I-Bisphosphonates ne-Denosumab ye-Bone Metastases ne-Adjuvant Therapy
I-cancer eye yasakazeka emathanjeni (amathambo ayisithupha) ajwayelekile kakhulu futhi angabangela ubuhlungu obukhulu nokukhubazeka okuhlobene nokuhlukana nezinye izinkinga. Eminyakeni yamuva imithi ebizwa ngokuthi ama-bones-modifying agents iye yanconywa ukuba ikhansela elilodwa lithinte ama-metastases ngokushesha uma itholakala. Kulesi silungiselelo, lezi zidakamizwa akugcini nje ukunciphisa ingozi yezinhlanzi kodwa kwezinye izimo zingase zithuthukise ukusinda.
Njengenzuzo yesibili, izigaba zombili izidakamizwa eziguqula amathambo zinempahla yokulwa nomdlavuza. Yini okudingeka ukwazi mayelana nezidakamizwa ezifana neZometa ne-denosumab uma uhlala nomdlavuza we-metastatic?
I-Bone Metastases vs. I-Cancer Cancer
Lapho abantu bezwa ngomdlavuza emathanjeni, kungaba ukudideka okukhulu. Iningi lesikhathi lapho abantu bekhuluma "ngomdlavuza wethambo" babhekisela emasitini ayisisindo ; umdlavuza oqala kwesinye isifunda somzimba futhi usakazeka emathanjeni. Ngesikhathi laba bantu bengasebenzisa igama elithi "umdlavuza wamathambo," amagciwane angasakazwa amathambo awabhekwa njengengculaza yethambo. Isibonelo, umdlavuza webele usakazeke emathanjeni awubizwa ngokuthi umdlavuza wesifuba kodwa kunalokho "umdlavuza webele wesifuba kuya emathanjeni" "noma umdlavuza webele we-bone metastases. Umdlavuza wamathambo oyinhloko awuncane kakhulu kunezibalo zamathambo. Ngaphansi kwe-microscope, umdlavuza wethambo wawuzobonisa amangqamuzana e-bone cancer. Ngokuphambene, ngamathambo ama-metastases amangqamuzana omdlavuza esitheni ayenesisindo esifanayo njengomdlavuza wokuqala; amangqamuzana ebelethwe umdlavuza esimweni somdlavuza webele, amangqamuzana emaphaphu omdlavuza emathanjeni (nomdlavuza wamaphaphu) njalonjalo.
Ngomdlavuza wamathambo oyinhloko, ngokuvamile i-tumor eyodwa kwelinye ithambo. Ngama-metastases amathambo, ngokuvamile kutholakala ubufakazi bomdlavuza ezindaweni ezahlukene zethambo noma emathanjeni ahlukahlukene.
Amakhansela Okungahle Asakaze Ukuthumba
Kunezinhlobo eziningi zegciwane ezingasakazekela emthanjeni umdlavuza wesifuba ovame kakhulu, umdlavuza wamaphaphu, umdlavuza wesifo sofuba, kanye ne-myeloma eminingi.
Amanye amakhemikhali angasakazeka emathanjeni ahlanganisa umdlavuza wezinso, umdlavuza wesisu, umdlavuza wesisu, umdlavuza wesibeletho, umdlavuza we-thyroid, kanye namagciwane angama-colorectal.
I-metastases ye-Bone ivele ngamaphesenti angama-70 abesifazane abanomdlavuza webele we-metastatic (amathambo yi-site evamile kakhulu ye-metastases), kanye nama- metastases amathambo avela emdlalweni webele webele. Isizathu esibalulekile sokuhlupheka nokukhubazeka kwalaba besifazane (namadoda). Kwabaningi balaba bantu, i-metastases ye-bone iyisibonakaliso sokuqala sokuthi umdlavuza uphindele ngemuva kweminyaka noma ngisho namashumi eminyaka okukhululwa. Ezinye zezokwelapha ze-hormonal ezisetshenziselwa umdlavuza webele (ezifana ne-aromatase inhibitors) zingaholela ekulahlekelweni kwethambo, okuqhubeka nokuhlanganisa inkinga. Amathambo avame kakhulu lapho umdlavuza wesifuba usakazeka khona umgogodla, izimbambo, isikhumba, namathambo emilenzeni nezingalo ezingenhla.
