1
|
Pantel AR, Eiber M, Beyder DD, Kendi AT, Laforest R, Rauscher I, Silberstein EB, Thorpe MP. SNMMI Procedure Standard/EANM Practice Guideline for Palliative Nuclear Medicine Therapies of Bone Metastases. J Nucl Med Technol 2023; 51:176-187. [PMID: 37316301 DOI: 10.2967/jnmt.123.265936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
| | - Matthias Eiber
- School of Medicine, Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | | | | | | | - Isabel Rauscher
- Technical University of Munich, Department of Nuclear Medicine; and
| | | | | |
Collapse
|
2
|
Chausov FF, Somov NV, Lomova NV, Zakirova RM, Shumilova MA, Zhirov DK, Petrov VG. Bis(hexaaquasodium) Bis(nitrilo(tris(methylenephosphonato))decaaquamonohydrogenhexasodiumsamarate Hexahydrate [Na(H2O)6]2[SmH{μ7-N(CH2PO3)3}2Na6(H2O)10] · 6H2O: Synthesis, Structure, and Nature of Coordination Bond. RUSS J INORG CHEM+ 2020. [DOI: 10.1134/s0036023620060030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
3
|
Palliation of Metastatic Bone Pain with Radiolabeled Phosphonates. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
4
|
Ma C, Li Y, Wang J, Qin C, Kong D, Gao J, Wu Q. Syntheses and structural determination of binuclear nine-coordinate (NH4)4[SmIII2(Httha)2]·16H2O and 2-D ladder-like binuclear nine-coordinate (NH4)4[SmIII2(dtpa)2]·10H2O. J COORD CHEM 2014. [DOI: 10.1080/00958972.2014.892074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Congcong Ma
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Ying Li
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Jun Wang
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Cui Qin
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Deyong Kong
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Jingqun Gao
- College of Chemistry, Liaoning University, Shenyang, PR China
| | - Qiong Wu
- College of Chemistry, Liaoning University, Shenyang, PR China
| |
Collapse
|
5
|
Bone-seeking radiopharmaceuticals as targeted agents of osteosarcoma: samarium-153-EDTMP and radium-223. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 804:291-304. [PMID: 24924181 DOI: 10.1007/978-3-319-04843-7_16] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteosarcoma is a cancer characterized by formation of bone by malignant cells. Routine bone scan imaging with Tc-99m-MDP is done at diagnosis to evaluate primary tumor uptake and check for bone metastases. At time of relapse the Tc-99m-MDP bone scan also provides a specific means to assess formation of bone by malignant osteosarcoma cells and the potential for bone-seeking radiopharmaceuticals to deliver radioactivity directly into osteoblastic osteosarcoma lesions. This chapter will review and compare a bone-seeking radiopharmaceutical that emits beta-particles, samarium-153-EDTMP, with an alpha-particle emitter, radium-223. The charged alpha particles from radium-223 have far more mass and energy than beta particles (electrons) from Sm-153-EDTMP. Because radium-223 has less marrow toxicity and more radiobiological effectiveness, especially if inside the bone forming cancer cell than samarium-153-EDTMP, radium-223 may have greater potential to become widely used against osteosarcoma as a targeted therapy. Radium-223 also has more potential to be used with chemotherapy against osteosarcoma and bone metastases. Because osteosarcoma makes bone and radium-223 acts like calcium, this radiopharmaceutical could possibly become a new targeted means to achieve safe and effective reduction of tumor burden as well as facilitate better surgery and/or radiotherapy for difficult to resect large, or metastatic tumors.
