phosphorus-radioisotopes and Bone-Neoplasms

This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates.. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival.. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010.. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope.. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis.. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 (. This update adds new evidence on efficacy of radioisotopes versus placebo,

Topics: Bone Neoplasms; Fractures, Bone; Humans; Hypercalcemia; Pain; Pain Measurement; Phosphorus Radioisotopes; Radioisotopes; Randomized Controlled Trials as Topic; Ruthenium Radioisotopes; Samarium; Spinal Cord Compression; Strontium Radioisotopes

Treatment of multisite, sclerotic bone metastases is successfully performed by radionuclide therapy. Pain palliation is the most common aim for the treatment. Two radiopharmaceuticals are currently approved by the European Medicines Agency ((153)Sm-EDTMP and (89)Sr-Cl₂) whilst other radiopharmaceuticals are at different stages of development, or are approved in some European countries ((186)Re-HEDP, (117)Snm-DTPA and (223)Ra-Cl₂). The tissues at risk for the treatment are bone marrow and normal bone. A review of the methods applied for dosimetry for these tissues and for tumours is performed, including the calculation of S values (the absorbed dose per decay) and optimal procedures on how to obtain biodistribution data for each radiopharmaceutical. The dosimetry data can be used to individualise and further improve the treatment for each patient. Dosimetry for radionuclide therapy of bone metastases is feasible and can be performed in a routine clinical practice.

Topics: Bone Neoplasms; Humans; Pain; Palliative Care; Phosphorus Radioisotopes; Radiopharmaceuticals; Radiotherapy Planning, Computer-Assisted; Radium; Rhenium; Samarium; Strontium Radioisotopes; Tin Radioisotopes

This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates.. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival.. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010.. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope.. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis.. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 ((89)Sr) with Samarium-153 ((153)Sm), Rhenium-186 ((186)Re) and Phosphorus-32 ((32)P). We observed no significant differences between treatments. Similarly, we observed no differences when we compared different doses of (153)Sm (0.5 versus 1.0 mCi).. This update adds new evidence on efficacy of radioisotopes versus placebo, (89)Sr compared with other radioisotopes, and dose-comparisons of (153)Sm and (188)Re. There is some evidence indicating that radioisotopes may provide complete reduction in pain over one to six months with no increase in analgesic use, but severe adverse effects (leucocytopenia and thrombocytopenia) are frequent.

Topics: Bone Neoplasms; Fractures, Bone; Humans; Hypercalcemia; Pain; Pain Measurement; Phosphorus Radioisotopes; Radioisotopes; Randomized Controlled Trials as Topic; Ruthenium Radioisotopes; Samarium; Spinal Cord Compression; Strontium Radioisotopes

Metabolic radiotherapy is a new therapy for management of bone pain in patients with bone metastatic prostate carcinoma. Strontium-89 and Samarium-153 concentrate in bone metastases and radiate them. A pain decrease is obtained in 60-70% of cases. Side effects are a significant hematological depression without great clinical consequences if good therapeutic indications are respected. Our multidisciplinary experience of these radionuclides in 54 performed treatments shows a rate of good responders of 66% with a rate of excellent results (total decrease of pain) in 47%. The therapeutic effectiveness is correlated with pain intensity measured by Visual Analogic Scale (VAS) and equivalent dose of morphine. Radionuclide therapy should be applied to patients as early as possible after establishment of bone metastases.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Analgesics, Opioid; Bone Neoplasms; Clinical Trials as Topic; Double-Blind Method; Forecasting; France; Hematologic Diseases; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Phosphorus Radioisotopes; Prospective Studies; Prostatic Neoplasms; Radioisotopes; Radiopharmaceuticals; Rhenium; Samarium; Strontium; Strontium Radioisotopes; Treatment Outcome

Bone metastasis is a common sequella of solid malignant tumors such as prostate, breast, lung, and renal cancers, which can lead to various complications, including fractures, hypercalcemia, and bone pain, as well as reduced performance status and quality of life. A multidisciplinary approach is usually required not only to address the etiology of the pain and its complicating factors but also to treat the patient appropriately. Currently, the treatment of bone pain remains palliative at best with systemic therapy (analgesics, hormones, chemotherapy, steroids, and bisphosphonates) as well as local treatments (such as surgery, nerve blocks, and external beam radiation). However, many of these treatments are limited in their efficacy or duration and have significant side effects that seriously limit the cancer patient's quality of life. Various radiopharmaceuticals have shown good efficacy in relieving bone pain secondary to bone metastasis. This systemic form of metabolic radiotherapy is simple to administer and complements other treatment options. This has been associated with improved mobility in many patients, reduced dependence on narcotic and non-narcotic analgesics, improved performance status and quality of life, and, in some studies, improved survival. Additional radiopharmaceuticals are under investigation and appear promising. All of these agents, although comprising different physical and chemical characteristics, offer certain advantages in that they are simple to administer, are well tolerated by the patient if used appropriately, and can be used alone or in combination with the other forms of treatment.

