Osseous metastases of gastro- entero - pancreatic neuroendocrine tumours

2012 ◽  
Vol 51 (03) ◽  
pp. 95-100 ◽  
Author(s):  
F. Heinemann ◽  
S. Guhlke ◽  
M. Muckle ◽  
W. Willinek ◽  
H.-J. Biersack ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Functional Imaging ◽  
Peptide Receptor Radionuclide Therapy ◽  
Rank Test ◽  
Bone Lesions ◽  
Time To Progression ◽  
Effective Treatment Option ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Imaging Results

SummaryAim: Peptide receptor radionuclide therapy with 177Lu-octreotate is an effective treatment option for metastatic gastroenteropancreatic neuroendocrine tumors (GEP NET) and allows intratherapeutic imaging through a 177Lu-octreotate scan (LuS). The diagnostic value of this treatment scan is not yet established. This study aims to compare the sensitivity of LuS and bone scintigraphy (BS) regarding bone metastases and investigate potential implications of functional imaging results. Patients, methods: We retrospectively analyzed 29 consecutive GEP NET patients with bone metastases and baseline BS treated with 177Lu-octreotate. A semi-quantitative scoring system was used for the comparative evaluation. Treatment outcome (time-to-progression of bone metastases) was correlated with the intra-individual imaging discrepancy (Kaplan- Meyer curves, log-rank test, p < 0.05). Results: In 19 of 29 patients (65.5%) LuS was superior (LuS > BS), whereas in 10 patients (34.5%) both modalities were comparable. BS showed no additional (LuS-negative) metastatic bone lesions in our cohort. None of the investigated baseline characteristics was associated with Imaging discrepancy. On the other hand, functional imaging discrepancy had no impact on treatment response (p = 0.43) or time-to-progression (p = 0.92). Conclusions: Intra-therapeutic 177Lu-octreotate imaging is superior over bone scintigraphy for detection of bone metastases in GEP NET. BS may help to distinguish osseous from non-osseous localization. The presence of an osteoblastic correlate in BS seems to have no impact on therapeutic outcome

scholarly journals Optimizing the treatment mode for de novo metastatic nasopharyngeal carcinoma with bone-only metastasis

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng Lin ◽  
Sheng Lin ◽  
Lili Zhu ◽  
Shaojun Lin ◽  
Jianji Pan ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Bone Metastases ◽  
Protective Factor ◽  
Cox Regression ◽  
De Novo ◽  
Progression Free Survival ◽  
Rank Test ◽  
Bone Lesions ◽  
Metastatic Nasopharyngeal Carcinoma ◽  
The Difference

Abstract Background No standard radiotherapy regimens have been established for the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LRRT) with or without local radiotherapy (RT) for metastatic bone lesions in mNPC. Methods We retrospectively analysed 131 de novo patients with mNPC who had bone-only metastasis and received at least two cycles of PCT with LRRT. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analyses were performed by Cox regression. Results The median overall survival (OS) and progression-free survival (PFS) were 33.0 months and 24.0 months, respectively. Patients with five or fewer metastatic bone lesions had significantly longer OS (72.0 months vs. 23.0 months, Hazard ratios (HR) = 0.45, p <  0.001) and PFS (48.0 months vs. 15.0 months, HR = 0.52, p = 0.004) than those who had more than five metastatic bone lesions. Patients who received four or more cycles of chemotherapy were associated with significantly longer OS (unreached vs. 19.0 months, HR = 0.27, p <  0.001) and PFS (66 months vs. 16.0 months, HR = 0.32, p <  0.001). Multivariate analysis confirmed that fewer bone metastases (≤ 5) and more chemotherapy cycles (≥ 4) were favourable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bone lesions tended to prolong OS (83.0 months vs. 45.0 months) and PFS (60 months vs. 36.5 months) in patients with five or fewer metastatic bone lesions than in those without RT to metastatic bone lesions (p > 0.05). Patients who received a RT dose > 30 Gy had neither better OS (63.5 months vs. 32.0 months, p = 0.299) nor PFS (48.0 months vs. 28.0 months, p = 0.615) than those who received a RT dose ≤30 Gy. Conclusions Local RT to bone metastases may not significantly improve survival in patients with de novo mNPC with bone-only metastasis who have already received PCT plus LRRT. Receiving four or more cycles of chemotherapy can significantly prolong survival and is a favourable independent protective factor.

Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management.

1998 ◽  
Vol 16 (3) ◽  
pp. 1040-1053 ◽  
Author(s):  
F Gibril ◽  
J L Doppman ◽  
J C Reynolds ◽  
C C Chen ◽  
V E Sutliff ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Liver Metastases ◽  
Bone Metastases ◽  
Bone Scan ◽  
Somatostatin Receptor ◽  
Axial Skeleton ◽  
Bone Lesions ◽  
Endocrine Tumors ◽  
Bone Scanning ◽  
Imaging Results

PURPOSE To determine whether bone scan, magnetic resonance imaging (MRI), or somatostatin receptor scintigraphy (SRS) is best for identifying bone metastases in patients with gastrinomas, as well as their frequency and location, whether their detection affects management, and what patient subgroups should be examined. MATERIALS AND METHODS One hundred fifteen patients with gastrinoma were prospectively studied. Patients were examined yearly and those with liver metastases were reexamined every 3 months. Based on clinical history, histology, growth pattern, and development of new bone lesions, possible bone metastases were classified as to whether they were or were not bone metastases. Imaging results were correlated at different times in the disease course and with disease extent. RESULTS Bone scan was positive in 52 patients, MRI in seven, and SRS in six. Eight patients (7%) were determined to have bone metastases and MRI was correctly positive in seven, SRS in six, and bone scan in five. SRS or MRI was positive in all patients with bone metastases. Bone scan had significantly lower specificity and sensitivity, and a higher rate (P < .02) of false-negative results than MRI or SRS. Bone metastases occurred in 31% of patients with liver metastases and 0% with only lymph node metastases. The initial bone metastases were in the spine or sacrum (75%) followed in descending order by the pelvis or sacroiliac joints (38%), scapula or shoulder, and ribs. In all cases, detection of bone metastases changed the management. CONCLUSION SRS and MRI, because of high sensitivity and specificity, are recommended over bone scanning to screen for bone metastases in patients with gastrinomas. However, because bone metastases can occur initially outside the axial skeleton, SRS is the recommended initial localization method of choice. Bone metastases occur in 7% of all patients and 31% of patients with liver metastases, only occur in patients with liver metastases, are usually in the axial skeleton initially, and their detection changes management in all cases. Patients with pancreatic endocrine tumors with liver metastases should undergo SRS every 6 months to 1 year to detect bone metastases.

scholarly journals Radionuclide Bone Scintigraphy: An Interesting Case Report

2015 ◽  
Vol 17 (1) ◽  
pp. 111-115
Author(s):  
Mohana Hossain ◽  
Hosne Ara Rahman ◽  
Mahbubul Haque ◽  
Mahbubur Rahman ◽  
Md Sanowar Hossain ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Eosinophilic Granuloma ◽  
Metastatic Lesion ◽  
Interesting Case ◽  
Whole Body ◽  
Osteolytic Lesions ◽  
Multiple Imaging ◽  
Imaging Results

It is well established that Technetium99mmethylene diphosphonate (Tc99m MDP) whole body bone scintigraphy (WBBS) can demonstrate multiple lesions with increased radiotracer concentration in involved bone. But it is hard to differentiate multiple benign osteolytic lesions from disseminated bone metastases. Even combined with medical history and multiple imaging results, clinical diagnosis of metastatic lesion remains a challenge. This can affect the treatment procedure. Here the role of skeletal scintigraphy in a case of eosinophilic granuloma is evaluated and concluded that additional attention should be given before diagnosing any case as bone metastases. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22502 Bangladesh J. Nuclear Med. 17(1): 111-115, January 2014

