Bones Metastases (Bm) in Gastric Cancer Patients (Pts): a Monoinstitutional Analysis

Background: Bone metastases (BM) are a common occurrence in advanced breast, lung, prostate, kidney and thyroid cancers. In gastric cancer BM occur rarely and are known to have a very poor prognosis. Methods: We analysed 563 pts of gastric cancer admitted at the Medical Oncology Department of S. Chiara Hospital – Trento, between January 2000 and December 2012. The aim of this retrospective study is to evaluate the radiological, clinical and therapeutic aspects in gastric cancer with BM. Results: In a total of 563 pts analyzed, BM was detected in 24 pts (4%). The mean age at the time of diagnosis of gastric cancer was 58 years (range: 31-82 years). BM were synchronous to gastric cancer in 5 pts and in 19 pts occurred from 1 to 84 months after primary tumor diagnosis (mean 17 months). Undifferentiated and poorly differentiated histology was predominant (84% of cases). Positive nodal status was found in 16 cases (67%). BM were associated with nodal metastases in 17 cases (71%), liver metastases in 6 cases (25%), peritoneal dissemination in 6 cases (25%) and lung metastases in 4 cases (17%). 5 pts (21%) had only BM. Diagnosis of BM was achieved by computed tomography in 13 pts (54%), by bone scintigraphy in 6 pts (25%) and by PET in 5 pts (24%). All pts had symptoms related to BM: bone pain in 13 pts (54%), spinal cord compression in 1 pts (4%). 11 pts (46%) developed thrombocytopenia. 13 pts were treated with analgesic drugs, 11 pts (46%) with palliative chemotherapy, 8 pts (33%) with bisphosphonates and 4 pts (16%) with radiotherapy. The median survival from diagnosis of BM was 5 months (1-25 months). In the pts with thrombocytopenia the median survival was even shorter (1-150 days). Conclusion: Our data confirmed the low incidence of BM in the gastric cancer. The prognosis of pts with gastric cancer and BM is poor. In this population, the development of thrombocytopenia is associated with a lower survival. Related to the quick clinical deterioration of pts with BM, an early diagnosis and multidisciplinary approaches may be important in the management of these pts.