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ED ITOR Ð L yons and colleagues report a patient with m etastatic adamantinom a complicated by hyper-calcem ia. We too have seen such a patient in whom hyp ercalcemia was resistant to bisph ospho nates but initially responsive to chem otherapy. In 1980 when aged 18 the patient underwent a right above-knee am putation for adam antinoma of the right tibia. In 1993 a thoracic vertebral m etastasis was excised, but recurred the following year. It was again treated by debulking and radiotherapy, the patient also undergoing removal of a single pulm onary m etastasis. In 1996 extensive liver and lung m etas-tases were noted. A t this tim e, seru m calcium was noted to be 3 .1 5 m m o l/ 1 (n o r m a l r a n g e 2 .2± 2 .6 m m o l/ 1). Repeated infusions of pam idronate failed to im prove the hyp ercalcem ia an d he w as therefore treated with cisplatin 100 m g/m 2. T here w as nor m alisation o f the seru m calciu m w ithin 3 weeks, but carboplatin was su bsequen tly su bstituted for cisplatin becau se of renal dysfun ction an d severe tin nitus and hearin g lo ss. T here was no objective response in either the liver or lung disease. The patient remained normocalcaem ic for 7 months before the serum calcium rose again, to 4.02 mmol/1. There was no response to either oral or intravenous bisphosphonates or to the reintroduction of carbo-platin. Oral corticosteroids were also unsuccessful and the patient died of disease 5 months later. C learly this is a very uncom m on com plication of a rare disease and indicates a poor prognosis. Lyons et al., report of hypercalcem ia resolving after radiation to the hem ithorax is interesting. In patients w ho m ay have m ore widespread disease consideration should be given to the use of platinum-based chemotherapy.

Response to Article Published in Vol. 3. No. 1. Palliative Response to Radiotherapy in a Patient with Hypercalcemia Caused by Metastatic Adamantinoma