Meningosis prophylaxis with intrathecal 198Au-colloid and methotrexate in childhood acute lymphocytic leukemia

Since 1972, telecobalt irradiation plus intrathecal methotrexate (ITMTX) has been successfully replaced in Jena by intrathecal colloidal radioactive gold (198Au) plus ITMTX for meningosis prophylaxis in leukemia. Seventy-three children with acute lymphocytic leukemia (ALL) were given 1.24-4.89 mCi (45.8-181 MBq) of colloidal 198Au IT after successful initiation of remission. During cytostatic therapy, the following relapses occurred: meningosis leucaemica, five patients (6.8%); bone-marrow relapse and the meningosis leucaemica, one patient; and bone-marrow relapse, 20 patients (27.4%). In 18 children, combination chemotherapy was terminated after two and a half or three years of treatment. After that time, one meningeal relapse and six bone-marrow relapses occurred. Within the first 24 hours after application of radioactive gold, headaches, vomiting, and fever occurred in less than 10% of the children. An apathy syndrome, leukecephalopathy, or severe infections, were not observed in a single case. Radioactive gold spreads in the subarachnoid space and is phagocytized by the arachnoidea. The tumoricide effect extends selectively over the space of distribution of the latent meningosis leucaemia. The cerebral parenchyma remains unaffected by radiation. Thus, radioactive gold may be preferable to telecobalt irradiation in preventing central nervous system leukemia.

[Cessation of treatment in childhood acute lymphatic leukemia. Long-term observations after meningosis prevention with intrathecal gold colloid radioisotopes and methotrexate]

Cytostatic long-term treatment for about 36 months was administered to 18 children with acute lymphatic leukaemia who were in long-term remission (43-98 months). Prophylaxis of meningosis involved intrathecal 198Au colloid and methotrexate. Seven recurrences occurred during the long-term remissions: the bone marrow was involved six times, leukaemic meningosis occurred once. Five out of seven recurrences occurred within one year of cessation of treatment. There were no complications induced by intrathecal radio-gold, such as the apathy syndrome or leukoencephalopathy. Intrathecal methotrexate led to side effects before administration of radio-gold: encephalopathy twice, paraplegia once. Symptoms regressed completely in two children, one child with encephalopathy continues to have symptoms. All three children were given 198Au colloid intrathecally thereafter which was tolerated very well. 198Au colloid represents an alternative for prophylaxis of meningosis with 60Co telecobalt irradiation in leukaemias and non-Hodgkin lymphomas in childhood.

Use of radioactive gold in the treatment of pleural effusions caused by metastatic cancer

This paper presents a series of 12 patients suffering from advanced gynecological cancer with the occurrence of pleural effusions. All patients received at least one intrapleural dose of radioactive gold (100 m Ci Au198) when the necessity for thoracentesis became more than once every three weeks. Three showed no recurrence of fluid, five a significant slowing down of effusion, and four did not show any response. Severe complications were minimal, and were comparable to those resulting from thoracentesis in general.

Histopathologic studies of the liver following intravenous colloidal 198Au therapy

Histologic studies of liver tissue from 27 patients given up to 395 mCi (cumulative) of intravenous colloidal 198Au showed no definite radiation injury and no correlation between hepatic abnormalities and dose. Demonstration of aggregates of colloidal gold in the Kupffer cells was inconsistent, suggesting slow removal or dispersion. Although the liver ordinarily receives the highest radiation dose, the critical organ is the marrow. Results support the recent introduction of 198Au to supplement teletherapy for certain neoplasms diffusely infiltrating the liver. Apparently the beta distribution minimizes endothelial injury in large vessels, which has been shown to be the cause of radiation hepatitis.

Complications following parametrial radiogold treatment for cervical carcinoma

Between January 1950 and March 1965, 382 patients with carcinoma of the uterine cervix were treated with parametrial radiogold injections. One hundred and ninety-two patients are known to have survived 5 or more years after the treatment without evidence of recurrence. Major complications with significant morbidity requiring hospitalization or additional surgery was observed in 9.4% of the patients. Parametrial radiogold injection is associated with a high incidence of major lower urinary tract complications, including an increased incidence of ureteral obstruction as a result of radiation fibrosis, Heterogenous distribution of radioactive material with localized areas of heavy irradiation is probably responsible for the development of late major complications.

