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Bone scan flare phenomenon

Antonio Alcaraz, Luís Martínez-Piñeiro, Alfredo Rodríguez, José Rubio, Ángel Borque, Javier Burgos, Joaquín Carballido, José Manuel Cózar, Itziar Crespo, Salvador Esquena, Francisco Gómez-Veiga, Dionisio López, Bernardino Miñana, Juan Morote, María José Ribal, Eduardo Solsona, José Francisco Suárez, Miguel Unda
OBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing...
November 2017: Archivos Españoles de Urología
A Weisman, S Harmon, T Perk, M Scarpelli, G Liu, R Jeraj
PURPOSE: Bone flare has been observed on Tc-99m bone scans during early assessment in metastatic Castration-Resistant Prostate Cancer (mCRPC) patients receiving select androgen-signaling pathway (AR) targeted treatments, including CYP17-inhibitor Abiraterone. This study investigates the appearance and potential clinical impact of bone flare in mCRPC patients receiving CYP17-inhibitors using (18) F-NaF PET/CT. METHODS: Twenty-three mCRPC patients being treated with CYP17-inhibitors received NaF PET/CT scans at baseline, week 6, and week 12 of treatment...
June 2016: Medical Physics
Lea Bottlaender, Marie Perier-Muzet, Véronique Lapras, Luc Thomas, Stephane Dalle
BRAF inhibitors (vemurafenib and dabrafenib) are commonly prescribed in BRAF-mutant metastatic melanoma and allow improvement of the overall survival and progression-free survival. They are, however, accompanied by many adverse effects which mainly affect the skin. We observed on computed tomographic scans in three different patients after 3 months of treatment, the onset of osteosclerotic lesions. In parallel, the computed tomographic scans showed a significant reduction in all of the previously identified metastases in all patients...
February 2017: Melanoma Research
Mehrosadat Alavi, Shapour Omidvari, Alireza Mehdizadeh, Amir R Jalilian, Ali Bahrami-Samani
(177)Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using (177)Lu-EDTMP for MBP palliation. (177)Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward...
May 2015: World Journal of Nuclear Medicine
Chidambaram Natrajan Balasubramanian Harisankar, Rajalakshmi Preethi, Jijoe John
Increase in radiopharmaceutical uptake is an indicator of progression of disease. Paradoxical increase in the radiopharmaceutical uptake also occurs during favorable response to therapy, which is designated as flare phenomenon. Flare phenomenon is well documented on bone scinitgraphy when initially noted lesions show increased radiotracer uptake after therapy is instituted. This happens despite favorable response to the treatment. The osteoblastic activity associated with healing response of bone tumors is the cause of flare phenomenon...
April 2015: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
Andrea D'Amico, Teresa Kowalska
Patients with estrogen-receptor-positive advanced breast cancer are treated with endocrine therapy. The majority of breast cancer localizations show 18F-fluorodeoxyglucose (FDG) uptake at positron emission tomography (PET) examination. In these patients, the metabolic flare after therapy is common and was proposed as an index of therapy efficacy. Nevertheless, prolonged persistence of flare can lead to misinterpretation. We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors...
January 2014: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
Khalsa Al-Nabhani, Rizwan Syed, Athar Haroon, Omar Almukhailed, Jamshed Bomanji
We present a case report of a patient with metastatic non-small cell lung cancer (NSCLC) who had a series of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans for assessment of response to treatment. A restaging 18F-FDG PET/CT scan after six cycles showed increased FDG activity in the bone lesions with reduced activity in the lung and liver lesions. The increased bone activity was considered to be due to flare phenomenon rather than metastasis. A short interval follow up scan after 1 month was advised to confirm this interpretation but this repeat scan showed disease relapse...
November 2012: Journal of Radiology Case Reports
Min-Chuan Lu, Tzyy-Ling Chuang, Moon-Sing Lee, Wen-Yen Chiou, Hon-Yi Lin, Shih-Kai Hung
A 26-year-old man with a history of nasopharyngeal carcinoma (NPC) presented with bone metastasis. Bone scan revealed diffuse skeletal metastases with superscan appearance. Afterward, radiotherapy for bone lesions was arranged and the effects were evaluated. The bone scan flare phenomenon appeared within a short time after radiotherapy. Diffuse bone metastasis, which is common in NPC, were indeterminate on images showing superscan pattern or flare.