I-metastases ye-Bone yomdlavuza wamaphaphu nayo ivamile, ethinta cishe amaphesenti angu-30 kuya kwangu-40 abantu abanomdlavuza wamapapu ophakeme. Amathambo avame ukuthinteka kakhulu umgogodla, i-pelvis, kanye namathambo angenhla nangenhliziyo. Umdlavuza we-Lung uyingqayizivele ngendlela yokuthi izidakamizwa zingase zenzeke emathanjeni ezandleni nasezinyaweni. Phakathi kwabantu abanesifo samathambo esivela emdlalweni wamaphaphu, amaphesenti angama-22 kuya ku-59 azoba nesenzakalo "esihlobene nesigameko" njengokuhlukana.
I-metastases ye-Bone nayo ivame kakhulu emdlalweni ophezulu we-prostate . Njengabesifazane abanomdlavuza wesifuba, ukwelashwa kwama-hormonal ne-androgen yokunqanda ukwelashwa nakho kunganciphisa amathambo. Amadoda amane kwayisishiyagalombili abanomdlavuza we-metastatic prostate bazoba netastases kuya amathambo. Indawo evamile ye-metastases yizintambo, umgogodla, namathambo e-pelvic.
I-metastases ye-Bone evela kuma-myeloma amaningi nawo avamile. Ngama-x-ray, amathambo athatha ukubukeka kwenundu. Lapho i-myeloma eningi ihlasela amathambo amaseli omdlavuza avimbela amathambo okwenza amangqamuzana (ama-osteoblasts) futhi akhuthaze amangqamuzana amathambo aphule amathambo (ama-osteoclasts). I-myeloma eminingi ivame ukutholakala emathanjeni amakhulu njengomgogodla, i-skull, i-pelvis, izimbambo namathambo amakhulu emilenze.
Izinhlobo ze-Bone Metastases
Kunezinhlobo ezimbili eziyinhloko zamathambo ayisithupha: i-osteolytic ne-osteoblastic. Nge-metastases ye-osteolytic, i-tumor ibangela ukwehla (lysis) kwethambo. I-metastases ye-osteolytic ibonakala nge-myeloma eminingi kanye nezicubu eziqinile ezifana nomdlavuza webele. I-metastases ye-osteoblastic yenza kube nokukhiqizwa kwethambo okwandisa futhi kuvame ukubonakala ngomdlavuza we-prostate. Iningi lamakhansela anomabili ama-metastase amathambo nakuba amaphesenti angama-80 kuya kwangu-85 we-metastases nomdlavuza wesifuba yi-osteolytic. Ama-fractures cishe angenzeka emathambo nge-metastase ye-osteolytic kune-metastases ye-osteoblastic.
Izinkinga Ezivela Emathemethini E-Bone
I-metastases ye-Bone inganciphisa kakhulu izinga lakho lokuphila nomdlavuza, kodwa ukwelashwa okusha kunokwenza umehluko kubantu abaningi. Ama-metastase amathambo asho nje ukuthi umdlavuza usakaze futhi awusaphuluki, kodwa kungaholela ezinkingeni eziningana.
Ubuhlungu obuvela emathisini we-bone bungaba lukhuni kakhulu futhi ngokuvamile kudinga ukuthi ukwelashwa ngezihlungu zendlebe kuyanciphisa kanye nemithi elwa nokuvuvukala.
I-metastases ye-Bone iphinde ikhulise amathuba okuphuka ezindaweni zethambo ezibuthakathaka yi-tumor. Uma kwenzeka ukuphuka emathanjeni nomdlavuza we-metastatic, kubizwa ngokuthi ukuphulwa kwe-pathologic. I-pathologic fractures ingenzeka ngokulimala kakhulu. Ngaphandle kokufakela izidakamizwa, ama-metastase amathambo angenza kube nzima ukuba amathambo aphukile aphuluke.