Collapse
|
6
|
Abstract
Primary and metastatic malignant bone lesions result in significant pain and disability in oncology patients. Targeted bone-seeking radioisotopes including 153Samarium ethylene-diamine-tetramethylene-phosphonic acid (153Sm-EDTMP) have been shown to effectively palliate bone pain, often when external beam radiotherapy (EBRT) is not feasible. However, recent evidence also suggests 153Sm-EDTMP has cytotoxic activity either alone or in combination with chemotherapy or EBRT. 153Sm-EDTMP may be useful as anti-neoplastic therapy apart from pain palliation in a variety of malignancies. For prostate cancer patients, several phase I and II clinical trials have shown that combined 153Sm-EDTMP and docetaxel-based chemotherapy can result in >50% decrease in prostate-specific antigen with manageable myelosuppression. In hematologic malignancies, 153Sm-EDTMP produced clinical responses when combined with bortezomib in multiple myeloma. 153Sm-EDTMP also can be used with myeloablative chemotherapy for marrow conditioning prior to stem cell transplant. In osteosarcoma, 153Sm-EDTMP infusion delivers radiation to multiple unresectable lesions simultaneously and provides local cytotoxicity without soft tissue damage that can be combined with chemotherapy or radiation. Prior to routine incorporation of 153Sm-EDTMP into therapeutic regimens, we must learn how to ensure optimal delivery to tumors, determine which patients are likely to benefit, improve our ability to assess clinical response in bone lesions and further evaluate the efficacy 153Sm-EDTMP in combination with chemotherapy, radiation and novel targeted agents.
Collapse
Affiliation(s)
- Breelyn A Wilky
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David M Loeb
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
7
|
Tomblyn M. The Role of Bone-Seeking Radionuclides in the Palliative Treatment of Patients with Painful Osteoblastic Skeletal Metastases. Cancer Control 2012; 19:137-44. [DOI: 10.1177/107327481201900208] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Pain from skeletal metastases represents a major burden of advanced disease from solid tumors. Analgesic medications, bisphosphonates, hormonal agents, cytotoxic chemotherapy, and external beam radiotherapy are all effective treatments. However, patients often suffer from diffuse painful metastases and respond poorly to these standard therapies. Bone-seeking radionuclides can specifically target osteoblastic lesions to offer palliation of pain. Methods This article offers a narrative review of bone-seeking radionuclides, examines the evidence of safety and efficacy for the treatment of painful skeletal metastases, and presents guidelines for their appropriate use in this patient population. Results Seven bone-seeking radionuclides have shown evidence of both safety and efficacy in reducing pain from diffuse skeletal metastases. 153Sm-EDTMP and 89Sr are most commonly used in the United States and have been safely utilized for both repeat dosing as well as concurrent dosing with cytotoxic chemotherapy. Conclusions Targeted bone-seeking radionuclides are underutilized in the treatment of painful diffuse osteoblastic metastases. Several new agents are in active clinical investigation, and the pending approval of the first alpha-emitting radionuclide (223Ra) may offer a new class of agents that provide greater efficacy and less toxicity than those currently available for routine clinical use.
Collapse
Affiliation(s)
- Michael Tomblyn
- Department of Radiation Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
8
|
Paes FM, Serafini AN. Systemic metabolic radiopharmaceutical therapy in the treatment of metastatic bone pain. Semin Nucl Med 2010; 40:89-104. [PMID: 20113678 DOI: 10.1053/j.semnuclmed.2009.10.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed.
