The CT flare response of metastatic bone disease in prostate cancer
The CT flare response of metastatic bone disease in prostate cancer
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DOI：
10.1258/ar.2011.100342
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发表时间：
2011-06-01
期刊：
影响因子：
1.3
通讯作者：
de Souza, Nandita M.
中科院分区：
文献类型：
--
作者：
Messiou, Christina;Cook, Gary;de Souza, Nandita M.
背景资料：对治疗有反应的患者中新发或恶化的骨病变，称为耀斑现象，在（99 m）Tc-MDP骨显像中有很好的描述，但据我们所知，以前在CT上没有描述过。因此，前列腺癌患者在CT上出现新的或恶化的骨硬化可能被错误地归类为疾病进展。目的：评估去势抵抗性前列腺癌患者在3个月CT评估时成骨细胞愈合闪光反应的发生率，并确定能够与3个月时进行性转移性骨疾病区分的相关特征。材料和方法：67例接受治疗的去势抵抗性前列腺癌患者的CT扫描由对临床结果不知情的放射科医生进行审查。记录转移性骨病变的数量、大小和密度的变化，并使用软组织病变的实体瘤疗效评价标准（RECIST）、碱性磷酸酶、前列腺特异性抗原和（99 m）Tc-MDP骨扫描进行相关性分析。在39例接受3个月和6个月随访的患者中，8例患者（21%）的数量、大小尽管PSA和软组织病变有所改善，但3个月CT扫描显示硬化病变或密度。8例患者中有3例（8%）在随访时维持部分缓解/保持稳定，并被定义为表现出复发缓解：在该组中，CT上明显的骨转移显示出密度的定性和定量增加，并且在3个月时没有病变消退。相比之下，在所有患者的进展，在3个月的PSA/RECIST标准（n = 8）骨病变表现出一种混合模式，一些病变增加和其他降低density.Conclusion：耀斑反应的转移性骨疾病的发病率明显在3个月后治疗CT前列腺癌患者进行系统治疗是8%。在PSA下降且3个月时软组织疾病稳定/缓解的患者中，骨硬化增加而骨转移不消退可解释为复发，可能代表缓解。
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.Material and Methods: CT scans of 67 patients with castrate-resistant prostate cancer undergoing treatment were reviewed by a radiologist blinded to clinical outcome. Changes in number, size, and density of metastatic bone lesions were documented and Response Evaluation Criteria in Solid Tumours (RECIST) in soft tissue lesions, alkaline phosphatase, prostate specific antigen, and (99m)Tc-MDP bone scans were used for correlation.Results: Of the 39 patients who had 3- and 6-month follow-up, eight patients (21%) demonstrated an increase in number, size, or density of sclerotic lesions on the 3-month CT scan despite improvement in PSA and soft tissue lesions. Three out of eight patients (8%) maintained partial response/remained stable at follow-up and were defined as showing a flare response: in this group bone metastases evident on CT showed a qualitative and quantitative increase in density and no lesions faded at 3 months. In contrast, in all patients who progressed at 3 months by PSA/RECIST criteria (n = 8) bone lesions showed a mixed pattern with some lesions increasing and others decreasing in density.Conclusion: The incidence of flare response of metastatic bone disease evident at 3-month post-treatment CT in patients with prostate cancer undergoing systemic treatment is 8%. In patients with falling PSA and stable/responding soft tissue disease at 3 months an increase in bone sclerosis in the absence of fading bone metastases can be interpreted as flare and is likely to represent a response.