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DNA within tumor cells at sites of bone metastasis exhibits unique genetic alterations (both nuclear and mitochondrial) that contribute to metastatic behavior. These alterations can serve as biomarkers for disease detection, prognosis, and monitoring response to therapy. Analysis of circulating tumor DNA (ctDNA) and disseminated tumor cells (DTCs) provides insights into the mechanisms underlying skeletal colonization by cancers and informs the development of targeted therapies and risk-adaptive treatment strategies.
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