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Yamada K, Kaise H, Taguchi T, Horiguchi J, Takao S, Suzuki M, Kubota T, Miura D, Narui K, Tawaraya K, Machida Y, Akazawa K, Kohno N, Ishikawa T. Strontium-89 plus zoledronic acid versus zoledronic acid for patients with painful bone metastatic breast cancer. J Bone Miner Metab 2022; 40:998-1006. [PMID: 36042056 DOI: 10.1007/s00774-022-01366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION β-ray strontium-89 (Sr-89) intra-irradiation therapy has been approved and clinically used to reduce bone metastasis pain not alleviated by bone-modifying agents, external radiation, and analgesic agents. We examined the efficacy of zoledronic acid (ZOL) and Sr-89 combination therapy compared with ZOL alone in breast cancer patients with bone metastases. MATERIALS AND METHODS A randomized controlled trial was conducted on breast cancer patients with bone metastasis to compare the efficacy between ZOL monotherapy and ZOL plus Sr-89 combination therapy. The primary endpoints were changes in urinary NTX levels at 13 weeks and brief pain inventory scores. The secondary endpoints were analgesic drug usages, response rates, changes in bone metabolism markers, quality of life, and adverse event rates. RESULTS Thirty of the planned 60 cases were randomly assigned to ZOL alone or ZOL + Sr-89. There were no significant differences in the changes in urinary NTX levels between the 2 groups (P = 0.365). There was no consistent difference in the pain score changes between the 2 groups. Sr-89 addition to ZOL slightly reduced the white blood cell and platelet counts. However, all adverse events were Grade 1. Safety and analgesic drug dose reduction were more evident in ZOL + Sr-89. CONCLUSION This trial showed the lack of benefits from Sr-89 addition to ZOL for breast cancer patients with painful bone metastases. However, safety and analgesic drug dose reduction were more evident in ZOL + Sr-89, indicating its potential for pain control. Sr-89 therapy is safe, thus more effective radiopharmaceuticals are anticipated.
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Affiliation(s)
- Kimito Yamada
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
- Department of Breast surgery, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan.
| | - Hiroshi Kaise
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
- Department of Breast Surgery, Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Horiguchi
- Department of Breast Surgery, International University of Health and Welfare, Chiba, Japan
| | - Shintaro Takao
- Department of Breast Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Masato Suzuki
- Department of Surgery, National Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Tomoyuki Kubota
- Department of Surgery, Kamiiida Daiichi General Hospital, Aichi, Japan
| | | | - Kazutaka Narui
- Department of Breast and Endocrine Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | | | - Yurika Machida
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kouhei Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Norio Kohno
- Department of Breast Surgery, Kobe Kaisei Hospital, Hyogo, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Talip Z, Favaretto C, Geistlich S, van der Meulen NP. A Step-by-Step Guide for the Novel Radiometal Production for Medical Applications: Case Studies with 68Ga, 44Sc, 177Lu and 161Tb. Molecules 2020; 25:E966. [PMID: 32093425 PMCID: PMC7070971 DOI: 10.3390/molecules25040966] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
The production of novel radionuclides is the first step towards the development of new effective radiopharmaceuticals, and the quality thereof directly affects the preclinical and clinical phases. In this review, novel radiometal production for medical applications is briefly elucidated. The production status of the imaging nuclide 44Sc and the therapeutic β--emitter nuclide 161Tb are compared to their more established counterparts, 68Ga and 177Lu according to their targetry, irradiation process, radiochemistry, and quality control aspects. The detailed discussion of these significant issues will help towards the future introduction of these promising radionuclides into drug manufacture for clinical application under Good Manufacturing Practice (GMP).
