Tumor Flare Syndrome | Metastatic Carcinoma to Bone

 

Patients affected:

(1) males with prostate cancer treated with anti-androgenic agents

(2) females with breast cancer treated with anti-estrogenic agents such as Tamoxifen

(3) therapy with other hormonal agents

 

Findings:

(1) tumor pain

(2) diffuse bone pain

(3) hypercalcemia, which may be severe

(4) systemic symptoms

(5) "flare" on bone scan or X-ray studies, with apparent worsening of bone involvement shortly after starting therapy

(6) clinical enlargement of palpable tumor masses

(7) increase in serum tumor markers

Pain Findings	CTC Grade
none	0
mild pain, not interfering with function	1
moderate pain; pain or analgesics interfere with function but not activities of daily living	2
severe pain; pain or analgesics interfere with activities of daily living	3
disabling pain	4

 

where:

• Considering the significance of hypercalcemia, it would seem grading the hypercalcemia might also be useful for following the patient.

 

The time course may be important in distinguishing tumor flare from disease progression:

(1) Tumor flare usually starts within 1-2 weeks of therapy and resolves in 2-4 weeks (up to 12 weeks after starting therapy). As symptoms resolve the size of lesions on imaging studies regress.

(2) Progressive disease continues beyond 12 weeks and there is evidence of further progression in lesions.