Accuracy of NaF PET/CT scan to detect bone metastases in CRPC.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 186-186
Author(s):  
Modar Alom ◽  
Ilija Aleksic ◽  
Brian Ruhle ◽  
Peter Iannotta ◽  
Colin Okeefe ◽  
...  
Keyword(s):  
Ct Scan ◽  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Metastatic Disease ◽  
Bone Lesions ◽  
Castration Resistant Prostate Cancer ◽  
Current Standard ◽  
Pet Ct ◽  
Feasible Option ◽  
Pet Ct Scan

186 Background: The current standard for imaging Castration Resistant Prostate Cancer (CRPC) is aimed at detecting metastatic lesions to the bones. However, discovery, validation, and implementation of new imaging modalities have fallen considerably behind that of new therapies for this population. Recent studies have shown the NaF PET/CT Scans are significantly more sensitive and accurate in detecting bone lesions than conventionally used Bone Scintigraphy with Technetium-99 (Tc-99). This study conducted retrospective analysis to compare the competence of these two methods for identifying bone metastases. Methods: We conducted a charts review of 613 patients being currently treated with androgen deprivation therapy (ADT) and identified 55 patients who obtained a Na18F PET/CT Scan. Results: The median age was 75.5 years with a range of 52-89, for our cohort. Of these 55 patients, 5 (11.9%) were determined to have metastasis with Tc-99 Bone Scintigraphy alone while 27 (49.1%) were determined to have metastases with NaF Scan (p<0.005). 8 (19%) patients had equivocal findings on Tc-99 Bone Scintigraphy. Therefore, for all of them we performed NaF scan to define a bone metastatic disease that demonstrated in 5 (62.5%) cases of these as having no bone involvement and 3(37.5%) as positive for bone lesions (Table). However, data of NaF scan also indicated 5(9%) patients as having equivocal findings for metastatic disease. Conclusions: According to our data, NaF is more sensitive for detecting bone lesions (11.9 vs. 49.1%). It was also able to delineating equivocal TC-99 Bone Scintigraphy findings, where it deemed 62.5% as negative and 37.5% as positive for bone lesions. NaF PET scan is a feasible option for CRPC for detecting bone metastases, early in disease progression. With coverage of this procedure by Medicare patients have more sensitive and specific tool for early diagnosis and monitoring of treatment of CRPC. [Table: see text]

Assessment of bone metastases in patients (pts) with urothelial carcinoma using 18F-sodium fluoride PET/CT (18F-NaF) versus 18F-fluorodeoxyglucose PET/CT (18F-FDG).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 329-329
Author(s):  
Benjamin Adam Weinberg ◽  
Maria Liza Lindenberg ◽  
Karen A. Kurdziel ◽  
Seth M. Steinberg ◽  
David J. Liewehr ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Stable Disease ◽  
Rank Test ◽  
Bone Lesions ◽  
Planar Imaging ◽  
Median Difference ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
Medicine Physician ◽  
Signed Rank Test

329 Background: 18F-NaF has shown improved sensitivity for bone imaging when compared to conventional planar imaging or SPECT/CT using 99mTc-MDP. We compared the number of bone lesions detected on 18F-NaF versus 18F-FDG in urothelial cancer pts with known bone metastases undergoing treatment. Methods: Pts enrolled in a prospective single-arm phase II study of cabozantinib underwent 18F-NaF and 18F-FDG scans at baseline and at 8 weeks of therapy. In a lesion-based analysis independently confirmed by a nuclear medicine physician, abnormal foci of radiotracer uptake were categorized by location (skull, spine, pelvis, thorax, or long bones) and by disease state (benign, malignant, or indeterminate). A patient-based analysis was performed to determine if findings indicated disease progression, stable disease, or improvement of disease, based on the number of lesions and standardized uptake values (SUVs). Results: 294 total bone lesions were identified at baseline in 10 pts (8 male and 2 female, ages 44-73). 18F-NaF identified more lesions than 18F-FDG at baseline, 294 vs. 119. In a paired analysis, the median difference was 11.5 more lesions detected per patient on 18F-NaF vs. 18F-FDG (by Wilcoxon signed-rank test, p = 0.023). More total thoracic bone lesions at baseline, 100 vs. 23, were also detected on 18F-NaF vs. 18F-FDG, median 6.5 vs. 1.0 with a median difference of 6 more lesions per patient on 18F-NaF (p = 0.016). 18F-NaF also detected more skull lesions at baseline, 19 vs. 1, which was clinically but not statistically significant (p = 0.250). There was general concordance in the patient-based analysis; only 1 18F-NaF scan demonstrated progressive disease while its corresponding 18F-FDG scan showed stable disease. Conclusions:18F-NaF identified more lesions than 18F-FDG at baseline, making it a good staging exam. However, there was agreement between 18F-NaF and 18F-FDG in terms of tumor response in almost all the follow-up scans. Therefore, although a greater number of bone lesions are seen in 18F-NaF compared with 18F-FDG, the clinical significance in assessing treatment response remains to be determined. Clinical trial information: NCT01688999.

