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Master Thesis

Caractérisation des complications osseuses éligibles pour une vertébroplastie chez des patients atteints d’un cancer de prostate

Abstract : Introduction: Prostate Cancer (PCa) provides skeletal complications (SC), particularly Vertebral Compression Fractures (VCF) which impact on quality of life and mortality in patients with bone metastases (Symptomatic Skeletal Events SSE) or not. Although PCa is well known for osteoblastic metastases, we assume that specific subtypes of VCF characterized by “bone loss” (benign VCF such as osteoporosis or malignant VCF such as osteolytic metastases) are a rising concern. Since VCF represents a good indication for vertebroplasty, we also assume that vertebroplasty can select our population of interest. Objectives: To characterize vertebral compression fractures (VCF), benign (bVCF) versus malignant VCF (mVCF) in prostate cancer (PCa) patients (pts) who underwent vertebroplasty, and describe respective populations. Methods: An observational monocenter retrospective study, from 2008 to 2015. Characterization of VCF was made using a composite criterion (bone scan, CT scan, MRI +/- bone biopsy). Results: Fifty-one pts, mean age 71.3 (52-89) and 67 VCFs were reported: 38 (57%) mVCF and 29 (43%) bVCF. Among bVCF, 8 (12%) occured in bone metastatic pts. Among mVCF, 13 (34%) of bone metastases were purely osteolytic and 25 (66%) with osteolytic component. Regarding bVCF, continuous androgen deprivation therapy and high doses of corticosteroids (> 6 months, ≥7.5 mg/day prednisone equivalent) were given in 87% and 34% of cases respectively. Dual X-ray Absorptiometry was performed in 18% of pts. Vitamin D supplementation was prescribed in 43% of pts. Conclusion: These data remind the necessary prevention of bVCF even in patients with bone metastases with consequences on patient management, while studies for bone targeted agents approval used skeletal related events with no definition of the cause, i.e. benign or malignant. Occurrence of bVCF is a rising concern since these pts, and especially those with bone metastasis are experiencing longer survival and then are more exposed to such events, also favored by longer exposure to corticosteroids and chemical castration. Finally, mVCF were mostly with osteolytic component, which constitutes one feature of rising dedifferentiated phenotype. Vertebroplasty may play a major role in these newly defined populations.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01417664
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Thursday, December 15, 2016 - 5:51:23 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:33 PM
Long-term archiving on: : Tuesday, March 21, 2017 - 8:38:45 AM

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Julie Lallier. Caractérisation des complications osseuses éligibles pour une vertébroplastie chez des patients atteints d’un cancer de prostate . Médecine humaine et pathologie. 2016. ⟨dumas-01417664⟩

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