Schneider J A, Divgi C R, Scott A M, Macapinlac H A, Seidman A D, Goldsmith S J, Larson S M
The Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York 100213.
J Nucl Med. 1994 Nov;35(11):1748-52.
Our goal was to determine if a healing flare response seen on bone scintigraphy occurs following chemotherapy with Taxol (paclitaxel; Bristol-Myers Squibb Co., Princeton, NJ), a novel antimicrotubule agent for metastatic breast cancer.
We performed 74 bone scans on 21 females with breast cancer and bone metastases entering a Phase II trial of Taxol chemotherapy with granulocyte colony stimulating factor (G-CSF). All patients had baseline scans within 6 wk prior to therapy, after the second cycle (4-6 wk) of Taxol, and then after 6-12 mo. All bone scans were reviewed by two nuclear medicine physicians, without knowledge of the patients' clinical history. Skeletal radiographs, CT and MRI scans, as well as clinical history were compared with scan findings.
Seven of the 21 patients showed improvement in bone scan findings. Of these seven, three had a flare response following two cycles (4-6 wk) of Taxol, characterized by increased activity in baseline lesions and the appearance of new lesions, followed by improvement on follow-up scans. Evidence of clinical response (> or = 50% reduction in tumor mass) was seen in all of these patients. Seven patients showed no change in baseline findings on follow-up bone scans. Seven patients had post-Taxol scans showing new lesions, with no overall improvement on later follow-up.
Flare on bone scintigraphy may be seen shortly after commencing Taxol chemotherapy. Bone scans done within the first 3 mo must be interpreted with caution and should be correlated with clinical and radiological findings to avoid inappropriate discontinuation of Taxol chemotherapy.
我们的目标是确定在用泰素（紫杉醇；百时美施贵宝公司，新泽西州普林斯顿）进行化疗后，骨闪烁显像上出现的愈合性闪烁反应是否会发生。泰素是一种用于转移性乳腺癌的新型抗微管药物。
我们对21名患有乳腺癌和骨转移的女性进行了74次骨扫描，这些患者进入了一项联合粒细胞集落刺激因子（G-CSF）的泰素化疗II期试验。所有患者在治疗前6周内、泰素第二个周期（4 - 6周）后以及6 - 12个月后进行了基线扫描。所有骨扫描均由两名核医学医师进行评估，他们对患者的临床病史不知情。将骨骼X线片、CT和MRI扫描以及临床病史与扫描结果进行了比较。
21名患者中有7名骨扫描结果有所改善。在这7名患者中，有3名在泰素两个周期（4 - 6周）后出现了闪烁反应，其特征为基线病变处活性增加以及出现新病变，随后在后续扫描中有所改善。所有这些患者均有临床反应证据（肿瘤肿块缩小≥50%）。7名患者在后续骨扫描中基线结果无变化。7名患者在泰素治疗后的扫描显示有新病变，后期随访时总体无改善。
开始泰素化疗后不久可能会在骨闪烁显像上出现闪烁现象。在开始治疗的前3个月内进行的骨扫描必须谨慎解读，并应与临床和放射学检查结果相关联，以避免不适当中断泰素化疗。