June 2012: Journal of Clinical Medicine Research
Christina Messiou, Gary Cook, Alison H M Reid, Gerhardt Attard, David Dearnaley, Johann S de Bono, Nandita M de Souza
BACKGROUND: New or worsening bone lesions in patients responding to treatment, known as the flare phenomenon is well described on (99m)Tc-MDP bone scintigraphy, but to our knowledge has not previously been described on CT. The appearance of new or worsening bone sclerosis on CT in patients with prostate cancer may therefore be erroneously classified as disease progression. PURPOSE: To assess the incidence of osteoblastic healing flare response at 3-month CT assessment in patients with castrate-resistant prostate cancer and to identify associated features that enable differentiation from progressive metastatic bone disease at 3 months...
June 1, 2011: Acta Radiologica
Gary J R Cook, Ram Venkitaraman, Aslam S Sohaib, Valerie J Lewington, Sue C Chua, Robert A Huddart, Christopher C Parker, David D Dearnaley, Alan Horwich
PURPOSE: Bone scintigraphy (BS) lacks sensitivity for detecting very early skeletal metastases (SM) in prostate cancer (PC) and is often limited by poor specificity. Also scintigraphic flare of SM can occur following effective treatment and mislead an early response assessment. We hypothesised that a flare reaction might amplify the signal from subclinical SM, increasing the sensitivity of BS and that the phenomenon may be specific for metastases. METHODS: We conducted a prospective study to determine the frequency of the flare phenomenon in patients with metastatic PC starting hormone therapy and to explore its utility in patients with negative staging scans but considered at high risk of SM and in those with equivocal baseline BS abnormalities...
January 2011: European Journal of Nuclear Medicine and Molecular Imaging
Joline S W Lind, Pieter E Postmus, Egbert F Smit
BACKGROUND: The osteoblastic bone flare or response is the paradoxical phenomenon of increase in the quantity and/or density of bone lesions in the presence of well-documented disease response to treatment in other tumor sites. It results from the rapid repair and increased osteoblastic activity in bone metastases responding to therapy and therefore represents treatment efficacy. Nevertheless, no reliable markers can differentiate an osteoblastic flare or response from disease progression...
April 2010: Journal of Thoracic Oncology
Heng-Sheng Chao, Cheng-Pei Chang, Chao-Hua Chiu, Lee-Shing Chu, Yuh-Min Chen, Chun-Ming Tsai
PURPOSE: The bone scan flare phenomenon has been evaluated in various cancers in the presence of positive response to therapy. The aim of this study was to determine whether flare phenomenon occurs in non-small-cell lung cancer patients, especially adenocarcinoma in East-Asians, who respond dramatically and promptly to gefitinib. METHODS: We retrospectively evaluated the radiographic and scintigraphic images of 125 lung cancer patients who had previous gefitinib treatment between July 2003 and October 2005...
June 2009: Clinical Nuclear Medicine
Yelena Krupitskaya, Hedieh K Eslamy, Dorothy D Nguyen, Atul Kumar, Heather A Wakelee
Positron emission tomography (PET) is used routinely to follow therapeutic response in patients treated for non-small cell lung cancer (NSCLC). In responding patients it is generally expected that the observed decrease in fluorodeoxyglucose uptake should be similar in all lesions. In other disease entities though, isolated cases have been documented of asynchronous increases in activity in metastatic bone lesions ("bone flare") despite evidence of therapeutic response or stability in other lesions. Here, we describe four NSCLC cases in which the results of interim PET scans were misleading due to osteoblastic flare phenomenon...