scholarly journals Multiple Metastasis-Like Bone Lesions in Scintigraphic Imaging

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ying Zhang ◽  
Chunlei Zhao ◽  
Hongbiao Liu ◽  
Haifeng Hou ◽  
Hong Zhang
Keyword(s):  
Bone Metastases ◽  
Eosinophilic Granuloma ◽  
Clinical Work ◽  
Whole Body ◽  
Bone Lesions ◽  
Osteolytic Lesions ◽  
Multiple Imaging ◽  
Imaging Results ◽  
Multiple Bone Metastases ◽  
Treatment Procedures

Multiple benign osteolytic lesions are very hard to differentiate from disseminated bone metastasis. Whole-body bone scintigraphy (WBBS) with technetium-99m methylene diphosphonate (Tc-99m MDP) demonstrates multiple lesions with increased uptake in any bone involved. Even combined with medical history and multiple imaging results, such as MRI and CT, the clinical diagnosis of metastasis lesion remains as a challenge. These clinical characteristics are similar to multiple malignant bone metastases and therefore affect the following treatment procedures. In this paper, we analyzed multiple benign osteolytic lesions, like eosinophilic granuloma (EG), multiple myeloma (MM), disseminated tuberculosis, fibrous dysplasia, or enchondroma, occurring in our daily clinical work and concluded that additional attention should be paid before giving the diagnosis of multiple bone metastases.

Peptide Receptor Radionuclide Therapy for Pancreatic Neuroendocrine Tumours

2019 ◽  
Vol 12 (2) ◽  
pp. 126-134 ◽  
Author(s):  
Shahad Alsadik ◽  
Siraj Yusuf ◽  
Adil AL-Nahhas
Keyword(s):  
Side Effects ◽  
Effective Treatment ◽  
Radionuclide Therapy ◽  
Neuroendocrine Tumours ◽  
Peptide Receptor Radionuclide Therapy ◽  
Progression Free Survival ◽  
Treatment Modalities ◽  
Effective Treatment Option ◽  
Peptide Receptor ◽  
Pancreatic Neuroendocrine Tumours

Background: The incidence of pancreatic Neuroendocrine Tumours (pNETs) has increased considerably in the last few decades. The characteristic features of this tumour and the development of new investigative and therapeutic methods had a great impact on its management. Objective: The aim of this review is to investigate the outcome of Peptide Receptor Radionuclide Therapy (PRRT) in the treatment of pancreatic neuroendocrine tumours. Methods: A comprehensive literature search strategy was used based on two databases (SCOPUS, and PubMed). We considered all studies published in English, evaluating the use of PRRT (177Luteciuim- DOTA-conjugated peptides and 90Yetrium- DOTA- conjugated peptides) in the treatment of pancreatic neuroendocrine tumours as a standalone entity or as a subgroup within the wider category of Gastroenteropancreatic Neuroendocrine Tumours (GEP NETs). Results: PRRT was found to be an effective treatment modality as a monotherapy or in combination with other therapies in the treatment of non-operable and metastatic pNETs where other options are limited. Complete response was reported to be between 2-6% while partial response was achieved in up to 60% of cases. Survival analysis was also impressive. Progression Free Survival (PFS) reached a mean of 34 months and Overall Survival (OS) of 53 months. PRRT also proved to improve patients’ Quality of Life (QoL). Acute and sub-acute side effects like nephrotoxicity and haematotoxicity are usually mild and reversible. Conclusion: PRRT is well tolerated and effective treatment option for non-operable and/or metastatic pNETs. Side effects are usually mild and reversible. Larger randomized controlled trails need to be done to compare PRRT with other treatment modalities and to provide more detailed guidelines regarding patient selections, the choice of PRRT, follow up and response assessment to maximum potential benefit.

