Added value of hybrid SPECT with CT imaging for predicting poor therapeutic efficacy of 89Sr in patients with bone metastasis

Ben Meng,Longlan Chen,Xiaoliang Chen,Jia Song,Lisheng Liu

doi:10.1038/s41598-020-78372-5

Abstract

To utilize single-photon emission computed tomography/computed tomography (SPECT/CT) scanning to investigate the usefulness of nerve root compression (NRC) and radioactive cold zone lesions (RCZLs) for predicting poor therapeutic efficacy of strontium-89 chloride (Sr-89) in patients with bone metastasis. Patients with bone metastatic neoplasms who had undergone baseline bone SPECT/CT scanning before Sr-89 therapy (148 MBq Sr-89 chloride by an intravenous injection for each patient) between July 2011 and July 2018 were included. Bone SPECT/CT images were assessed by two readers independently. Associations between imaging features and therapeutic efficacy were obtained via multivariate logistic regression analysis. Of 231 patients analyzed, 50 (21.6%) had NRC at baseline. Of 31 patients who experienced poor therapeutic efficacy, 29 (93.5%) had NRC. In multivariate logistic regression analysis baseline NRC independently predicted poor therapeutic efficacy. The sensitivity of NRC for predicting poor therapeutic efficacy was 93.5%, specificity was 89.5%, positive predictive value was 58.0%, and negative predictive value was 98.9%. RCZLs were detected in17 patients (7.4%), of whom 14 experienced poor Sr-89 therapeutic efficacy. The sensitivity of the presence of RCZLs for predicting poor therapeutic efficacy was 45.2%, specificity was 98.5%, positive predictive value was 82.4%, and negative predictive value was 92.1%. After adjusting for age, bone metabolism and lesion type, the significant independent predictors of poor Sr-89 therapeutic efficacy were presence of NRC (p < 0.001) and RCZL (p = 0.001). NRC and RCZL on baseline bone SPECT/CT are reliable independent predictors of poor Sr-89 therapeutic efficacy in patients with bone metastasis. These associations may facilitate the administration of more effective therapeutic interventions.

Highlights

The incidence of bone metastasis is pretty high in advanced breast, prostate and lung cancer
To date strontium-89 chloride (Sr-89) has been used extensively in the palliation of pain arising from bone metastases, with the aid of single photon emission computed tomography (SPECT)/computed tomography (CT)
Patients aged older than 18 years with bone metastases who had undergone baseline bone SPECT/CT scanning prior to Sr-89 therapy at our hospital from July 2011 to July 2018 were screened for inclusion in the study

Summary

Introduction

The incidence of bone metastasis is pretty high in advanced breast, prostate and lung cancer. Improve quality of life, and further control the development of bone metastasis, treatment methods including surgery, external irradiation, chemotherapy, hormone therapy and radionuclide therapy have been utilized. Specific inhibitors (like bisphosphonates, mithramycin, and calcitonin) are playing an increasing role in alleviating bone pain. These agents usually require a long period of administration to be e ffective[14,15]. As for hormones therapy, it appears to be effective only when treating breast or prostate cancer patients. In the present study nerve root compression (NRC) and radioactive cold zone lesions (RCZLs) were investigated as potential SPECT/CT imaging-derived predictors of poor Sr-89 therapeutic efficacy in patients with bone metastasis

Methods

Results

Conclusion