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Affiliation(s)
- Zeynep Talip
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland
| | - Chiara Favaretto
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Susanne Geistlich
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Nicholas P. van der Meulen
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland
- Laboratory of Radiochemistry, Paul Scherrer Institute, 5232 Villigen-PSI, Switzerland
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Systematic review and meta-analysis on the proportion of patients with breast cancer who develop bone metastases. Crit Rev Oncol Hematol 2017; 115:67-80. [DOI: 10.1016/j.critrevonc.2017.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 04/07/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
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Owaki Y, Inoue K, Narita H, Tsuda K, Fukushi M. Characteristic X-ray imaging for palliative therapy using strontium-89 chloride: understanding the mechanism of nuclear medicine imaging of strontium-89 chloride. Radiol Phys Technol 2017; 10:227-233. [PMID: 28054241 DOI: 10.1007/s12194-016-0388-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/21/2016] [Accepted: 12/26/2016] [Indexed: 12/01/2022]
Abstract
Strontium-89 (Sr-89) chloride is a targeted palliative therapy used for painful bone metastasis in which repeated doses can be administered, and its usefulness has been reported in the case of bone metastasis of various primary tumors. However, the effectiveness of the pain relief treatment is only described using a subjective index such as the visual analog scale, which lacks objectivity. Although various attempts at quantifying the effectiveness of Sr-89 chloride therapy have been reported using nuclear medicine imaging for energy peaks around 70-80 keV, the principle of Sr-89 chloride imaging has not been explained. In this study, the principle of nuclear medicine imaging for Sr-89 chloride was evaluated using a fundamental study. Additionally, the optimal collimator for acquiring Sr-89 chloride image data was evaluated. Based on the results, the principle of nuclear medicine imaging for Sr-89 chloride could be explained: the energy peaks were characteristic X-rays produced by interactions between gamma rays (514 keV) emitted from Sr-85, which is included during the manufacturing process of the Sr-89 chloride solution, and the lead collimator used in the imaging. The optimal collimator for generating characteristic X-rays efficiently was identified as a middle-to-high energy collimator.
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Affiliation(s)
- Yoshiki Owaki
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, 116-8551, Japan.,Office of Radiation Technology, Keio University Hospital, Tokyo, 160-0016, Japan
| | - Kazumasa Inoue
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, 116-8551, Japan.
| | - Hiroto Narita
- Department of Radiology, The Jikei University Hospital, Tokyo, 105-8471, Japan
| | - Keisuke Tsuda
- Department of Radiological Technology, Tsukuba International University, Tsukuba, Ibaraki, 300-0051, Japan
| | - Masahiro Fukushi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, 116-8551, Japan
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Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, Wong R, Hahn C. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2016; 7:4-12. [PMID: 27663933 DOI: 10.1016/j.prro.2016.08.001] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/15/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose is to provide an update the Bone Metastases Guideline published in 2011 based on evidence complemented by expert opinion. The update will discuss new high-quality literature for the 8 key questions from the original guideline and implications for practice. METHODS AND MATERIALS A systematic PubMed search from the last date included in the original Guideline yielded 414 relevant articles. Ultimately, 20 randomized controlled trials, 32 prospective nonrandomized studies, and 4 meta-analyses/pooled analyses were selected and abstracted into evidence tables. The authors synthesized the evidence and reached consensus on the included recommendations. RESULTS Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases. High-quality data confirm single fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity. One prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints. Advanced radiation therapy techniques such as stereotactic body radiation therapy lack high-quality data, leading the panel to favor its use on a clinical trial or when results will be collected in a registry. The panel's conclusion remains that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy. CONCLUSION Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.
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Affiliation(s)
- Stephen Lutz
- Department of Radiation Oncology, Eastern Woods Radiation Oncology, 15990 Medical Drive South, Findlay, Ohio 45840.
| | - Tracy Balboni
- Department of Radiation Oncology, and Department of Psychosocial Oncology and Palliative Care Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joshua Jones
- Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Joshua Petit
- Department of Radiation Oncology, University of Colorado Health, Fort Collins, Colorado
| | - Shayna E Rich
- Hospice and Palliative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Carol Hahn
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Heianna J, Toita T, Endo W, Kasuya G, Ariga T, Hashimoto S, Maemoto H, Terui K, Miura N, Togashi A, Miyauchi T, Murayama S. Concurrent use of strontium-89 with external beam radiotherapy for multiple bone metastases: early experience. Ann Nucl Med 2015; 29:848-53. [PMID: 26266885 DOI: 10.1007/s12149-015-1010-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to consider the safety and efficacy of concurrent use of strontium-89 (Sr-89) with external beam radiotherapy (EBRT) for multiple bone metastases, including lesions that require urgent therapy. METHODS A retrospective review was performed of a consecutive series of patients who received Sr-89 for multiple bone metastases. Forty-five patients with multiple bone metastases received Sr-89 injection. Since 17 of the 45 patients had osteolytic bone lesions requiring emergent EBRT, they underwent concurrent use of Sr-89 with EBRT (concurrent group). The remaining 28 patients, none of whom had osteolytic lesions requiring urgent EBRT, were given Sr-89 injection only (singularity group). The injection of Sr-89 was to be given during EBRT, or on the day before the first day of EBRT. The dose of EBRT was 30 Gy in 10 fractions or 40 Gy in 20 fractions. Adverse events were evaluated according to hematological toxicity as measured by the Common Terminology Criteria for Adverse Events (V4.0). To assess efficacy, we checked changes in the pain scale and analgesic drug dosages, and the presence or absence of serious complications from bone metastases. RESULTS Fifteen of 17 patients (88.2%) in the concurrent group and 17 of 28 patients (60.7%) in the singularity group reported bone pain relief. A statistically significant difference was found between the two groups, and severe complications (spinal cord compression and pathological fracture) from bone metastases could be prevented in all patients in the concurrent group. Severe hematological toxicity (grade 3 or higher) was not observed in the two groups. There was no statistical difference between the two groups. No one required additional intervention. The adverse events were tolerable. CONCLUSIONS The results of our study suggest that concurrent use of Sr-89 with EBRT for multiple bone metastases can be performed safely if it is carried out with care, and that it may be an effective therapy in cases requiring emergency treatment.