[Synoviorthesis with radioactive gold in hemophilia]

Intra-articular haemorrhage in haemophiliacs often provokes chronic synovitis which leads to further repeated haemorrhages. This conditions has been treated by means of intra-articular injection of 198Au in colloidal solution and this treatment has cured the synovitis in 50 per cent of cases and given a notable improvement in about another 40 percent. Because of this, in this group of patients it was possible to reduce replacement therapy to less than 1/4 and the effect persisted over at least 3 years. This treatment even means that surgical synovectomy may be avoided in many cases. No unfavourable effects were seen on joint mobility or on bone growth but an undesirable effect of the radioactivity has been described in the form of chromosome changes in the circulating lymphocytes, and the importance of these pathological transformations is the subject of new experiments.

Spread of gold injected into the joints of healthy rabbits

This study shows that after intra-articular injection, aurothiomalate and colloidal gold of small (200 A) particle size were rapidly absorbed from joints while the larger, 300 A, particle size colloidal radioactive gold could not be found outside them. Larger particle size suspensions seem therefore more likely to remain localised in the joint and its lining synovium after intra-articular injection, the systemic absorption from the joint cavity diminishing with increasing particle size. It was also found that the intra-articular injection of small amounts of aurothiomalate, of colloidal gold and of colloidal radioactive gold produces identical degenerative lesions in the lining cells of the proximal convoluted tubules of the kidneys. These lesions were always found, although gold particles were demonstrated only in sampled kidney tissues of the animals injected with the soluble gold preparation whereas no gold could be detected in the tissues of animals injected with colloidal non-radioactive or radioactive gold. Electron microscopic evidence is presented to suggest the possibility that the mitochondria are the "target" organelles of the gold-induced cellular damage. Mitochondrial damage was demonstrated in liver and spleen in addition to the already described kidney damage. The correlation between structure and function of the mitochondrial changes is not clear, and ionic shifts may be both a cause and a result of damage.

Parametrial calcification in cervical carcinoma patients treated with radioactive gold

A unique appearance of soft tissue calcification in the pelvis which may be specific for patients treated with parametrial injection of 198Au colloid is described. The calcification appears in the area of maximum radiation dose and can appear within 5 years of treatment. It is significant because it occurred in approximately one-half of the cases radiographically reviewed and may be confused with calcification from other etiologies.

Adverse reactions to radiopharmaceuticals

This review covers the side effects and adverse reactions to radiopharmaceuticals that were reported in the literature over the past 25 years. The information published prior to 1970 is sporadic, but due to the increased utilization of nuclear medicine procedures and the recognition that radiopharmaceuticals may have pharmacologic side effects, a registry has existed since 1971 to tabulate information on such effects. This survey is medical, rather than pharmaceutical in emphasis and so the adverse reactions are classified according to the target-organ systems involved rather than according to the specific radionuclides or to pharmaceuticals. If any of the radiopharmaceuticals of present or past use are not mentioned in this review, it is because no reports on their side effects were retrived by us. Hopefully, the organized registry system suggested by the Society of Nuclear Medicine (SNM) will enable a more complete recording of side effects from radiopharmaceuticals in the future.

[Cytogenetic investigations in patients receiving an intraarticular injection of gold-198 (author's transl)]

The chromosomes of lymphocyte cultures from the peripheral blood were investigated in 10 patients (rheumatoid arthritis, ankylosing spondylitis, osteoarthrosis of the knee) before and at short-term intervals (1 day, 3 to 4 days, 14 to 18 days) after the injection of gold-198 (5 to 20 mC; usually 8 mC; average particle size 300 A) into the knee-joint. The number of structural chromosomal abberrations increased markedly in 4 of the 10 patients. On the first day after the gold injection the mean aberration rate was significantly higher than the control value (Chi2-5.18; df=1; P less than 0.05). Most of the observed aberrations were chromatid aberrations and this finding is discussed.

Pulmonary embolism following liver scan with colloidal gold

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The treatment of persistent knee effusions with intra-articular radioactive gold: preliminary report

Eighteen chronic knee effusions unresponsive to the usual methods of therapy were treated by intra-articular injections of radioactive gold ((198)Au) and followed up for one year. Ten patients had classical rheumatoid arthritis; three intermittent hydrarthrosis (both knees were treated in one patient); two ankylosing spondylitis, and one synovitis of undetermined cause. In 12 knees the effusion completely disappeared, usually within three months. Temporary increased pain and swelling occurred during the first week in five cases. Radiation dosimetry is discussed in detail.