Skeletal Metastases in Pancreatic Cancer: A Retrospective Study and Review of the Literature

Background: Skeletal metastases represent an underappreciated site of metastasis in patients with pancreatic cancer. Previous reports have estimated the prevalence to range from 5 percent to 20 percent. With the use of gemcitabine and novel targeted agents such as erlotinib, there has been a modest increase in survival in patients with advanced pancreatic cancer. As such, it is anticipated that previously uncommon occurrences such as skeletal metastases will become more frequent. Patients and Methods: Retrospective chart review was conducted at two academic institutions to identify pancreatic cancer patients with skeletal metastases over a two-year period. Results: Seven patients were identified from a database of 323 patients (2.2 percent). All patients had advanced disease and had received prior systemic therapy (range: 1-4 lines, median: 2 lines). Approximately half (57.1 percent) of the patients were symptomatic from their skeletal metastases. The most common sites of skeletal metastases were vertebrae (100 percent), hips (57.1 percent), and ribs (57.1 percent). Both blastic and lytic lesions were noted, with a predominance of blastic lesions (71.4 percent). A majority of patients (71.4 percent) received bisphosphonates as part of their care. Discussion: Skeletal metastases are an uncommon but clinically important occurrence in patients with pancreatic cancer. Clinicians caring for patients with pancreatic cancer should be alert regarding skeletal metastases, due to the morbidity it can cause for these patients (e.g., back pain, fractures, etc.).