as it included most Centers involved in NET patients’ management. It showed that overall, BM from NEN are associated with a relatively long survival. Bisphosphonates were used in a low percentage of cases, probably related to SRE. Tumor grade confirmed its value in separating two survival categories, irrespective of primary site. The results of this analysis generated hypotheses for prospective trials in homogeneous clinical settings.

Clinical trial identification

Legal entity responsible for the study

Nicola Fazio




All authors have declared no conflicts of interest.