Collapse
Affiliation(s)
- Fabio M Paes
- Division of Nuclear Medicine, Department of Radiology, University of Miami/Jackson Memorial Medical Center/Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | | |
Collapse
|
9
|
Liu B, Hu P, Wang J, Xu R, Zhang LQ, Gao J, Wang YF, Zhang XD. Synthesis and structures of nine-coordinate K[SmIII (Edta)(H2O)3] · 2H2O and Ten-Coordinate K2[SmIII(Pdta)(H2O)2]2 · 4.5H2O complexes. RUSS J COORD CHEM+ 2009. [DOI: 10.1134/s107032840910008x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Papatheofanis FJ, Najib MM. Bone marrow recovery following use of systemic (153)Sm-lexidronam and (89)Sr-chloride for bone pain palliation after myelosuppressive therapy. Int J Radiat Biol 2009; 85:448-53. [PMID: 19437245 DOI: 10.1080/09553000902818899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Using plasma flt3 ((FMS (Friend murine strain))-like tyrosine kinase 3)-ligand cytokine (FL) as a biomarker, the purpose of this study was to determine whether patients receiving palliative radionuclide treatment following chemotherapy experienced enhanced myelosuppression. MATERIALS AND METHODS A total of 48 patients with solid tumors who failed multi-agent chemotherapy were investigated; they previously received 1-3 cycles of combination chemotherapy over 4-10 months. Patients were divided into four cohorts including 10 patients with early stage solid tumors prior to chemotherapy induction (naive group), 10 patients with (non-metastatic) malignancy actively undergoing chemotherapy without radionuclide follow-up (chemotherapy-alone group), 13 patients who underwent standard (1.0 mCi/kg) dose (153)Sm ((153)samarium)-lexidronam therapy following chemotherapy ((153)Sm group), and 15 patients who underwent standard (4 mCi) dose (89)Sr ((89)strontium)-chloride therapy following chemotherapy ((89)Sr group). Plasma FL was measured using a quantitative sandwich enzyme immunoassay and CBC (complete blood count), measuring WBC (white blood cell) and PLT (platelet), was performed. RESULTS Plasma FL concentration demonstrated a gradual decrease after chemotherapy. In patients who received (153)Sm within two weeks of completing chemotherapy, there is a distinguishable spike in FL concentration at approximately three weeks after dose administration, which precedes a decrease in WBC and PLT counts. On the other hand, a spike in FL levels in patients who received (89)Sr therapy is noted at approximately 10 weeks (p < 0.034). CONCLUSIONS Increases in FL concentration associated with (153)Sm-lexidronam therapy following combination chemotherapy occurred earlier and returned to control levels more rapidly than did those in patients similarly treated with (89)Sr. These differences might be associated with the shorter decay half-life and lower particle emission energies of (153)Sm.
Collapse
Affiliation(s)
- Frank J Papatheofanis
- Department of Radiology, Rebecca and John Moores UCSD Comprehensive Cancer Center, University of California, San Diego, USA
| | | |
Collapse
|
11
|
Biological Activity of Aminophosphonic Acids and Their Short Peptides. TOPICS IN HETEROCYCLIC CHEMISTRY 2009. [DOI: 10.1007/7081_2008_14] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
|
13
|
Anderson P, Nuñez R. Samarium lexidronam (153Sm-EDTMP): skeletal radiation for osteoblastic bone metastases and osteosarcoma. Expert Rev Anticancer Ther 2008; 7:1517-27. [PMID: 18020921 DOI: 10.1586/14737140.7.11.1517] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Radiation therapy can be an effective means to treat bone metastases, which occur in more than 50% of cancer patients. (153)Samarium lexidronam ((153)Sm-EDTMP; Quadramet, Cytogen) is a radiopharmaceutical designed for deposition into bone metastases. Bone scans can identify patients that may benefit from targeted radiation therapy with (153)Sm-EDTMP. As an unsealed source of radiation therapy, (153)Sm-EDTMP is simple to administer: 1 mCi/kg is given in a similar fashion to a bone scan injection ((99m)Tc-MDP bone scan injection is given at 0.2-0.35 mCi/kg. Therefore, both are administered intravenously. However, the radiation-absorbed dose and radiopharmaceutical energy are different). Nevertheless, despite simplicity of administration, (153)Sm-EDTMP is underutilized for improving cancer pain in the skeleton. Repeated cycles and combined treatment with other modalities such as bisphosphonates, chemotherapy and/or external beam radiation are possible. (153)Sm-EDTMP combined with bisphosphonates, chemotherapy and/or radiation may provide better palliation of bone metastases and also in bone-forming tumors (osteosarcoma). Encouraging experience using high-dose (153)Sm-EDTMP for total marrow irradiation in hematologic malignancies involving the bones (e.g., myeloma or acute leukemia) is also reviewed.
