Patient: Lung adenocarcinoma with bone metastasis was found on August 20, 2008. Before diagnosis, he was diagnosed with significant lumbar and leg pain and generalized pain, with significant wasting, muscle atrophy of both lower limbs, (history of surgery for lumbar synostosis) numbness and weakness, difficulty walking, no coughing and hemoptysis, no fever, urination and defecation, moderate appetite, like soft food with fluid, general malaise and discomfort. After one course of chemotherapy (gemcitabine, cisplatin), the patient was treated with gefitinib 0.25 qd x 180 days, salmon calcitonin 50u intramuscular injection qd x 20 days, and propoxyphene oral pain relief, 1~2 capsules/day. The patient’s general condition improved. He gained weight. Now the patient has pain in many parts of the body: right clavicle, left and right rib arch, back and waist, and both lower limbs, and numbness of both lower limbs is obvious, and walking is weak, how to actively treat the patient in order to improve the quality of life. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: The patient’s condition shows that the lung tumor shrank significantly during the course of gefitinib treatment, indicating that gefitinib treatment is effective and can be continued. If the bone metastasis occurs in the vertebral body, it is necessary to prevent paraplegia caused by bone metastasis, and local treatment such as PVP and external radiation should be given actively. Patient: Thank you, Dr. Guo, but can external radiation be used for systemic multiple metastases? Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Yes, external radiation therapy is mainly for the areas with obvious damage and pain. The survival period of patients with multiple metastases of lung cancer is usually about 1 year, which is of course closely related to the chosen treatment method and efficacy. Patient: Is zoledronic acid a chemotherapeutic agent, does it have an inhibitory effect on bone metastases, and can you briefly discuss its pharmacological effects? Is it effective if the metastases are predominantly spinal and what kind of therapy is pvp? Thank you for your advice. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Zoledronic acid is not a chemotherapeutic drug, its treatment for bone metastases is symptomatic, including inhibition of bone destruction, promotion of bone regeneration and pain relief. The immediate filling of the bone cement helps to prevent paraplegia due to bone metastases. Patient: Thank you, doctor, you have made me understand a lot about medicine. I would like to consult you again if I encounter any difficulties in the process of patient treatment. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: I wish the patient a speedy recovery. Patient: The patient is suffering from more frequent and severe pain, the effect of oral propoxyphene is not satisfactory, can tramadol be chosen? In addition, I would like to ask if I can use troche if gefitinib is not effective. Is troche also a targeted therapy? Can salmon calcitonin be used with diphosphonates to enhance pain relief? Thank you! Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: You can choose tramadol. Gefitinib and erlotinib (i.e. Troche) are similar in mechanism of action, so they are not recommended. Salmon calcitonin and bisphosphonates are also not recommended for concomitant use.