A 52-year-old man presented with gradually increasing pain in his neck and left upper arm over a 3 month period. When he had visited our hospital, he could not move his neck as a result of the pain. The plain radiographs demonstrated a collapsed vertebral body at C-6 (Fig. 1A). The CT scan findings of the lung revealed a solitary round tumor with an irregular margin in the left upper lobe. The size was 2 cm in diameter. Technetium-99 bone scintigraphy demonstrated multiple spinal bone metastases, which were diagnosed as a stage IV (T1N0M1).

The patient underwent posterior decompression and spinal fusion as palliative surgery. The visual analog scale (VAS) improved to 2 cm from 10 cm. The pathological diagnosis was adenocarcinoma. Although platinum-based chemotherapy was administered, the tumor marker and size did not improve. The patient rejected additional therapy. Four months after the first operation, the C3-6 vertebral body collapsed and he could sit up (Fig. 1B). Therefore, the patient underwent C2-7 anterior body fusion as palliative surgery again. After surgery, the neck pain was reduced, and the VAS was improved to 4 cm from 10 cm. However, two months after the second operation, he presented with intolerable neck pain. The performance status deteriorated to 3. Since the radiograph showed the progress of osteolysis (Fig. 1C) and the primary focus progressed, the oral administration of gefitinib 250 mg/day was started as a second-line chemotherapy with informed consent. After administration for one month, the pain was reduced to allow walking. The performance status improved to2. The VAS improved to 4 cm from 10 cm. At three months after administration, the cervical metastatic lesions showed remarkable increasing bone formation (Fig. 1D). The CT scan findings of the cervical vertebrae confirmed osteosclerosis matched with the metastatic bone tumor lesion (Fig. 2). The patient survived for a further two years after having a recognized bone metastasis. The activity of daily living (ADL) continued during the term of gefitinib administration.

A 78-year-old woman presented with cough and weight loss over a 3 month period. The plain radiographs and CT scan findings revealed a tumor in the left upper lobe of the lung. A pathological diagnosis by sputum suggested an adenocarcinoma. In addition, to the brain metastases, there were multiple bone metastases of the pelvis, spine and femur. She was diagnosed with stage IV (T4N3M1) lung cancer. The oral administration of gefitinib 250 mg/day was commenced with informed consent. One week later, she suffered from the pathological fracture of the femur, and underwent internal fixation. Three months after surgery, remarkable bone formation and union was observed in the plain radiograph (Fig. 3A). She was able to walk without pain. The cervical metastatic lesions revealed remarkable bone formation in the plain radiographs and CT scan findings (Fig. 3B and C). She was still alive one year after the recognized bone metastasis with an improvement in the pain and ADL after gefitinib administration.