The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy

Park, Won; Huh, Seung Jae; Yang, Jung Hyun; Nam, Seok Jin; Kim, Jeong Han; Choi, Joon Young; Woo, Sook Young; Kim, Hae Young; Noh, Jae Myoung; Ryu, Jung Il

doi:10.1007/s12149-008-0158-8

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…However, these previous studies detected RIRF using X-ray or CT scan, and other previous studies using bone scintigraphy to detect RIRF reported an incidence rate of 12.9-18.5%, which is similar to the incidence rate in our study [9,10,12]. Since bone scintigraphy has a high sensitivity for detecting fractures and patients with RIRF often lack symptoms, a signi cant proportion of patients with breast cancer undergoing adjuvant radiotherapy, which could be higher than the expected proportion, might experience RIRF during followup without clinical recognition [9,12].…”

Section: Discussionsupporting

confidence: 90%

“…Moreover, radiation causes vascular injuries such as obliterative endarteritis and periarteritis in the bone [20,23]. These in ammatory changes in the vascular structure can lead to atherosclerosis formation and vessel occlusion, which affects blood ow to the bone [12,20,23]. Given these damages, irradiated bones are fragile to the fracture; therefore, in patients with thoracic malignant diseases, follow-up examination after radiotherapy often reveals RIRF [9,21,24].…”

Section: Discussionmentioning

confidence: 99%

“…Although most patients with RIRF show no or minimal symptoms, several patients experience long-lasting moderate pain and receive analgesic treatment for pain relief [5,9,11]. Furthermore, RIRF is characterized by abnormal ndings on bone scintigraphy, which is often used for follow-up surveillance of patients with breast cancer, and these abnormal ndings can be misdiagnosed as bone metastasis [9,10,12]. Therefore, several studies have tried to identify the risk factors for RIRF among radiotherapy-related factors and clinical factors [7][8][9]12].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

Lee

Kim

et al. 2021

Preprint

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Background Radiation-induced rib fracture (RIRF) is one of the adverse effects of conventional radiotherapy on breast cancer. This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on RIRFs in patients with breast cancer. Methods We retrospectively included 510 women with breast cancer who underwent curative surgical resection with subsequent adjuvant radiotherapy and were followed up using bone scintigraphy. Adjuvant radiotherapy was administered to the whole breast at 50 Gy in 25 fractions for 5 weeks and to the tumor bed at 10–16 Gy in 5–8 fractions. The tumor-rib distance was measured using preoperative computed tomography (CT) images. Postoperative chest wall thickness and dose-dependent rib volumes, which are absolute rib volumes receiving >20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 45 Gy (V45), and 50 Gy (V50), were measured from the stimulation CT images for radiation treatment planning. RIRFs were identified using follow-up bone scintigraphy images. We assessed the relationship of RIRF with tumor-rib distance, postoperative chest wall thickness, and dose-dependent rib volumes. Results The median follow-up duration was 58.8 months, and 92 patients (18.0%) experienced RIRF. Univariate analysis revealed that osteoporosis, surgery type, radiation field, tumor-rib distance, postoperative chest wall thickness, V20, V30, V40, V45, and V50 were risk factors for RIRF (p<0.05). Patients with high values of tumor-rib distance and postoperative chest wall thickness had significantly lower risks of RIRF than those with low values. Patients with high values of V20, V30, V40, V45, and V50 had significantly higher risks of RIRF than those with low values. In multivariate analysis, tumor-rib distance and all five dose-dependent rib volumes, as well as osteoporosis and radiation field, were independent risk factors for RIRF (p<0.05). Conclusions Tumor-rib distance and dose-dependent rib volume were independent risk factors for RIRF in patients with breast cancer. Restriction of the absolute rib volumes in the radiation field could be effective in reducing the risk of RIRF.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

Lee

Kim

et al. 2021

Preprint

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“…Moreover, reduced rate of bone metastasis were found in a radiotherapy field owing to radiotherapy3738. Therefore, the rates of metastasis were different in different localizations of the rib in patients with rib abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Risk of metastasis among rib abnormalities on bone scans in breast cancer patients

Chen

Zhao

et al. 2015

Sci Rep

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Bone scan abnormalities, especially rib lesions, are often confusing for physicians due to a high number of false-positive lesions. This study investigated risk factors that are associated with bone metastasis in 613 breast cancer patients with bone scan abnormalities. Significantly increased rates of bone metastasis were observed in patients with multiple lesions, large tumor sizes, and lymph node involvement. In addition, patients with concurrent lesions of rib and other sites exhibited a significant higher rate of metastatic disease compared to those with other site lesions (P = 0.009). In the subset of 324 patients with rib abnormalities, the rate of metastasis was extremely low in patients with pure rib lesions (1.2%; 95% CI: 0.1%–4.1%). Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P < 0.001). Moreover, multiple rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P < 0.001). Our data suggest that patients with pure rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients.

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“…Although most patients with RIRF show no or minimal symptoms, several patients experience longlasting moderate pain and receive analgesic treatment for pain relief [5,9,11]. Furthermore, RIRF is characterized by abnormal findings on bone scintigraphy, which is often used for follow-up surveillance of patients with breast cancer, and these abnormal findings can be misdiagnosed as bone metastasis [9,10,12]. Therefore, several studies have tried to identify the risk factors for RIRF among radiotherapy-related factors and clinical factors [7][8][9]12].…”

Section: Introductionmentioning

confidence: 99%

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

Lee

Kim

et al. 2022

JPM

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This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast cancer. We retrospectively included 510 women with breast cancer who underwent surgical resection with adjuvant radiotherapy. The tumor-rib distance was measured using preoperative computed tomography (CT) images. Postoperative chest wall thickness and dose-dependent rib volumes, which are absolute rib volumes receiving >20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 45 Gy (V45), and 50 Gy (V50), were measured from the stimulation CT images for radiation treatment planning. We assessed the relationship of RIRF with tumor-rib distance, postoperative chest wall thickness, and dose-dependent rib volumes. Patients with high values of tumor-rib distance and postoperative chest wall thickness had significantly lower risks of RIRF than those with low values. Patients with high values of V20, V30, V40, V45, and V50 had significantly higher risks of RIRF than those with low values. In a multivariate analysis, tumor-rib distance and all five dose-dependent rib volumes, as well as osteoporosis and radiation field, were independent risk factors for RIRF. Tumor-rib distance and dose-dependent rib volume were independent risk factors for RIRF in patients with breast cancer.

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The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy

Abstract: We confirmed that the hot spots within the irradiated fields might be benign, especially in patients who were postmenopause, had a low body weight, received adjuvant hormonal therapy and who had radiation that included the supraclavicular area.

Cited by 11 publications

References 30 publications

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

Risk of metastasis among rib abnormalities on bone scans in breast cancer patients

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

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