Lapho izidakamizwa zenzeka emgodleni ophansi, isimo esiphuthumayo esibizwa ngokuthi ukucindezela komgogodla kungase kwenzeke. I-Cancer ku-vertebrae ingabangela ukuba bawa futhi bacindezele izinzwa ezihamba kusukela emthonjeni womgogodla kuya engxenyeni engezansi yomzimba. Izimpawu zihlanganisa ubuhlungu obubuyela emuva emlenzeni, obuthakathaka, kanye nokuphefumula kwemilenze, nokulahlekelwa isilonda kanye / noma ukulawula isisu. Ukwelashwa okuphuthumayo ngemisebe noma ukuhlinzwa kungasimisa umgogodla ukugwema ukukhubazeka okungapheli.
I-hypercalcemia ye-malignancy noma izinga eliphakeme le-calcium egazini lingase livele ngenxa yokukhululwa kwe-calcium kusuka ezingxenyeni ezibhubhisayo zethambo ukuya egazini. Kucatshangwa ukuthi abantu abangamaphesenti angu-10 kuya kwezingu-15 abanomdlavuza ophakeme bazobhekana nalesi simo (esinezinye izimbangela kanye nokwengeza kwamathambo).
Ukulahlekelwa ukuhamba ngenxa yezinhlupho kunganciphisi izinga lempilo kuphela kodwa kungakubeka engozini yezinye izinkinga. Ingozi yezindwangu zegazi kubantu abanomdlavuza usuvele ukhuphukile, futhi ukungahambi kahle kuphakamisa ingozi yokuthuthukisa izifo ezincane ze-vein noma i-pulmonary emboli
Ukwelashwa kweMetastases ye-Bone
Kukhona okwamanje okunye okukhethwa kukho okungafani okutholakala ekuphatheni ama-metastases amathambo. Ezinye zezokwelapha ezijwayelekile ezisetshenziselwa umdlavuza we-metastatic zingabuye zinciphise i-metastases yamathambo. Lezi zokwelapha zingase zibandakanye i- chemotherapy , imithi ehlosiwe, ama-antibodies monoclonal , kanye nezidakamizwa ze- immunotherapy . Kukhona nemithi yokwelashwa ekhuluma nge-bone metastases ngokuqondile. Lokhu kufaka:
- Ukwelashwa kwezikhambi: Ukwelashwa kwe- radiation kuyindlela yokwelashwa yendawo futhi kunganciphisa kakhulu ubuhlungu bobabili kanye nokuhlelwa kwephutha.
- I-Radiopharmaceuticals: I- Radiopharmaceutics yizidakamizwa lapho i-particle ye-radiation ifakwe komunye amakhemikhali ongabekwa ngayo egameni legazi. Izibonelo zifaka i-Strontium-89 ne-Radium-223. Njengoba lezi zinhlayiya zemisebe ziqhutshwa ngegazi emathambo wonke emzimbeni, zingase zisebenze ngokukhethekile kubantu abanezibalo eziningi noma ezisakazekile.
- Ukuhlinzwa: Kungase kudingeke ukwelashwa ukuze kuqiniswe ukuphuka noma ukuzinzisa amathambo okonakaliswe ukuvimbela ukuhlukana.
- I-radiotherapy yomzimba ebizwa ngokuthi i- stereotactic radiotherapy (i-SBRT) ne- proton yokwelashwa kwesiguli: Ngomuthi owodwa noma ombalwa kuphela we-metastases (isifo se-oligometastatic), ukuqedwa kwe-metastases ngezokwelapha njenge-stereotactic body body radiotherapy noma ukwelashwa kweproton kungenziwa ngomzamo wokupheka, kodwa lokhu okungavamile.
- Ama-agent-modifying agents: Lokhu kuzoxoxwa ngezansi.
Imithi ye-Bone Metastases (I-Bone-Modifying Agents)
Kunezigaba ezimbili eziyinhloko zezidakamizwa ezisetshenziselwa ukwelapha i-metastases yamathambo. Lokhu kuhlanganisa i-bisphosphates (njenge-Zometa) ne-denosumab. Ama-bone-modifying agent aphakanyiswa kunoma ubani onomdlavuza webele webele, futhi uvame ukusetshenziselwa nezinye izicubu eziqinile (njengomdlavuza wamaphaphu). Ezinye izindlela zokwelapha (ezifana nokwelashwa kwemisebe) ngokuvamile zidinga kanye nemithi yokulawula ubuhlungu.
