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671 Bone scintigraphy predicts bisphosphonat-induced osteonecrosis of the jaw in patients with metastatic prostate cancer
Title
671
Bone scintigraphy predicts bisphosphonat-induced osteonecrosis of the jaw in patients with metastatic prostate cancer Eur Urol Suppl 2015;14/2;e671
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Thomas C.1 , Spanidis M. 1 , Engel C.2 , Roos F.1 , Frees S. 1 , Neisius A. 1 , Hampel C.1 , Thüroff J. 1 , Walter C.2 , Miederer M. 3 1 University
Of Mainz, Dept. of Urology, Mainz, Germany, 2 University Of Mainz, Dept. of Maxillofacial Surgery, Mainz, Germany, 3 University
Of Mainz, Dept. of Nuclear Medicine, Mainz, Germany INTRODUCTION & OBJECTIVES: Bisphosphonat-related osteonecrosis of the jaw (BRONJ) is a rare but feared complication in prostate cancer (PCa) patients with bony metastases. If BRONJ becomes clinically symptomatic, conservative treatment options are limited. So far, no risk tool exists to predict the risk of developing BRONJ in daily clinical practice. Aim of this study was to evaluate the role of bone scintigraphy (BS) in early prediction of clinically asymptomatic BRONJ in metastatic PCa patients. MATERIAL & METHODS: For data aquisation we used our prospective risk-assessment database for BRONJ in PCa patients with bony metastases. BS of metastatic PCa patients treated with BP were evaluated for pathologic findings of the jaw. Results were compared to the development of clinically evident BRONJ during treatment. Sensitivity, specificity and predicitive value of BS for the detection of BRONJ were investigated. Moreover, the latency from the beginning of BP-therapy to first presence of pathologic findings on BS as well as the latency from pathologic findings on BS to clinically evident BRONJ was determined. RESULTS: Thirty patients with representative bone scintigraphies were included in the study. Six of 30 patients (20%) developed BRONJ. Nine patients had suspicious lesions of the jaw in BS. Sensitivity and specificity of BS for BRONJ prediction were 66.7% and 79.2%. Positive and negative predictive values were 44.4% and 90.5%. Median time from the start of BP treatment to suspicious BS was 28m (range 10m-39m). Median time from suspicious BS to clinical evident BRONJ was 6.5m (range 2-19m). Suspicious findings on BS were signficantly more often observed in patients who developed BRONJ compared to patients who did not (p=0.049). CONCLUSIONS: We are able to show that patients who show suspicious findings of the jaw on BS significantly more often develop BRONJ during clinical course. While median time between start of BP and suspicious findings on BS is more than 2 years, clinically symptomatic BRONJ is present half a year after suspicious BS. An unsuspicious BS is highly predicitive for absence of BRONJ in the future.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/671.html[19/02/2015 08:18:22]
671
Bone scintigraphy predicts bisphosphonat-induced osteonecrosis of the jaw in patients with metastatic prostate cancer Eur Urol Suppl 2015;14/2;e671
Print! Print!
Thomas C.1 , Spanidis M. 1 , Engel C.2 , Roos F.1 , Frees S. 1 , Neisius A. 1 , Hampel C.1 , Thüroff J. 1 , Walter C.2 , Miederer M. 3 1 University
Of Mainz, Dept. of Urology, Mainz, Germany, 2 University Of Mainz, Dept. of Maxillofacial Surgery, Mainz, Germany, 3 University
Of Mainz, Dept. of Nuclear Medicine, Mainz, Germany INTRODUCTION & OBJECTIVES: Bisphosphonat-related osteonecrosis of the jaw (BRONJ) is a rare but feared complication in prostate cancer (PCa) patients with bony metastases. If BRONJ becomes clinically symptomatic, conservative treatment options are limited. So far, no risk tool exists to predict the risk of developing BRONJ in daily clinical practice. Aim of this study was to evaluate the role of bone scintigraphy (BS) in early prediction of clinically asymptomatic BRONJ in metastatic PCa patients. MATERIAL & METHODS: For data aquisation we used our prospective risk-assessment database for BRONJ in PCa patients with bony metastases. BS of metastatic PCa patients treated with BP were evaluated for pathologic findings of the jaw. Results were compared to the development of clinically evident BRONJ during treatment. Sensitivity, specificity and predicitive value of BS for the detection of BRONJ were investigated. Moreover, the latency from the beginning of BP-therapy to first presence of pathologic findings on BS as well as the latency from pathologic findings on BS to clinically evident BRONJ was determined. RESULTS: Thirty patients with representative bone scintigraphies were included in the study. Six of 30 patients (20%) developed BRONJ. Nine patients had suspicious lesions of the jaw in BS. Sensitivity and specificity of BS for BRONJ prediction were 66.7% and 79.2%. Positive and negative predictive values were 44.4% and 90.5%. Median time from the start of BP treatment to suspicious BS was 28m (range 10m-39m). Median time from suspicious BS to clinical evident BRONJ was 6.5m (range 2-19m). Suspicious findings on BS were signficantly more often observed in patients who developed BRONJ compared to patients who did not (p=0.049). CONCLUSIONS: We are able to show that patients who show suspicious findings of the jaw on BS significantly more often develop BRONJ during clinical course. While median time between start of BP and suspicious findings on BS is more than 2 years, clinically symptomatic BRONJ is present half a year after suspicious BS. An unsuspicious BS is highly predicitive for absence of BRONJ in the future.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/671.html[19/02/2015 08:18:22]