Collapse
Affiliation(s)
- Pete Anderson
- University of Texas, Department of Pediatrics, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA.
| | | |
Collapse
|
14
|
Wang J, Liu X, Zhang Z, Zhang X, Gao G, Kong Y, Li Y. The syntheses and structures of ten-coordinate K6[PrIII(ttha)]2 · 10H2O and nine-coordinate K4[ (Httha)2] · 14H2O complexes. J COORD CHEM 2007. [DOI: 10.1080/00958970600773630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jun Wang
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Xinzhu Liu
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Zhaohong Zhang
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Xiangdong Zhang
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Guangrui Gao
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Yumei Kong
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| | - Ying Li
- a Department of Chemistry , Liaoning University , Shenyang, 110036, P.R. China
| |
Collapse
|
15
|
Coronado M, Redondo A, Coya J, Espinosa E, Couto RM, Zamora P, Marin MD, Castelo B, Lillo ME, Frutos L, Barón MG, Curto LMM. Clinical Role of Sm-153 EDTMP in the Treatment of Painful Bone Metastatic Disease. Clin Nucl Med 2006; 31:605-10. [PMID: 16985364 DOI: 10.1097/01.rlu.0000238304.08812.c1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Sm-153 EDTMP is an effective treatment of painful bone metastases from different neoplasms. However, there are few studies describing clinical experience with this therapeutic modality. The aim of this clinical study was to evaluate the efficacy of Sm-153 EDTMP in a group of patients with skeletal metastases and poor pain control with conventional therapies. MATERIALS AND METHODS Sixty-four patients with painful bone metastases treated with Sm-153 EDTMP were retrospectively evaluated. Nine patients were treated twice. The most common primaries were breast in 28 cases (44%) and prostate in 27 (41%). Treatment efficacy was assessed by a visual analog scale, analgesic consumption, and performance status before and after treatment. Response was graded as complete, moderate, or minor. Toxicity evaluation included analytic parameters (blood counts, renal function) and clinical follow up. RESULTS Efficacy and toxicity were evaluated separately for each dose (total doses: 73), and complete follow up was only possible in 62 of 73 administrations. The response rate was 85% (21% complete, 40% moderate, and 24% minor). Onset of improvement took place a median of 7 days after Sm-153 EDTMP administration, and pain relief persisted for a mean of 3 months. No relevant toxicity was found in the early phase. Myelotoxicity appeared in 29% of the administrations and was mild in most cases (there was one case of grade 4 leukopenia). CONCLUSIONS Sm-153 EDTMP is a good therapeutic option for patients with painful bone metastases. It is an effective treatment of pain relief without major secondary effects.
Collapse
Affiliation(s)
- Mónica Coronado
- Nuclear Medicine Department, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Wang J, Liu XZ, Zhang ZH, Zhang XD, Gao GR, Kong YM, Li Y. Syntheses and structures of mononuclear eight-coordinate Na[ErIII(Cydta)(H2O2]·5H2O (Cydta = trans-1,2-cyclohexanediaminetetraacetic acid) and binuclear nine-coordinate Na2[SmIII(Cydta)][SmIII(Cydta)(H2O)3] · 11H2O. RUSS J COORD CHEM+ 2006. [DOI: 10.1134/s1070328406080112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Abstract
Samarium-153 lexidronam (153Sm-EDTMP) is FDA approved for painful osteoblastic bone metastases that image on bone scan. 153Sm-EDTMP decay has a therapeutic beta-emission and a gamma-photon for bone scan imaging. Monitoring of osteosarcoma radiation treatment effectiveness was performed with bone, CT, MRI and PET/CT fusion imaging. Bone scan and PET/CT improved in 5 out of 9 and 16 out of 18 osteosarcoma sites, respectively. 153Sm-EDTMP targets multiple sites of disease, with a single administration. Side effects of 153Sm-EDTMP (0.5-2.5 mCi/kg) have been minimal and include transient thrombocytopenia and neutropenia. 153Sm-EDTMP can be combined with radiation therapy, bisphosphonates and/or chemotherapy to synergistically improve palliation. This article reviews the rationale, indications and monitoring of standard-dose samarium and investigational high-dose 153Sm-EDTMP treatment of cancer involving bone.