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Affiliation(s)
- Joichi Heianna
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Takafumi Toita
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Wataru Endo
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Goro Kasuya
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Takuro Ariga
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Seiji Hashimoto
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hitoshi Maemoto
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Kazuyuki Terui
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Naoki Miura
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Aki Togashi
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Takaharu Miyauchi
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Sadayuki Murayama
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
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Maeda O, Ando T, Ishiguro K, Watanabe O, Miyahara R, Nakamura M, Funasaka K, Furukawa K, Ando Y, Kato K, Goto H. A patient with esophageal cancer with bone metastasis who achieved pain relief with repetitive administration of strontium-89 chloride. Clin J Gastroenterol 2015; 7:387-91. [PMID: 26184016 DOI: 10.1007/s12328-014-0515-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/29/2014] [Indexed: 10/25/2022]
Abstract
A 75-year-old woman was diagnosed with esophageal cancer with difficulty in swallowing. She had a past history of rheumatoid arthritis, scleroderma, interstitial pneumonia, angina pectoris (with coronary artery bypass surgery) and arrhythmia (with pacemaker implantation). She refused surgery, and chemotherapy and radiotherapy were not performed because of the high risk accompanied with multiple comorbidities. She received proton therapy at another hospital and the primary lesion shrank. Bone metastasis in the thoracic vertebrae was diagnosed 10 months after diagnosis of esophageal cancer. Non-steroidal anti-inflammatory drugs and zoledronic acid were administered for back pain. Oxycodone was also administered but discontinued due to nausea. After strontium-89 ((89)Sr) chloride administration, her back pain was relieved. (89)Sr was administered five times every 3 months, and the pain did not worsen until her death due to pneumonia 2 years after diagnosis of esophageal cancer. (89)Sr was effective for pain from bone metastasis of esophageal cancer, and its repeated administration was safe.
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Affiliation(s)
- Osamu Maeda
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan,
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Heianna J, Miyauchi T, Endo W, Miura N, Terui K, Kamata S, Hashimoto M. Tumor regression of multiple bone metastases from breast cancer after administration of strontium-89 chloride (Metastron). Acta Radiol Short Rep 2014; 3:2047981613493412. [PMID: 25298863 PMCID: PMC4184432 DOI: 10.1177/2047981613493412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 05/20/2013] [Indexed: 11/16/2022] Open
Abstract
We report a case of tumor regression of multiple bone metastases from breast carcinoma after administration of strontium-89 chloride. This case suggests that strontium-89 chloride can not only relieve bone metastases pain not responsive to analgesics, but may also have a tumoricidal effect on bone metastases.
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Affiliation(s)
- Joichi Heianna
- Department of Radiation Oncology, Akita Red Cross Hospital, Akita, Japan
| | - Takaharu Miyauchi
- Department of Diagnostic Radiology, Akita Red Cross Hospital, Akita, Japan
| | - Wataru Endo
- Department of Radiation Oncology, Akita Red Cross Hospital, Akita, Japan
| | - Naoki Miura
- Department of Radiation Oncology, Akita Red Cross Hospital, Akita, Japan
| | - Kazuyuki Terui
- Department of Diagnostic Radiology, Akita Red Cross Hospital, Akita, Japan
| | - Syuichi Kamata
- Department of Breast Oncology, Akita Red Cross Hospital, Akita, Japan
| | - Manabu Hashimoto
- Department of Radiology, Akita University of Medicine, Akita, Japan
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Li F, Wang W, Li L, Chang Y, Su D, Guo G, He X, Li M. An Effective Therapy to Painful Bone Metastases: Cryoablation Combined with Zoledronic Acid. Pathol Oncol Res 2014; 20:885-91. [DOI: 10.1007/s12253-014-9769-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
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