Indian Journal of Nuclear Medicine
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Year : 2014  |  Volume : 29  |  Issue : 1  |  Page : 34-37

Paradoxal metabolic flare detected by 18F-fluorodeoxyglucose positron emission tomography in a patient with metastatic breast cancer treated with aromatase inhibitor and biphosphonate

1 Department of Diagnostic PET, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
2 Department of Radiotherapy, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow, Poland

Correspondence Address:
Andrea D'Amico
Department of Diagnostic PET, Maria Skłodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Ul Wybrzeże AK 15, 44-101 Gliwice
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-3919.125769

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Patients with estrogen-receptor-positive advanced breast cancer are treated with endocrine therapy. The majority of breast cancer localizations show 18F-fluorodeoxyglucose (FDG) uptake at positron emission tomography (PET) examination. In these patients, the metabolic flare after therapy is common and was proposed as an index of therapy efficacy. Nevertheless, prolonged persistence of flare can lead to misinterpretation. We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors. Initially, the patient underwent endocrine therapy in addition to a biphosfonate. Owing to progression observed in a bone scan, Tamoxifen was substituted with aromatase inhibitors. Successive bone scan examinations showed stabilization with a marked clinical improvement. A second FDG PET was performed 28 months after the first examination and showed a metabolic flare phenomenon with concomitant partial calcification of osteolitic lesions. This is an unusual case of prolonged metabolic flare.

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