[Systematic hormone- and chemotherapy in the management of skeletal metastases]

Bone is among the most common sites of metastatic disease in cancers of the breast, prostate, and lung. The decision about systemic therapy depends on the histology, presence and extent of extraskeletal disease, and the performance status of the patient. For patients with estrogen-receptor-positive breast cancer or prostate cancer, hormonal treatment represents the treatment of choice. In estrogen-receptor-negative breast cancer, and for patients who have failed hormonal therapy or have liver metastases, chemotherapy should be initiated. All patients with small-cell lung cancer should receive chemotherapy. Bone metastases of differentiated thyroid cancers can be treated with radioisotopes. In non-small-cell lung cancer or renal cell cancer, systemic chemotherapy should be confined to younger patients and patients in good general condition. Radiologic assessment of responses of skeletal metastases to systemic therapy is often difficult. New approaches in measuring bone metabolites in urine might prove helpful.