Ama-agent-modifying agents angasiza abantu abanomdlavuza ngezindlela eziningana.
- Bangakwazi ukuqinisa amathambo aphethwe yi-metastase ukunciphisa kokubili ubuhlungu kanye nengozi yezinsalela
- Eziningi zokwelashwa ezisetshenziselwa umdlavuza webele kanye nomdlavuza we-prostate, zingandisa ingozi ye-osteoporosis, futhi kanye ne-metastases yamathambo abantu abaningi abafake imfucuza. Lokhu kubaluleke kakhulu njengoba abantu manje behlala isikhathi eside kunomdlavuza.
- Ngenxa yemiphumela yabo ezincane zamathambo, ama-agent-modifying agents anganciphisa ingozi ye-metastase yamathambo eyenzeka okokuqala (ngesifo somdlavuza webele futhi mhlawumbe umdlavuza we-prostate kuze kube manje). Ingozi ye-metastases yamathambo yanciphisa isisindo esisodwa, kanti izinga lokushona liye lahla ngesithupha.
- Ezifundweni zamuva zibheka ama-bone-modifying agents ephethe umdlavuza wamaphaphu, kubonakala sengathi lezi zidakamizwa zingathuthukisa kokubili ukuqhubeka-mahhala nokuphila okuphelele.
I-Bisphosphonates (i-Zometa)
Ama-bisphosphonates yimishanguzo eyasetshenziswa ekutholeni ukwelashwa kwe-osteoporosis futhi kamuva yaphawula ukusiza ngama-metastases amathambo. Uma isetshenziselwa ukwelapha esesakaze emathambo angenza umsebenzi ophindwe kabili. Akugcini nje ukuthi banciphise ukulahleka kwethambo kodwa banomthelela wokulwa nomdlavuza. Basebenza ngokunciphisa ukwehla kwethambo ukuze kuthuthukiswe amathambo.
Ama-bisphosphonates ngokuvamile asetshenziselwa amathambo ayisithupha afaka:
- I-Zometa (i-zoledronic acid): I- Zometa imithi e-intravenous esetshenziselwa ama-metastases amathambo avela kumagciwane amaningi ahlukene.
- I-Aredia (i-pamidronate) : i-Aredia iyi-bisphosphonate engaphakathi. Kuvunyelwe umdlavuza webele kanye ne-myeloma eminingi.
Imiphumela emibi kakhulu ye-Zometa ne-Aredia yi-syndrome efana nomkhuhlane omncane ezinsukwini ezimbalwa zokuqala ngemva kokumnika. Eminye imiphumela emibi ejwayelekile ye-bisphosphonates enikezwe kwangaphakathi ingabandakanya umonakalo wezinso, amazinga aphansi e-calcium, ubuhlungu besisindo, ohlangene, kanye / noma amathambo (angavela noma nini emva kokwelashwa), ukuphuka okungavamile kwe-femur, kanye nokufabula kwe-atrial. Ama-bisphosphonate angeke anconywe kubantu abanesifo sezinso.
Isigameko esingavamile kodwa esibi kakhulu esihambisana nokusetshenziswa kwe-Zometa (nezinye izipho ze-bisphosphonates) yi-osteonecrosis yomhlathi. Lesi simo sibonakala ukuwohloka okuqhubekayo endaweni yethambo ku-mandible noma i-maxilla futhi kungaba yinselele KuLwazi lwangempela ukuthi kwenzeke kangakanani, kodwa ingozi engamaphesenti amabili atholakele kwabesifazane abaphathwa nge-Zometa njenge-adjuvant therapy emdlalweni webele wesifuba. I-Osteonecrosis ingenzeka nanoma yikuphi izidakamizwa esigabeni sama-bisphosphonates kodwa amaphesenti angama-94 amacala atholakala ngezidakamizwa ezingenayo i-bisphosphonate futhi akuvamile neze ngezidakamizwa zomlomo.