scholarly journals Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients

2021 ◽  
Author(s):  
Nils Martin Bruckmann ◽  
Julian Kirchner ◽  
Lale Umutlu ◽  
Wolfgang Peter Fendler ◽  
Robert Seifert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Bone Scintigraphy ◽  
Fdg Pet ◽  
Primary Breast Cancer ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Initial Staging

Abstract Objectives To compare the diagnostic performance of [18F]FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Material and methods A cohort of 154 therapy-naive patients with newly diagnosed, histopathologically proven breast cancer was enrolled in this study prospectively. All patients underwent a whole-body [18F]FDG PET/MRI, computed tomography (CT) scan, and a bone scintigraphy prior to therapy. All datasets were evaluated regarding the presence of bone metastases. McNemar χ2 test was performed to compare sensitivity and specificity between the modalities. Results Forty-one bone metastases were present in 7/154 patients (4.5%). Both [18F]FDG PET/MRI and MRI alone were able to detect all of the patients with histopathologically proven bone metastases (sensitivity 100%; specificity 100%) and did not miss any of the 41 malignant lesions (sensitivity 100%). CT detected 5/7 patients (sensitivity 71.4%; specificity 98.6%) and 23/41 lesions (sensitivity 56.1%). Bone scintigraphy detected only 2/7 patients (sensitivity 28.6%) and 15/41 lesions (sensitivity 36.6%). Furthermore, CT and scintigraphy led to false-positive findings of bone metastases in 2 patients and in 1 patient, respectively. The sensitivity of PET/MRI and MRI alone was significantly better compared with CT (p < 0.01, difference 43.9%) and bone scintigraphy (p < 0.01, difference 63.4%). Conclusion [18F]FDG PET/MRI and MRI are significantly better than CT or bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. Both CT and bone scintigraphy show a substantially limited sensitivity in detection of bone metastases. Key Points • [18F]FDG PET/MRI and MRI alone are significantly superior to CT and bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. • Radiation-free whole-body MRI might serve as modality of choice in detection of bone metastases in breast cancer patients.

scholarly journals The state of PRRT and its sequencing amongst current therapeutic options for gastroenteropancreatic neuroendocrine tumors

2021 ◽  
Author(s):  
Lauren M Raymond ◽  
Tetiana Korzun ◽  
Adel Kardosh ◽  
Kenneth J. Kolbeck ◽  
Rodney Pommier ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Standard Dose ◽  
Peptide Receptor Radionuclide Therapy ◽  
Somatostatin Analogues ◽  
Tumor Burden ◽  
Treatment Modalities ◽  
Its Sequencing ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Reduce Tumor Burden ◽  
Spectrum Of Patients

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most common form of neuroendocrine neoplasia, but there is no current consensus for the sequencing of approved therapies, particularly with respect to peptide receptor radionuclide therapy (PRRT). This comprehensive review evaluates the data supporting approved therapies for GEP-NETs and recommendations for therapeutic sequencing with a focus on how PRRT currently fits within sequencing algorithms. The current recommendations for PRRT sequencing restrict its use to metastatic, inoperable, progressive midgut NETs, however, this may change with emerging data to suggest PRRT might be beneficial as neoadjuvant therapy for inoperable tumors, is more tolerable than other treatment modalities following first-line standard dose somatostatin analogues, and can be used as salvage therapy after disease relapse following prior successful cycles of PRRT. PRRT has also been shown to reduce tumor burden, improve quality of life, and prolong the time to disease progression in a broad spectrum of patients with GEP-NETs. As the various potential benefits of PRRT in GEP-NET therapy continues to expand, it is necessary to review and critically evaluate our treatment algorithms for GEP-NETs.

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