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


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


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