I-Osteonecrosis yomhlathi ingenzeka uma abantu behlushwa isifo sofuba, banokuhlanzeka kwamazinyo amancane, noma baqhube izinqubo zamazinyo ezinjengezici zinozinyo. Kunobufakazi bokuthi ukuhlela ukuhlolwa kwamazinyo njalo ezinyangeni ezintathu nokusebenzisa ama-antibiotic okuvimbela ngezinqubo ezifana nokukhipha izinyo kunganciphisa ingozi. Izinketho zokwelapha zihlanganisa inhlanganisela yokuhlinzwa, ama-rinses, ama-antibiotic, kanye ne-hyperbaric oksijeni yokwelashwa.
Ama-bisphosphonates nawo avunyelwe abesimame be-postmenopausal abanekhambi lomdlavuza wesifuba. Ezilingo zomtholampilo, i-Zometa itholakale ukunciphisa ingozi yokuthuthukisa izibalo zamathambo ngengxenye yesithathu kanye nengozi yokufa ngomunye wesithupha.
I-Denosumab (i-Xgeva ne-Prolia)
I-Xgeva ne- Prolia (i-denosumab) i-antibody yamonoclonal (i-antibody eyenziwe ngamuntu) enganciphisa izinkinga (njengama-fractures) ahlotshaniswa nama-metastases amathambo. Kunezinhlobo ezimbili zalesi sidakamizwa esinemibono ehlukile ngomdlavuza. Zinikezwa ngomjovo njalo emavikini amane.
I-Denosumab isebenza ngokubophezela futhi ingenise i-receptor kwiprotheni (RANKL) elawula ukulungiswa kwamathambo. Kunezinhlobo ezimbili eziyinhloko zamangqamuzana emathanjeni: ama-osteoblasts abangela ukukhula kwamathambo, kanye nama-osteoclasts aphula ithambo. I-Denosumab ivimbela ama-osteoclasts futhi ikhulisa amandla we-bone.
Kubuyekezwa kwezifundo ezingu-2016, i-denosumab yahlolwa ngezilingo ezintathu ezihlukene zemitholampilo ebheka indima yayo emdlalweni webele webele, umdlavuza wesifo sofuba, kanye nesifundo sesithathu nabantu ababenama-myeloma amaningi noma ama-tumor amaningi ngaphandle kwebele noma isifo somdlavuza we-prostate. Ngomdlavuza wesifuba nomdlavuza we-prostate, i-denosumab yayinamandla kune-Zometa ekunciphiseni ingozi yezinhlupho ezihlobene namathambo emasaka. Ngama-myeloma amaningi nezinye izicubu eziqinile (leyo denosumab yayilingana nokuphumelela kuZometa.
Ngomdlavuza wamaphaphu, isifundo se-2015 sithole ukuthi uma kuqhathaniswa neZometa, i-denosumab inciphise ingozi yokuhlukana okwenzeka ngamaphesenti angu-17. Kubuye kubonakale ukubambezela ukuthuthukiswa kwamathambo ayisisindo, ukunciphisa ukukhulelwa kwesisu, kanye nokuphucula isikhathi esingaphansi kwenyanga.
I-Denosumab nayo itholakala ekunciphiseni ingozi yokwelashwa okuhlobene nokwelashwa ekhanda lomabele kanye nomdlavuza wesibeletho (okuhlobene nokusetshenziswa kwe-aromatase inhibitors emdlalweni webele webele kanye nokwelashwa kwe-androgen emdlalweni wesibeletho)
Imiphumela emibi ye-denosumab ifana ne-bisphosphonates kodwa lezi zidakamizwa cishe ziholela ezingeni eliphansi le-calcium ngokusetshenziswa kwesikhathi eside. Ngenxa yalesi sizathu, ukuthatha isithako se-calcium ne-vitamin D kuvame ukuphakanyiswa. Ngokungafani nama-bisphosphonates, i-denosumab ingasetshenziselwa abantu abanezinkinga zezinso ezikhubazekile. Njengama-bisphosphonates, kunengozi encane ye-osteonecrosis yomhlathi kanye nalezi zidakamizwa.