Collapse
Affiliation(s)
- Pete Anderson
- Department of Pediatrics, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 87, Houston, TX 77030-4009, USA.
| |
Collapse
|
18
|
Abstract
Bone pain from metastatic prostate cancer can be effectively palliated by a single fraction of 8 Gy with no increase in toxicity, which can occur with more protracted fractionation schemes. Re-treatment, if required, is simple and effective. For multiple painful sites on the same side of the diaphragm, hemi-body radiotherapy is rapidly effective; pre-medication with odanstetron and steroids has markedly improved tolerance. For multiple painful sites on both sides of the diaphragm, radiopharmaceuticals can be considered but will not treat adjacent soft tissue disease or neurologic compromise.
Collapse
Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University of Toronto/Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
| |
Collapse
|
19
|
Ubieto MA, Abós MD, Tardin AL, Razola P, Prats E, García F, Polo E, Yubero A, Banzo J. [Treatment of bone metastatic pain with Sm153-EDTMP. Evaluation of the analgesic response and the existence of differences according to the primary tumor and the metastatic pattern]. ACTA ACUST UNITED AC 2005; 24:297-304. [PMID: 16194461 DOI: 10.1157/13079280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate the response to Sm153-EDTMP treatment in patients with metastatic bone pain and the existence of differences in the response according to the scintigraphic pattern (99mTc-MDP) and the primary tumor. MATERIAL AND METHODS We have evaluated the response to Sm153-EDTMP treatment in 32 patients (17 male and 15 female) who received 38 doses (1 mCi/kg). The primary tumor was prostate cancer in 15 patients, breast in 13, lung in 2, intestinal carcinoid in one and unknown in one. Two types of response were considered: a) effective and b) non-effective. Patients were classified into 3 groups according to the metastatic pattern: 1) Superscan (SS), 2) Generalized metastases (GM) and 3) Regional metastases (RM). RESULTS There was effective response in 24 doses (63.15%) and non-effective in 14 (36.84%). The mean duration of the response was 12.08 weeks. Patients with GM pattern showed 16 effective responses (76.19%) and 5 non-effective (23.8%). In SS pattern there were 6 effective responses (60%) and 4 non-effective (40%) and 2 effective (28.57%) and 5 non-effective (71.53%) in RM pattern. These differences did not reach statistical significance (p > 0.05). We did not find differences in the response between prostate cancer (12 effective and 6 non-effective) and breast cancer (10 effective and 6 non-effective) (p = 0.79968). CONCLUSIONS Sm153-EDTMP treatment is efficacious in patients with metastatic bone pain with effective response in 63.15% of the treatments. The response percentage was lower in patients with RM pattern but the differences did not reach statistical significance. There were no differences in the response between prostate and breast cancer patients.
Collapse
Affiliation(s)
- M A Ubieto
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Dispenzieri A, Wiseman GA, Lacy MQ, Litzow MR, Anderson PM, Gastineau DA, Tefferi A, Inwards DJ, Micallef INM, Ansell SM, Porrata L, Elliott MA, Lust JA, Greipp PR, Rajkumar SV, Fonseca R, Witzig TE, Erlichman C, Sloan JA, Gertz MA. A phase I study of 153Sm-EDTMP with fixed high-dose melphalan as a peripheral blood stem cell conditioning regimen in patients with multiple myeloma. Leukemia 2004; 19:118-25. [PMID: 15526021 DOI: 10.1038/sj.leu.2403575] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite response rates of 30% after high-dose chemotherapy with autologous hematopoietic stem cell transplant, patients with multiple myeloma are not cured. 153Samarium ethylenediaminetetramethylenephosphonate (153Sm-EDTMP; Quadramet) is a short-range, beta-emitting therapeutic radiopharmaceutical with avid skeletal uptake. In total, 12 patients were treated with escalating doses of 153Sm-EDTMP (N=3/group; 6, 12, 19.8, and 30 mCi/kg) and a fixed dose of melphalan (200 mg/m(2)). No dose limiting toxicity was seen. To better standardize the marrow compartment radiation dose, the study was modified such that an additional six patients were treated at a targeted absorbed radiation dose to the red marrow of 40 Gy based on a trace labeled infusion 1 week prior to the therapy. Despite rapid elimination of unbound radiopharmaceutical via kidneys and bladder, no episodes of nephrotoxicity, hemorrhagic cystitis, or delayed radiation nephritis were observed with a median follow-up of 31 months (range 8.5-44). Median times to ANC>0.5 and platelet >20 x 10(6)/l were 12 and 11 days, respectively, with no graft failures. Overall response rate was 94% including seven very good partial responses and five complete responses. Addition of 153Sm EDTMP to melphalan conditioning appears to be safe, well-tolerated and worthy of further study.
