#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Flare phenomenon in patient with breast cancer


Authors: Otto Lang;  Ivana Kuníková
Authors‘ workplace: Klinika nukleární medicíny, 3. LF UK a FNKV, Praha 10, ČR
Published in: NuklMed 2016;5:15-16
Category:

Overview

70-y-old lady with spread breast cancer (T4, N1–2, MX, G2) was sent to bone scan for staging. This first bone scan performed with 99mTc-MDP (Fig. 1) revealed two pathological foci (skull and rib) that were interpreted as bone metastases. Patient was treated with chemotherapy (4x EC, 9x TXT). Mastectomy with axillar dissection and pectoral muscle resection was performed and Tamoxifen treatment followed. External beam radiotherapy to the thoracic wall with linear accelerator (25x, 50 + 16 Gy together) was then performed. Patient felt well, her clinical status was stable and therapeutic effect was considered effective. Second bone scintigraphy (Fig. 2) performed half year after radiotherapy detected multiple lesions mainly in the skull, spine and pelvis; it was interpreted as a significant progression. Denosumab (XGEVA) was added but only one injection was applied due to a jaw necrosis. Last scintigraphy (Fig. 3) performed 5 months thereafter showed significant regression with a new focus caused by a jaw necrosis. Pattern seen on the second bone scan was, therefore, interpreted as a flare phenomenon.

Key words:
flare phenomenon, bone scintigraphy, breast cancer


Sources

1. Lu MC, Chuang TL, Lee MS, et al. The super-scan and flare phenomena in a nasopharyngeal cancer patient: a case report. J Clin Med Res 2012;4:221-223

2. Messiou C, Cook G, deSouza NM. Imaging metastatic bone disease from carcinoma of the prostate. British Journal of Cancer 2009;101:1225-1232

3. Alavi M, Omidvari S, Mehdizadeh A, et al. Metastatic Bone Pain Palliation using 177Lu-Ethylenediaminetetramethylene Phosphonic Acid. World J Nucl Med 2015;14:109-115

4. Hashisako M, Wakamatsu K, Ikegame S, et al. Flare phenomenon following gefitinib treatment of lung adenocarcinoma with bone metastasis. Tohoku J Exp Med 2012;228:163-168

5. Al-Nabhani K, Syed R, Haroon A, et al. Flare response versus disease progression in patients with non-small cell lung cancer. Radiology Case 2012;6:34-42

6. D´Amico A, Kowalska T. Paradoxal metabolic flare detected by 18F-fluorodeoxyglucose positron emission tomography in a patient with metastatic breast cancer treated with aromatase inhibitor and biphosphonate. Indian J Nucl Med 2014;29:34-37

7. Amoroso V, Pittiani F, Grisanti S, et al. Osteoblastic flare in a patient with advanced gastric cancer after treatment with pemetrexed and oxaliplatin: implications for response assessment with RECIST criteria. BMC Cancer 2007;7:94

Labels
Nuclear medicine Radiodiagnostics Radiotherapy
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#