Izinkombandlela ze-Bone-Modifying Agents Nge-Bone Metastases
Ucwaningo olwenziwe ngama-bone-modifying agents luholele ezihlakalweni ezikhona kwezinye zegciwane.
Ngomdlavuza wesifuba we-metastatic, nge-metastases yamathambo, i-American Society of Clinical Oncology imihlahlandlela kusukela ngo-2017 uncoma abesifazane ukuthi baphathwe ngenye yezidakamizwa ezilandelayo ngokushesha nje lapho kutholakala izidakamizwa ze-bone:
- I-Xgeva noma i-Prolia 120 mg ngaphansi kwamasonto amane onke
- I-Aredia 90 mg IV njalo emavikini amathathu kuya kwangu-4
- I-Zometa 4 mg IV njalo ngamasonto angu-12 noma onke amasonto amathathu kuya kwangu-4
Ngomdlavuza we-prostate, izinkombandlela zokwelapha zika-2017 nazo zancoma ukuthi ama-agent-modifying agents aqalwe ngesikhathi sokuxilongwa kwe-metastases yamathambo. Izinketho zihlanganisa noma:
- I-Xgeva / Prolia (i-denosumab) i-120 mg ngaphansi kwamasonto amane
- I-Zometa 4 mg IV njalo ngamasonto angu-12 noma onke amasonto amathathu kuya kwangu-4
Zonke ezinye izicubu eziqinile nge-bone metastases zingaphathwa ngenye yalezi ezilandelayo:
- Zometa 4 mg IV njalo emavikini amathathu kuya ku-4
- I-Denosumab 120 mg ngaphasi kwamasonto amane
Ngaphambi kokuqala Ukwelashwa
Ngaphambi kokuba uqale ukwelashwa nge-denosumab noma i-bisphosphonates, kunconywa ukuthi abantu babe nokuhlolwa okuphelele kwamazinyo abafuna ubufakazi bokugula kwegum nokuthi noma yimuphi umsebenzi wamazinyo okudingeka wenziwe ngaphambi kokuqala le mithi.
Ngaphansi kwe-Bone-Ukuguqula Imithi Ye-Bone Metastases Ezingxenyeni Eziqinile
I-metastases ye-Bone inselele kubantu abaningi abanomdlavuza we-metastatic futhi inganciphisa izinga lokuphila nokuphila. Ama-agent-modifying agents ajwayelekile futhi manje anconywa kusenesikhathi ngemva kokuxilongwa kwe-bone metastases yezinkinga eziningi ze-kansa.
Ama-bisphosphonates afana ne-Aredia ne-Zometa anganciphisa ingozi yezinsalela, futhi kamuva imbangela yobuhlungu nokungahambi kahle. I-Denusomab iphumelela ekunciphiseni ama-fractures kanye futhi angase abe ngcono kakhulu kune-bisphosphonates for cancer kanye ne-prostate kancers. Zombili izigaba zemithi zithwala ingozi engavamile ye-osteonecrosis yomhlathi, futhi ukuhlolwa ngokucophelela kwamazinyo okubheka izibonakaliso zesifo sofuba kunconywa ngaphambi kokuqala le mithi.
Ngaphezu kokunciphisa ingozi yokuhlukunyezwa, le mithi ingasiza ekulahlekeni kwethambo elungile ngenxa yezokwelapha ze-hormonal ezisetshenziselwa ukwelashwa kwebele kanye ne-prostate. Bobabili i-bisphosphonates ne-denosumab kubonakala sengathi banomsebenzi omkhulu wokulwa nomdlavuza, okwandisa izinzuzo zabantu abakhetha ukusebenzisa lezi zidakamizwa. Eqinisweni, ngaphezu kwabantu abanomdlavuza webele we-metastatic, manje i-Zometa isinconywa ngomdlavuza webele wesandulela njengengculazi ye-adjuvant ukunciphisa ithuba lokuthi umdlavuza webele uzosakazeka emathanjeni kuqala.
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