Vogel C L, Schoenfelder J, Shemano I, Hayes D F, Gams R A
Comprehensive Cancer Research Group, Inc., North Miami Beach, FL, USA.
J Clin Oncol. 1995 May;13(5):1123-8. doi: 10.1200/JCO.1995.13.5.1123.
Scintigraphic flare in association with response to therapy has been well described in the medical literature. During the course of a recent breast cancer trial, it became apparent that several patients with worsening bone scan but no other clinical evidence of disease progression might have potentially benefited from continued therapy, but had therapy discontinued. A retrospective analysis of this issue was performed to assess the magnitude and scope of this problem.
A total of 648 patients with hormone receptor-positive or unknown advanced breast cancer were treated as part of a large-scale trial of first-line hormonal therapy. Patients were assessed for response to therapy, including response duration, progression-free interval (PFI), overall survival, and quality of life. The retrospective analysis presented here was performed to assess whether patients with a possible scintigraphic flare within the first 16 weeks of therapy might have had therapy discontinued prematurely due to a worsening bone scan attributable to tumor flare, rather than due to disease progression.
Analysis of the hormonal trial showed that of 376 assessable patients 108 (29%) with bone disease had a possible scintigraphic flare by week 8 or 16 of the trial, based on data on the case report forms and radiology reports (bone scans and x-rays). Of these, 69 patients (64%) were continued on study therapy, which resulted in clinical benefit in 50 (72%) of those patients. In contrast, 39 patients (36%) with possible scintigraphic flare were removed from the trial.
We conclude that changes in bone scintigraphy that mimic progressive disease early in the course of hormonal treatment of patients with breast cancer metastatic to bone may represent scintigraphic flare associated with response. Thus, clinicians must be cognizant of the phenomenon of scintigraphic flare to avoid premature discontinuation of a potentially beneficial treatment.
与治疗反应相关的闪烁扫描“flare”现象在医学文献中已有充分描述。在近期一项乳腺癌试验过程中，明显发现有几名患者骨扫描结果恶化，但无其他疾病进展的临床证据，他们本可能从持续治疗中获益，却中断了治疗。对此问题进行了回顾性分析，以评估该问题的严重程度和范围。
共有648例激素受体阳性或情况不明的晚期乳腺癌患者作为一线激素治疗大规模试验的一部分接受了治疗。对患者的治疗反应进行了评估，包括反应持续时间、无进展生存期（PFI）、总生存期和生活质量。此处进行的回顾性分析旨在评估在治疗的前16周内可能出现闪烁扫描“flare”现象的患者，是否因肿瘤“flare”导致骨扫描恶化而非疾病进展而过早中断治疗。
对激素试验的分析表明，在376例可评估患者中，根据病例报告表和放射学报告（骨扫描和X光）的数据，108例（29%）有骨病的患者在试验第8周或第16周可能出现了闪烁扫描“flare”现象。其中，69例患者（64%）继续接受研究治疗，50例（72%）患者由此获得了临床益处。相比之下，39例（36%）可能出现闪烁扫描“flare”现象的患者被排除在试验之外。
我们得出结论，在转移性骨癌患者的激素治疗过程早期，骨闪烁扫描中类似疾病进展的变化可能代表与反应相关的闪烁扫描“flare”现象。因此，临床医生必须认识到闪烁扫描“flare”现象，以避免过早中断可能有益的治疗。
