Aizawa T, Tochimoto M, Ito T, Tsujino S, Akiyama A, Namiki K, Miki M, Ueda M
Department of Urology, Tokyo Medical College.
Nihon Hinyokika Gakkai Zasshi. 1994 May;85(5):815-8. doi: 10.5980/jpnjurol1989.85.815.
Seventy-seven cases of prostate cancer were treated for 5 years at our department and all cases were followed by bone scintigraphy and tumor markers. Of these cases on case of flare response on bone scintigraphy was recognized. A 51-year-old man was hospitalized with chief complaint of lumbago. Serum PAP and gamma-Sm levels were 320 ng/ml and 15 ng/ml, respectively. Prostate biopsy revealed moderately differentiated adenocarcinoma. Bone scintigraphy and CT scan demonstrated multiple bone metastases and lymph nodes involvements. Treatment was started with diethylstilbestrol diphosphate (DES). At one month after the initiation of treatment tumor markers fell down to the normal level and lumbago was diminished, but only serum alkaline phosphatase was elevated and bone scintigraphy showed apparent progression of individual lesions (flare response). The treatment was not altered. At the times after 2, 8, 12 and 36 months successful treatment the bone imaging improved with reduced tracer uptake and no new lesions. The flare response is a healing reaction and is followed apparent improvement. In general, serial bone scintigrams accurately depict the activity of bone metastases in the patients of prostate cancer, but between 1 and 3 months after starting treatment the paradoxical "flare phenomenon" should be taken care.
我科对77例前列腺癌患者进行了为期5年的治疗，所有病例均接受骨闪烁显像和肿瘤标志物检查。在这些病例中，发现1例骨闪烁显像出现闪烁反应。一名51岁男性因腰痛为主诉入院。血清酸性磷酸酶（PAP）和γ-精浆蛋白（gamma-Sm）水平分别为320 ng/ml和15 ng/ml。前列腺活检显示为中度分化腺癌。骨闪烁显像和CT扫描显示多处骨转移和淋巴结受累。开始用二磷酸己烯雌酚（DES）治疗。治疗开始1个月后，肿瘤标志物降至正常水平，腰痛减轻，但仅血清碱性磷酸酶升高，骨闪烁显像显示单个病灶明显进展（闪烁反应）。治疗方案未改变。在治疗成功后的2、8、12和36个月时，骨显像改善，示踪剂摄取减少，无新病灶。闪烁反应是一种愈合反应，随后会明显改善。一般来说，连续骨闪烁显像能准确描绘前列腺癌患者骨转移的活性，但在开始治疗后的1至3个月间，应注意出现矛盾的“闪烁现象”。
