Skeletal tumor burden on baseline ¹⁸F-fluoride PET/CT to predict bone marrow failure after radium-223.

Factors affecting 223Ra therapy: clinical experience after 532 cycles from a single institution

“…In patients imaged with 18 F-fluoride PET/CT scans and whole-body conventional bone scintigraphy, skeletal tumor burden was classified as low when the number of bone metastases was less than 20, intermediate when the number of bone metastases was between 20 and 50, and high when the number of bone metastases was above 50 or in the presence of diffuse disease (superscan). On whole-body metabolic 18 F-FDG PET/CT scans the metabolic tumor burden was classified as low when the number of metabolically active bone metastases was less than 6, intermediate when the number of bone metastases was between 6 and 20, and high when the number of bone metastases was above 20.…”

“…None of the clinical and laboratory parameters were independent predictors of the risk of developing BMF. To that effect, imaging biomarkers with 18 F-fluoride PET/CT may be useful to predict this outcome [18]. There are limitations to this study, as this was not a prospective randomized trial but rather an observational study based on clinical experience.…”

“…c The patient's ALP levels declined from 268 IU/l at the 1st Ra cycle to 70 IU/l after the 4th 223 Ra cycle. d An interim whole-body18 F-fluoride PET/CT scan (performed immediately prior to the 4th 223 Ra cycle) demonstrated marked improvement of the bone metastases, with reduction of uptake…”

Molecular Imaging in the selection and evaluation of response in patients treated with Radium-223 in six different solid tumors: A single center experience

“…Association of Urology (EAU), NCCN, and many another guidelines, are unclear in defining the evaluation of response to any treatment of a non-measurable disease such as bone disease of the blastic type; for these reason numerous investigations have suggested the use of nuclear medicine techniques for patient selection and response evaluation, in addition similar to other therapies for mPC, a flare phenomenon with increase of bone metastases-related pain, or "increase" in apparent number of bone metastases on bone scan, may be noted during the first treatment cycles, and should not be interpreted as disease progression [14][15][16][17][18][19] The present study showed that besides that 223 In patients with both types of lung cancer, the 6 cycles were allowed to conclude; however, in one of them, the progression occurred 8 weeks after the end of the treatment. Taber AM, et al, showed that 5 patients with NSCLC who have received front-line chemotherapy, the progression free survival (PFS) at 6 months was 80.0% and 40.0% at 12 months in patients treated with 6 cycles of 223 Ra; in addition, only one patient developed SSE after 219 days, and the four remaining patients did not experience a SSE during follow-up [25] Tahara RK, et al, carried out a single-center phase II study to determine the efficacy and safety of neutropenia (23%), anemia (14%), and thrombocytopenia (18%) in median follow-up time was 4 months; in addition, there were no grade 3 or 4 AEs [26]; however, no PET/CT with any radiotracer was performed baseline or in the follow-up.…”

The Prognostic Value of Quantitative Bone SPECT/CT Before 223Ra Treatment in Metastatic Castration-Resistant Prostate Cancer

“…For personal use only. jnm.snmjournals.org Downloaded from 223Ra (15). More recently, semi-automated estimation of bone metastatic involvement creating a "bone scan index" has been shown to be related to poor survival of patients with great tumor burden (16,17).…”