FIGURE 3 - uploaded by Christian Martin Kurbacher
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(A) MRI of the spine. T1-weighted sagittal sections. Inhomogeneous decrease of signal intensity in all vertebral bodies, due to replacement of fatty bone marrow by diffuse métastases. (B) Repeated MRI of the spine 24 mo later (parameters of acquisition unchanged). Homogeneous decrease of signal intensity is observed in all vertebral bodies, indicating progressive bone marrow involve ment.
Source publication
Bone scintigraphy of a 40-yr-old patient suffering from primary breast cancer suggested the possibility of diffuse metastases. Bone marrow scintigraphy using 99mTc-labeled monoclonal antibodies (BW 250/183) demonstrated diffuse destruction of bone marrow due to metastatic disease and consecutive bone marrow extension. Bone marrow scintigraphy was h...
Contexts in source publication
Context 1
... of bone marrow as far as to the cubital region and tibiae ( Fig. 2A). Unexpected accumulation of tracer was visualized in the liver, potentially due to extramedullary hemato- poiesis. MRI of the spine showed an inhomogeneous decrease of signal intensity in all vertebral bodies, confirming diffuse metastatic spread to the vertebral bone marrow (Fig. 3A). Therapy was changed from tamoxifene 30 mg daily to medroxyprogesterone acetate 1000 mg ...
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Rationale:
Central nervous system (CNS) metastases are rarely seen in patients with nasopharyngeal carcinoma (NPC).
Patient concerns:
Two NPC patients developed CNS metastases were collected in Fudan University Shanghai Cancer Center. The medical records were reviewed to document patients' characteristics, treatment, and outcomes. In addition, w...
Citations
... A systemic search of the relevant English literature in Pubmed, including abstracts, retrieved a small number of reports (10)(11)(12)(13)(14)(15)(16) and one case (8). The most common histology of bone marrow metastasis resulting from breast cancer is invasive ductal carcinoma, followed by invasive lobular carcinoma. ...
Background:
Bone marrow metastasis is very uncommon in breast cancer. Cancer patients showing a dramatic response to chemotherapy with full recovery are very rare.
Case report:
This is a case report of a 62-year-old woman who underwent partial mastectomy six years previously. The patient presented with increased fatigue and her hemoglobin level was 6.7 g/dl. Pathological examination of a bone marrow biopsy showed metastasis from breast cancer. Systemic therapy was initiated with doxorubicin and cyclophosphamide and pancytopenia was steadily improved. However, 15 months later, she felt severe fatigue again. Eribulin was administered and the patient showed sufficient recovery. She had two bone marrow metastases that caused pancytopenia including severe anemia. However, she survived twice with chemotherapy.
Conclusion:
Bone marrow metastasis of breast cancer is life-threatening; however, chemotherapy may significantly improve survival.
Disseminated carcinomatosis of the bone marrow (DCBM) is diffusely invasive bone metastasis resulting from solid tumors. DCBM is often associated with disseminated intravascular coagulation (DIC) or hemolytic anemia. Generally, DCBM treatment includes cytotoxic chemotherapy for underlying solid tumors and management of hematological conditions if present. We report a case of DCBM accompanied with DIC in hormone receptor-positive breast cancer. Due to her life-threatening condition, we used hormone therapies, not cytotoxic chemotherapies, to treat her DCBM. With zoledronic acid, her DIC and general condition gradually improved and eventually she could return to her daily life. If DCBM occurs in hormone receptor-positive breast cancer, hormone therapy can be one of the treatment choices.
This review summarizes the body of research reported on the use of radiolabeled antibodies for imaging and therapy of breast cancer, both in animal models and in clinical trials. Although no truly breast cancer-specific antibody has been described, numerous antibodies showing a selectivity of targeting several cancer types, including breast cancer, have been identified and investigated. The most prevalent targets radioimmunodetection and radioimmunotherapy (RAIT) of breast cancer include carcinoembryonic antigen (CEA), MUC-1 and other mucin antigens, TAG-72 and other Tn antigens, as well as the blood group-related antigen, Le(y). Interesting targeting studies with radiolabeled antibodies against the HER-2 proto-oncogene have also been reported, with the prospect than a better prediction of potential myocardial toxicity may emerge. In terms of complementing mammography, CEA imaging with a radiolabeled antibody fragment contributes to improving the specificity lacking in mammography. In RAIT, it also appears that pursuit of this with human or humanized antibodies in patients with limited disease and possibly in combination with other therapy modalities and in multidose schedules will be the basis for future advances in this discipline. Copyright 2002, Elsevier Science (USA). All rights reserved.
To specify the validity of bone marrow scanning using a monoclonal anti-granulocyte antibody labelled with 99mTc (BW 250/183) for the functional assessment of haemopoiesis, we compared this method with 52Fe scan in 16 patients with haematological disorders. The examinations were performed using a rectilinear whole-body scanner and the distribution of the two tracers was assessed visually and quantitatively in anatomical bone marrow segments, the spleen and liver. Qualitative comparison showed concordance in the bone marrow distribution of the two tracers in 83% of the segments. Discrepancies were found in six patients with hypoplastic or aplastic marrow. The spleen was visualized in all cases with the 99mTc-Moab, including nine patients without splenic haemopoiesis (i.e. without spleen uptake of 52Fe). The uptake of the two tracers, quantified in bone marrow segments and the spleen, correlated well (P < 0.001), but not in the liver (NS). The correlation between the uptake values for each patient was excellent, except in cases of aplastic bone marrow. In conclusion, bone marrow scanning using a 99mTc labelled anti-granulocyte monoclonal antibody enables functional evaluation of the distribution of haemopoiesis. Limitations include the evaluation of bone marrow aplasia and identification of splenic haemopoiesis, for which 52Fe remains the tracer of choice.
