Abstract
Osseous metastases often undergo an osteoblastic healing response following chemotherapy. The purpose of our study was to demonstrate the quantitative CT changes in attenuation of osseous metastases before and after chemotherapy. Our study was IRB approved and HIPAA compliant. Our cohort consisted of 86 consecutive cancer patients with contrast-enhanced CTs before and 14±2 (12-25) months after initiation of chemotherapy (60±11years, 36males, 50females). The average and maximum metastasis attenuations were measured in Hounsfield units (HU) by two readers. Treatment effects were assessed using paired t-tests and Fisher exact tests. Intraclass correlation coefficients (ICCs) were calculated. Patient records were reviewed to determine the patient's clinical status (worse, unchanged, or improved) at the time of follow-up CT. The distribution of lesion types was as follows: lytic (30/86, 35%), blastic (43/86, 50%), and mixed lytic-blastic (13/86, 15%). There was a significant increase in average and maximum CT attenuation of metastases following chemotherapy for all patients, which remained statistically significant when stratified by lesion type, clinical status (worsening or improving/stable), cancer type (breast, lung), and radiation therapy (P<0.05). In a subgroup of patients whose osseous metastases decreased in average attenuation (14/86, 16%), more patients had a worse clinical status (11/14, 79%) (P=0.02). ICC was almost perfect for average attenuation and substantial for maximum attenuation. Quantitative assessment of osseous metastatic disease using CT attenuation measurements demonstrated a statistically significant increase in attenuation more than 12months after initiation of chemotherapy.
Highlights
Osseous metastatic disease is common, affecting approximately 280,000 adults in the United States, and with approximately 68% of cases occurring in patients with primary breast, prostate, or lung cancer
Osseous metastases often undergo an osteoblastic response following chemotherapy known as the “flare phenomenon.”
CT Density of Metastatic Lesions The average and maximum CT densities of all metastases before and after chemotherapy for both readers are detailed in Table 1 and Table 2
Summary
Osseous metastatic disease is common, affecting approximately 280,000 adults in the United States, and with approximately 68% of cases occurring in patients with primary breast, prostate, or lung cancer. Osseous metastases often undergo an osteoblastic response following chemotherapy known as the “flare phenomenon.”. A similar response has been seen in CT density of metastases where an increase in density may considered to be a positive response to treatment [5]. This has been demonstrated qualitatively, it has not been proven with a systematic study of a cohort. It is not known if this difference is statistically significant and consistently reproducible. The numeric values associated with the densities before and after chemotherapy and the change in density is not known
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