[vince1]

lesions

by vince1 on Fri Jun 10, 2011 4:57 pm

I have had two differing opinions Re: bone lesions healing while on chemo. One oncoligist maintains the lesions will remain forever, another said they will heal with a combo of chemo drugs.

Can anyone please clarify. Does zumeta help in healing of lesions?

Thnak you in advance Vince

God Bless

[Dr. Edward Libby]

Re: lesions

by Dr. Edward Libby on Tue Jun 14, 2011 6:16 pm

Hello,
In general lytic lesions from myeloma do not heal with treatment. This is true even if the disease enters a remission. Successful treatment should stop the development of new lesions though. Zometa and the other bisphosphonates do not cause the lytic lesions to heal but they stop or slow advancement in existing lesions and stop/slow development of new lesions .

[Snip]

Re: lesions

by Snip on Tue Jun 14, 2011 10:50 pm

Dr. Edward Libby wrote:
> Hello,
> In general lytic lesions from myeloma do not heal with treatment. This is
> true even if the disease enters a remission. Successful treatment should
> stop the development of new lesions though. Zometa and the other
> bisphosphonates do not cause the lytic lesions to heal but they stop or
> slow advancement in existing lesions and stop/slow development of new
> lesions .

So my fractured vertebrae... remain fractured?

[Dr. Edward Libby]

Re: lesions

by Dr. Edward Libby on Sat Jun 18, 2011 10:28 am

If you are referring to compression fractures of the spine and/or fractures of bone due to osteopenic bone disease from myeloma....these do not "heal" completely even with treatment of the myeloma and administration of bisphosphonates. The bottom line is that fractured bones do not return to normal and lytic lesions do not go away and return to normal.

[NStewart]

Re: lesions

by NStewart on Sat Jun 18, 2011 10:46 am

What happens to the fractured bones? I had a pathologic fracture of my left humerus 2 years ago. The orthopedic doctor said during my last visit with him 5 months after it happened that it was healed. But, each x-ray that I've had since then mentions a "healing" fracture of the left humerus. They all mention callus formation around the fracture site, but they also mention evident lesions at the site. I know that if I carry too many things that are quite heavy in a short period of time that the fracture site hurts. Since this is the only fracture that I've ever had I don't know what a normal healed fracture feels like.

Thanks for your input,
Nancy

[Dr. Edward Libby]

Re: lesions

by Dr. Edward Libby on Mon Jun 20, 2011 12:57 pm

Hello Nancy,
Your question is not very specific and a complete explanation of what happens after a fracture is not possible. The answer also depends on the exact clinical scenario. It sounds like you had a pathologic fracture of the humerus that did not require surgical repair. Apparently you did not get radiation to the fracture site either. With treatment the local myeloma that caused the fracture can recede allowing healing in the area of the fracture. "Healing" does not necessarily mean that the fracture site is "as good as new" and in most cases it probably is not. Hoewever, many/most patients can return to their normal activities and will not suffer a fracture again in that area.

[adixs]

Re: lesions

by adixs on Mon Jun 20, 2011 3:52 pm

I am a little confused. Can you help clear this up for me?

1. Fractures or lessions never completely heal. They do improve however? Yes?

2. Breaks get better with vertebrae cement or other bone repairs as needed? (Less painful) Yes?

3. Local radiation can shrink tumor burden which would alleviate pain on the bone and lessions from being formed? Yes?

Thanks Dr Libby.

[Dr. Edward Libby]

Re: lesions

by Dr. Edward Libby on Wed Jun 22, 2011 7:41 pm

Yes to all.

[rmcarch]

Re: lesions

by rmcarch on Wed Jun 22, 2011 10:49 pm

Dr. Libby: Thank you for your thoughtful responses.
In your reply to Nancy you said:
"Hoewever, many/most patients can return to their normal activities and will not suffer a fracture again in that area."

Considering a patient diagnosed with Stage III B multiple myeloma with multiple vertebral and skeletal lesions, are "normal acitvities" such as biking, hiking, kayaking, etc. a possible part of the patient's future once remission is achieved? Do monthly infusions of Zometa gradually impact the patients ability to undertake these types of activities? Are there particular precautions a patient should take in resuming activities?

Thank you
Robert

[Dr. Edward Libby]

Re: lesions

by Dr. Edward Libby on Fri Jun 24, 2011 12:42 am

This is a difficult question Robert. Because the skeleton is in all likelihood is diffusely compromised in advanced myeloma such as you described I would recommend that you AVOID activities in which a major fall (e.g. mountain biking, rock climbing,etc) or the application of large amounts of force on long bones or the skeleton (e.g. weight lifting, hard physical excercise,etc) were highly likely. There is no perfect way to reevaluate your skeleton but a total body MRI and bone density test would be interesting. Even with that information though I would be unlikely to recommend heavy activity. As you know a fracture can be so terribly painful and debilitating its just not worth taking the risk. On the other hand, easy kayaking, walking, mild hiking, etc would be acceptable to me.
You should know that I hate to limit physical activity in any patient and do not give this type of advice lightly. But I think its in the patient's best interests.