Five patients with ductal breast cancer were studied using simultaneous administration of 99Tcm-labelled BW250/183 and 131I-labelled B72.3 monoclonal antibodies (MAbs). The distribution and dosimetry of these tracers were evaluated using the information from simultaneous anterior and posterior whole body scintigrams, together with 99Tcm and 131I standard activity sources, recorded on an average of 1, 4, 24, 90 and 224 h after injection. A method to eliminate 131I Scatter on 99Tcm-channel was developed. The geometric means of conjugate views and region-of-interest analysis were used to determine organ uptakes, mean residence times and absorbed radiation dose estimates of organs induced by the tracers. Organ uptakes (% of injected activity/ml) varied from 6.2 x 10(-3 /red marrow to 3.1 X 10(-2)/liver for 99Tcm-MAb and from 3.1 x 10(-2)/red marrow to 1.8 x 10(-1)/liver for 131I-MAb, one hour after injection. Calculated average residence times of organs for 99Tcm-labelled BW250/183 were in the range of physical mean-life of 99Tcm and from 71 to 95 h for 131I-B72.3 respectively. The average total absorbed dose from 99Tcm-MAb to the bone marrow was 0.01 and to the spleen 0.14 mGy/MBq and from 131I-MAb the corresponding values were 0.48 and 10.76 mGy/MBq. This double-tracer technique provides information from two antibodies having different kinetic behaviour and may facilitate in distinguishing various antigens in targeting and control MAb applications.
In 6 European countries a multicenter trial with the technetium-99m labelled monoclonal anti-granulocyte antibody BW 250/183 was conducted in 775 patients. The antibody is used for the immunoscintigraphic visualisation of accumulations of granulocytes. The present study was restricted on the investigation of patients having inflammations, essentially of the peripheral skeleton (mostly of the lower extremities), spinal column, the bowel, or had fever of unknown etiology. The overall sensitivity of the method was 83%, and specificity was of the same order of magnitude (82%). The procedure yielded additional information in 67% of the cases and the treatment strategy was influenced in 35% of the cases to positive effect, even though all conventional methods had previously been exhausted. Human anti mouse-IgG antibodies (HAMA) were detectable only in about 4% of patients investigated for the first time.
Over the last several decades bone scanning has been used extensively in the evaluation of oncology patients to detect bone involvement. It can provide information about disease location, prognosis, and the effect of therapy. Bone scanning offers the advantages of whole body evaluation and the detection of lesions earlier than other techniques. However, as newer diagnostic tools become available, indications for bone scanning must be revised and the results combined with these other tests in order to provide optimum patient care. Advances in instrumentation and the subsequent improvement in image quality have allowed nuclear medicine physicians to provide more accurate bone scan interpretations. By optimizing image acquisition, it is often possible to determine lesion characteristics, which are more likely to represent malignancy. Knowledge of disease pathophysiology and other specific properties of the patient's primary tumor, along with subsequent correlation of scan abnormalities to patient history, physical examination, previous studies, and other radiological examinations, is essential for determining lesion significance. The differential diagnosis of a scan abnormality should also include consideration of both false normal and abnormal causes. The final interpretation should be clearly communicated to the clinician with appropriate recommendations for further evaluation. Only through careful attention to the patient, the clinician, and appropriate study acquisition parameters will bone scanning maintain its place in the evaluation of oncology patients.
To evaluate the effect of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) on bone marrow glucose metabolism in rodents and in patients, as assessed by 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) uptake measured directly or by positron-emission tomography (PET) scanning.
Groups of three rats received either daily saline, G-CSF, or GM-CSF injections for 7 days. After treatment, FDG was injected and F-18 activities in tissues measured 1 hour later. Twenty-two breast cancer patients treated with multiagent chemotherapy were sequentially studied with PET. Eleven patients received G-CSF therapy as an adjunct to chemotherapy, while 11 received chemotherapy only. The standardized uptake value-lean (SUL) of bone marrow FDG uptake was measured and compared.
In rats, bone marrow F-18 activity was significantly higher in both CSF groups than in the saline group (G-CSF, 0.44 +/- 0.08; GM-CSF, 0.33 +/- 0.02; saline, 0.18 +/- 0.02% injected dose [ID]/g x kg; P < .05), but the other normal tissues had comparable biodistributions to controls. In breast cancer patients, the FDG uptake of bone marrow did not change with chemotherapy alone; however, marrow uptake was increased after treatment with G-CSF. The dose of G-CSF and duration of treatment were correlated with the extent of increase in FDG uptake. The SUL of bone marrow was as follows: baseline, 1.56 +/- 0.23; after one cycle, 3.13 +/- 1.40 (P < .01); after two cycles, 2.22 +/- 0.85 (P < .05); and after three cycles, 2.14 +/- 0.79 (P < .05), respectively. Although the FDG uptake of bone marrow declined after G-CSF treatment was completed, it was higher than the baseline level for up to 4 weeks postcompletion of G-CSF and the elevated marrow FDG uptake was sustained longer than the period of blood neutrophil count elevation.
Substantial increases in bone marrow FDG uptake are rapidly induced by CSF treatments and should not be misinterpreted as diffuse bone marrow metastases.
