technetium-tc-99m-medronate and Rhabdomyosarcoma

Bone scintigraphy is very sensitive in detecting metastases in an early stage, when changes in osteoblast function precede morphologic changes. In many oncologic situations, however, osteoarticular abnormal changes seen on the bone scan are not caused by tumor infiltration. They may be due to tumor associated conditions, such as carcinoma polyarthritis and hypertrophic pulmonary osteoarthropathy. They also may be due to therapy-associated conditions, such as the flare effect on metastases due to hormonal treatment, chemotherapy or radiotherapy, and osteonecrosis as a complication of radiotherapy or the use of corticosteroids. The introduction of Colony Stimulating Factors (CSF) to reduce myelotoxicity have allowed higher doses of chemotherapeutic agents to be administered. Currently, there is research being performed on the clinical effects of CSF in phase-II studies. In addition to the flare response of metastases, increased uptake in the axial skeleton and/or juxta-articular areas on bone scintigraphy in five patients receiving CSF has been observed. This new phenomenon could be explained by a reaction to a very cellular marrow caused by the use of CSF. The clinical relevance of this finding remains to be established. The authors present an overview of these old and new phenomena seen on the bone scan with clinical and roentgenologic correlation.

Topics: Adult; Aged; Bone and Bones; Breast Neoplasms; Female; Granulocyte Colony-Stimulating Factor; Humans; Iatrogenic Disease; Male; Middle Aged; Neoplasms; Paraneoplastic Syndromes; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Teratoma; Testicular Neoplasms

The TNM staging system is a modus for diagnosis and treatment in which T is the extent of the tumor involvement, N is lymph node involvement, and M is the metastases; this system is supplemented with a histologic malignancy grade. Staging systems identify specific prognostic factors with which to predict clinical outcome. Staging systems are useful for assigning treatment priorities, determining the role of adjuvant therapies, and evaluating clinical investigations. Unfortunately, no universally accepted staging system for soft-tissue sarcomas exists. This is related to the relatively low incidence of sarcomas, the unique and unpredictable behavior of sarcomas, significant disagreement regarding histogenesis and grading, and lack of consensus regarding the value of various prognostic factors. In adults, the two most commonly used staging systems are those developed by the American Joint Committee on Cancer and by Enneking. In children, the Intergroup Rhabdomyosarcoma Study and the International Union Against Cancer have described the systems most commonly used. These systems for soft-tissue sarcomas rely on an ability to accurately determine both the local and distant extent of disease. Advances in the field of computed tomography and magnetic resonance imaging have made this possible. It is likely that a staging system based upon a more sophisticated understanding of the basic biology of sarcomas will become available.

Topics: Adult; Biopsy; Child; Clinical Protocols; Humans; Incidence; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Rhabdomyosarcoma; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Biological Transport; Bone Neoplasms; Female; Humans; Leg Bones; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child, Preschool; Diagnosis, Differential; False Positive Reactions; Female; Humans; Ilium; Pelvic Neoplasms; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyosarcoma; Sacrum; Technetium Tc 99m Medronate; Urinary Bladder

The incidence of bone metastases in soft tissue sarcoma (STS) patients seems to be low but has not been studied separately. In this study, the authors aimed to determine the value of routine radionuclide bone scanning in preoperative staging of STS patients.. Preoperative bone scans were evaluated retrospectively in 109 consecutive patients (median age, 44 years; range, 1-86) with intermediate or high grade STS. Scans were scored in 3 categories: 1, metastases very likely; 2, equivocal; and 3, normal or benign lesions.. Category 1 scans were found in 8 of 109 patients (7%); in all 8 patients, bone metastases were confirmed. Six of these eight patients reported pain, and all had additional lung, bone marrow, or lymph node metastases. The highest rate (17%) was found in the rhabdomyosarcoma subgroup (n = 18). Category 2 (equivocal) scans were present in 12 of 109 patients (11%), in all of which bone metastases were excluded through additional investigations. Category 3 (normal) scans were found in 81%. Bone metastases were at least as frequent as lung metastases (4%) and were the single site of systemic disease in 4%. The rate of bone metastases was 55% in patients with bone pain versus 2% in patients without pain.. Bone metastases in primary STS patients are rare (7%) yet in this study at least as frequent as lung metastases. The low rate in asymptomatic patients versus the high rate in symptomatic patients supports the use of bone scanning in symptomatic patients only. The yield of routine bone scanning is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rhabdomyosarcoma; Sarcoma; Technetium Tc 99m Medronate

Topics: Adolescent; Female; Head and Neck Neoplasms; Humans; Necrosis; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Thallium; Thallium Radioisotopes

Urinary tract distortion caused by pelvic rhabdomyosarcoma was imaged during 99mTc-oxidronate bone scintigraphy for suspected metastatic disease. This appearance correlated well with the anatomy defined on other imaging modalities. Bone scanning also proved valuable in detecting an otherwise occult osseous metastasis from this unusual tumor.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Pelvic Neoplasms; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Urinary Tract

Three cases (rhabdomyosarcoma, lymphoma, and metastatic malignant melanoma) of unexpected increased uptake of methylenediphosphonate labelled by technetium 99m sodium pertechnetate (99mTc-MDP) are described. The possible mechanisms of the extraosseous tumoral accumulation of 99mTc-MDP in these malignancies are discussed. The usefulness of this method for the diagnosis, localization, and follow-up of some extraosseous tumors is evaluated.

Topics: Adult; Diphosphonates; Female; Humans; Lymphoma; Male; Melanoma; Middle Aged; Radionuclide Imaging; Rhabdomyosarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Child; Diphosphonates; Female; Femoral Neoplasms; Femur Neck; Gallium Radioisotopes; Humans; Radionuclide Imaging; Rhabdomyosarcoma; Technetium; Technetium Tc 99m Medronate

A comparison of radiographic and 99mTechnetium methyldiphosphonate scintigraphic evaluations for extent of skeletal disease was made retrospectively in 17 pediatric patients with Group III and IV rhabdomyosarcoma. Thirteen children had evidence of skeletal metastases. Of these, four exhibited multiple sites of blastic as well as lytic skeletal involvement on x-rays that were not detected by bone scans: two at the time of initial diagnosis, and two at relapse in children with prior radiotherapy to involved bones. In three additional patients a greater extent of bony disease was evident on x-rays than on bone scan. Neither the pathology of the tumor, lytic versus blastic quality of the bone lesion, nor lesion size per se was found to correlate with the failure to detect them on the bone scan. Although bone scans have greater sensitivity than x-rays for the detection of metastatic bone involvement in several adult and pediatric neoplasms, in the case of rhabdomyosarcoma, the radiographic exam appears to be a more sensitive indicator in some patients and should be considered an essential study in the evaluation of skeletal involvement by this tumor.

Topics: Bone Neoplasms; Diphosphonates; Humans; Radiography; Radionuclide Imaging; Retrospective Studies; Rhabdomyosarcoma; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Radionuclide Imaging; Rhabdomyosarcoma; Sternum; Technetium; Technetium Tc 99m Medronate

Topics: Child, Preschool; Diphosphonates; Humans; Male; Radionuclide Imaging; Rhabdomyosarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Carcinoma, Squamous Cell; Child, Preschool; Diphosphonates; Female; Histiocytoma, Benign Fibrous; Humans; Liposarcoma; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Rectal Neoplasms; Rhabdomyosarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate; Thigh

Topics: Adult; Diphosphonates; Humans; Male; Radionuclide Imaging; Rhabdomyosarcoma; Technetium; Technetium Tc 99m Medronate; Thigh