March 2009: Journal of Thoracic Oncology
S Sergieva, G Kirova, A Dudov
PURPOSE: To assess the role of the current imaging methods in the diagnosis, staging and post-therapeutic monitoring of cancer-induced bone disease. PATIENTS AND METHODS: 183 cancer patients underwent baseline whole body bone scintigraphy (WBBS) with 555- 740 MBq (99m)Tc-MDP. Computed tomography (CT) was carried out in 43 patients, and magnetic resonance imaging (MRI) in 26 patients with abnormal uptake on the bone scan in order to differentiate metastatic or degenerative skeletal lesions with similar scintigraphic appearance...
October 2007: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Vito Amoroso, Frida Pittiani, Salvatore Grisanti, Francesca Valcamonico, Edda Simoncini, Vittorio D Ferrari, Giovanni Marini
BACKGROUND: The RECIST guidelines are commonly used in phase II and III clinical trials. The correct definition of response can be controversial in some situations, as in the case we describe. CASE PRESENTATION: A 43 year-old man with advanced gastric cancer was enrolled in a phase II trial where he was treated with pemetrexed 500 mg/m2 plus oxaliplatin 120 mg/m2 every 3 weeks. At baseline, the target lesions were lymph-nodes, and the non-target lesions were small pulmonary nodules...
June 1, 2007: BMC Cancer
Yoshifumi Sugawara, Makoto Kajihara, Takatoshi Semba, Takashi Ochi, Takashi Fujii, Teruhito Mochizuki
"Flare" phenomenon has been primarily reported as a transient increase in the number or intensity of lesions on bone scans in patients receiving hormonal or chemotherapy. It has been well documented in patients with metastatic breast or prostate carcinoma, and recently reported in those with lung cancer. We present a case of bone metastasis from bladder carcinoma, in which healing flare phenomenon was observed after radiotherapy.
October 2005: Clinical Nuclear Medicine
Julie Lemieux, Jean Guimond, Francis Laberge, Carole St-Pierre, Yvon Cormier
PURPOSE: The bone scan flare phenomenon, defined as an increase in the number or intensity of bone lesions with subsequent improvement while the patient is receiving chemotherapy, has been described in solid tumors including breast cancers and small-cell lung cancers. The purpose of this study was to verify the existence of the bone scintigraphic flare phenomenon in patients with non-small-cell lung cancer (NSCLC) during chemotherapy and thus determine the utility of bone scintigraphy in the follow-up of these patients...
July 2002: Clinical Nuclear Medicine
G J Cook, I Fogelman
The nuclear medicine bone scan has historically been one of the most common investigations to stage and monitor skeletal malignancy. Current guidelines for using radiographs to assess the response of skeletal metastases to systemic therapy are limited in their ability to give a timely result. Despite some minor limitations caused by the flare phenomenon, skeletal scintigraphy remains widely used for this purpose, both clinically and in trials of new cancer treatments. Nuclear medicine has also played an important role in the posttherapy evaluation of primary bone tumors, both with bone agents and nonspecific tumor agents, such as 201Tl...
July 2001: Seminars in Nuclear Medicine
M Koizumi, S Matsumoto, S Takahashi, T Yamashita, E Ogata
Bone scan flare seriously complicates evaluations of the therapeutic response of bone metastases. The value of bone metabolic markers in monitoring the therapeutic response for bone metastases in breast cancer was assessed. Twenty-three breast cancer patients with bone metastases treated by combined chemotherapy of cyclophosphamide, doxorubicin, and 5-fluorouracil (CAF) were monitored using bone scans; a bone resorption marker, pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP); a bone formation marker, bone-specific alkaline phosphatase (BAI-p); and a tumor-specific marker (CA15-3)...
January 1999: Clinical Nuclear Medicine
R Bares
Since its introduction in 1971 bone scintigraphy has become the classical procedure to confirm or exclude metastatic spread of breast cancer to skeleton. Recent developments in tomographic imaging (CT, MRI) as well as a more critical attitude towards technical diagnostic tests have raised the question about the present role of scintigraphy in staging and follow-up of breast cancer patients. Based upon systematic retrospective analyses bone scintigraphy is recommended for the initial staging of high risk patients (node-positive)...
March 1998: Quarterly Journal of Nuclear Medicine
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