Administration of bisphosphonate for hypercalcemia associated with oral cancer

Sixteen hypercalcemic patients, most of whom had uncontrollable locoregional lesions and lung metastases, were studied. Nine patients had been given BP, and the rest had not.There were significant differences in age and serum ALT between the BP-treated and -untreated groups. The first administration of BP effectively and safely decreased the serum calcium level, but repeated administrations were less effective. Although the patients treated with BP survived significantly longer than the untreated subjects, the difference of the median was only about 2 weeks.The occurrence of hypercalcemia in oral cancer patients apparently implies an extremely poor prognosis, and long-term survival cannot be expected, even with BP treatment.Cancer-associated hypercalcemia (CAH) frequently occurs in patients with advanced oral cancer and indicates that the patients have entered the terminal stage of the disease [1]. Increased serum calcium (Ca) levels induce symptoms in the gastrointestinal, kidney, and central nervous systems [2], reducing the patients' quality of life (QOL). Although CAH cannot be adequately resolved without controlling tumor progression, the administration of bisphosphonate (BP) has been reported to effectively decrease the serum Ca level, and improve QOL [2-4]. Especially in the case of patients with a slow-growing tumor, such as breast cancer, BP can significantly control pain caused by bone metastasis [5]. Accordingly, BP administration might be useful to improve the QOL of CAH patients in whom long-term survival is anticipated. However, advanced oral cancers usually progress rapidly, and the average survival time after the occurrence of CAH is approximately 1 or 2 months [1,6]; thus, BP treatment might not be helpful for all CAH patients with advanced oral cancer. However, there have been few reports on the clinical effects of giving BP to oral cancer patients with CAH, so its potential usefulness is uncertain.Here we retrospectively investigated the clinical