Collapse
Affiliation(s)
- A Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Etchebehere ECSDC, Pereira Neto CAC, Lima MCLD, Santos ADO, Ramos CD, Silva CM, Camargo EE. Treatment of bone pain secondary to metastases using samarium-153-EDTMP. SAO PAULO MED J 2004; 122:208-12. [PMID: 15558143 PMCID: PMC11160335 DOI: 10.1590/s1516-31802004000500006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT More than 50% of patients with prostate, breast or lung cancer will develop painful bone metastases. The purpose of treating bone metastases is to relieve pain, reduce the use of steroids and to maintain motion. OBJECTIVE To evaluate the use of samarium-153-EDTMP (153Sm-EDTMP) for the treatment of bone pain secondary to metastases that is refractory to clinical management. TYPE OF STUDY Retrospective. SETTING Division of Nuclear Medicine, Universidade Estadual de Campinas (Unicamp). METHODS Fifty-eight patients were studied (34 males) with mean age 62 years; 31 patients had prostate cancer, 20 had breast cancer, three had lung cancer, one had lung hemangioendothelioma, one had parathyroid adenocarcinoma, one had osteosarcoma and one had an unknown primary tumor. All patients had multiple bone metastases demonstrated by bone scintigraphy using 99mTc-MDP,and were treated with 153Sm-EDTMP. Response to treatment was graded as good (pain reduction of 50-100%), intermediate (25-49%) and poor (0-24%). RESULTS All patients showed good uptake of 153Sm-EDTMP by bone metastases. Among the patients with prostate cancer, intermediate or good response to therapy occurred in 80.6% (25 patients) and poor response in 19.4% (6). Among the patients with breast cancer, 85% (17) showed intermediate or good response to therapy while 15% (3) showed poor response. All three patients with lung cancer showed poor response to treatment. The lung hemangioendothelioma and unknown primary lesion patients showed intermediate response to treatment; the osteosarcoma and parathyroid adenocarcinoma patients showed good response to treatment. No significant myelotoxicity occurred. DISCUSSION Pain control is important for improving the quality of life of patients with advanced cancers. The mechanism by which pain is relieved with the use of radionuclides is still not yet completely understood, however, the treatment is simple and provides a low risk of mielotoxicity. CONCLUSION Treatment with 153Sm-EDTMP can control the pain secondary to bone metastases effectively in most patients with breast and prostate cancer without significant side effects.
Collapse
Affiliation(s)
- Elba Cristina Sá de Camargo Etchebehere
- Division of Nuclear Medicine, Department of Radiology, and Research Committee, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Metastatic spinal tumors are an increasingly common and difficult problem encountered by neurosurgeons and orthopedic surgeons. To improve therapies and increase life expectancy for patients with tumors such as those of the breast and prostate, a global, systematic approach is required to maximize the preservation of neurological function, maintenance of spinal stability, and relief of pain, all with the ultimate goal of improved functional capacity and quality of life (QOL). Although radiotherapy and surgery are still the primary therapeutic options, several new adjuvant therapies initially implemented to control pain more effectively have also been shown to reduce overall skeleton-related complications (pathological fractures and hypercalcemia) and may ultimately improve and extend QOL. This more global approach to spinal metastases also includes optimizing each patient's overall medical condition and potential for healing (that is, nutrition), as well as avoiding potential complications associated with metastatic disease (such as deep vein thrombosis), including excessive blood loss in the case of renal metastasis. A thorough knowledge and understanding of these therapeutic adjuvants is required to optimize care and to respond to our increasingly medically knowledgable patient population whose access to prevalent medical information has been increased because of the internet.
Collapse
Affiliation(s)
- J M Schuster
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
| | | |
Collapse
|