Chemotherapy of metastatic cancer in bone.

A harmonious cooperation between the oncologist, orthopedist and radiotherapist can result in a more comfortable, more functional, and in some instances, longer life for the patient. Chemotherapy is an effective and important component of the total management of a patient with metastatic cancer. It provides a mode of therapy for all of the manifestations of disseminated cancer, including bone metastases. Combination chemotherapy has been demonstrated to be of important benefit in metastatic bone disease secondary to carcinomas of the breast, prostate and lung (small cell). The results with other types of lung cancer are less impressive. The chemotherapy of metastatic thyroid and renal carcinomas remains disappointing. Of the tumors that metastasize less frequently to bone, testicular and ovarian neoplasms have demonstrated significant responsiveness to combination chemotherapy. Results with Hodgkin's disease, other lymphomas and multiple myeloma are reproducible and may provide palliation and extended survival. Metastatic melanoma, colon cancer and miscellaneous other carcinomas in bone are ordinarily refractory. The limitations of the current modes of assessing response to therapy in osseous lesions impede the ability to recognize and thus, capitalize on effective treatments. New drugs and new combinations of drugs hold promise for the future.