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Related Experiment Videos

Bone scan flare predicts successful systemic therapy for bone metastases.

R E Coleman1, G Mashiter, K B Whitaker

  • 1Imperial Cancer Research Fund Clinical Oncology Unit, Guy's Hospital, London, England.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|August 1, 1988
PubMed
Summary

Successful systemic therapy for breast cancer bone metastases can initially worsen bone scans due to osteoblast flare. This transient increase in activity, indicated by osteocalcin and ALP-BI, may signal healing, not progression.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Biochemistry

Background:

  • Bone metastases from advanced breast cancer significantly impact patient outcomes.
  • Assessing treatment response in bone metastases is crucial for effective management.
  • Osteoblast function plays a key role in bone remodeling and response to therapy.

Purpose of the Study:

  • To investigate changes in osteoblast function during systemic therapy for bone metastases.
  • To correlate bone scan findings with biochemical markers of bone turnover.
  • To differentiate early treatment response from disease progression on bone scans.

Main Methods:

  • Serial bone scans were performed on 53 patients with advanced breast cancer and bone metastases.
  • Serum alkaline phosphatase bone isoenzyme (ALP-Bl) and osteocalcin levels were measured.

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  • Radiological assessments (X-ray) were used to evaluate lytic disease healing.

    • Main Results:

    • A paradoxical deterioration in bone scans was observed in 12/16 patients with radiological healing after 3 months of therapy.
    • This 'flare' response was characterized by increased tracer uptake in existing lesions and new foci.
    • A transient rise in osteocalcin and ALP-Bl correlated with this flare, particularly in responders (15/16) vs. non-responders (5/23).
    • Bone scans improved after 6 months of successful treatment, with reduced uptake and no new lesions.
    • New lesions appearing after 6 months indicated progressive disease.

    Conclusions:

    • A transient flare in osteoblast activity is common during successful systemic therapy for breast cancer bone metastases.
    • Early bone scan changes (first 3 months) can represent a flare response, not necessarily disease progression.
    • Biochemical markers (osteocalcin, ALP-Bl) can help identify this flare response.
    • Distinguishing flare from progression requires careful monitoring of bone scans and biochemical markers over time.