Topics: Analgesics; Animals; Bone Neoplasms; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain; Phosphates; Phosphorus Radioisotopes; Radioisotopes; Radiopharmaceuticals; Samarium; Strontium; Strontium Radioisotopes

Pain in patients with cancer metastatic to bone is a significant cause of morbidity and of referrals from general practice and specialist physicians. Management typically utilizes radiation therapy and the graduated use of opiate analgesics. Bone-seeking radiopharmaceuticals have provided a new option to these management strategies, which is effective and cost effective. Strontium 89 is now in routine clinical use, while rhenium 186 hydroxyethylidene diphosphonate (HEDP) and samarium 153 ethylenediaminetetramethylene phosphonate (EDTMP) are in Phase III trials and tin 117m (4+) diethylene triaminepentacetic acid (DTPA) is in Phase I trials. Evidence taken primarily from the Strontium 89 trial, shows unsealed source therapy with these bone-seeking radiopharmaceuticals to be effective in palliating pain, improving quality of life, reducing the rate at which new painful sites develop, reducing requirements for additional radiation therapy, and reducing lifetime management costs. Indications and contraindications to therapy have now been defined, and retreatment is an option with all radiopharmaceuticals.

Topics: Bone Neoplasms; Clinical Trials as Topic; Etidronic Acid; Female; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Pain Management; Palliative Care; Pentetic Acid; Phosphorus Radioisotopes; Radioisotopes; Rhenium; Safety; Strontium Radioisotopes; Syndrome

Bone pain is a common symptom in disseminated malignancy and may be difficult to manage effectively. Radiation is of proven benefit for pain palliation and there is growing interest in the therapeutic potential of bone-seeking radiopharmaceuticals. Clinical data relating to the use of phosphorus-32, strontium-89, samarium-153 EDTMP, rhenium-186 HEDP and tin-117m DTPA are reviewed in the context of the pathophysiology of metastatic bone pain. Possible mechanisms of action of palliative radiotherapy and, in particular, the theoretical role of early response genes are discussed. The application of Monte Carlo simulation to targeted radiotherapy for bone metastases may provide the basis for a clearer understanding of the microdosimetry and radiobiology of bone pain palliation and for reliable prediction of clinical response and toxicity.

Topics: Bone Neoplasms; Humans; Neoplasms; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Radiotherapy Dosage; Rhenium; Samarium; Strontium; Tin Radioisotopes

New advances in systemic radionuclide therapy have increased the number of treatment options available for patients with painful osseous metastases. This form of therapy has three major appeals: 1) it addresses all sites of involvement; 2) selective absorption into bone limits irradiation of normal tissues; and 3) as a result, toxicity may be reduced and the therapeutic ratio improved. The clinical experience with radioactive phosphorus, strontium, samarium, and rhenium are reviewed. To date, the best studied and the only Food and Drug Administration approved agent is strontium-89. About 60% to 90% of patients treated with strontium-89 respond with complete or partial relief of pain for a median duration of 6 months. Large, prospectively randomized clinical trials have established the efficacy of strontium-89 as a first-line therapy and as an adjuvant to external-beam radiotherapy. Particularly advantageous is its usefulness in situations in which external-beam radiotherapy options have been exhausted and normal tissue tolerance has been reached. Newer radiopharmaceuticals are still under investigation.

Topics: Bone Neoplasms; Humans; Phosphorus Radioisotopes; Radioisotopes; Rhenium; Samarium; Strontium Radioisotopes

Topics: 3-Iodobenzylguanidine; Antibodies, Monoclonal; Bone Neoplasms; Brachytherapy; Humans; Iodine Radioisotopes; Iodobenzenes; Neoplasms; Phosphorus Radioisotopes; Radioisotopes; Radiotherapy Dosage; Rhenium; Samarium; Strontium Radioisotopes; Thyroid Neoplasms

32P orthophosphate administered in a wide range of activity reduces or relieves the pain from osteoblastic metastases in approximately 80% of patients treated. The efficacy of this agent is equal to that of newer agents and of wide field radiotherapy, as documented in a literature review of 28 series reporting the use of 32P orthophosphate over a 50-year period. There is no dose-response relationship between the activity of 32P given and the percentage of patients experiencing pain reduction who received that activity. Only one death has been attributed to this radiopharmaceutical.

Topics: Adrenalectomy; Bone Neoplasms; Humans; Palliative Care; Phosphates; Phosphorus Radioisotopes; Radiometry

Several radiopharmaceuticals with a propensity to concentrate in painful metastatic bone cancer lesions are under development as a systemic radiation alternative to 32P. All are reactor produced and, when injected, have in all but 117mSn-DTPA decreased or eliminated the pain in more than three quarters of the patients, and all have caused transient myelotoxicity. Three of the four are under clinical evaluation and the generated data will be used for new drug applications for routine human use.

Topics: Animals; Bone Neoplasms; Clinical Trials as Topic; Humans; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Rhenium; Samarium; Strontium Radioisotopes; Tin Radioisotopes

Topics: Bone Neoplasms; Energy Metabolism; Humans; Magnetic Resonance Spectroscopy; Osteosarcoma; Phosphorus Radioisotopes; Sensitivity and Specificity

The radiation oncologist is an important member of the multidisciplinary team involved in the management of patients with metastatic bone disease. Radiation therapy provides local tumor control of the metastatic deposit and effective pain relief in the majority of patients. If there is a risk of fracture, prophylactic fixation is done before radiation therapy.

Topics: Analgesia; Bone Neoplasms; Humans; Palliative Care; Phosphorus Radioisotopes; Radiotherapy Dosage; Strontium Radioisotopes

Phosphorus-32, employed as the orthophosphate or polyphosphate, can reduce or relieve the pain of osteoblastic metastases without serious hematologic toxicity, especially if used as a single injection. Uptake of this beta-emitter by osteoblastic-reactive bone and possibly by tumor and other cells can lead to pain reduction and often to cell killing. Efficacy has been demonstrated for the treatment of pain in 84% of 322 breast cancer patients and 77% of 444 prostate cancer patients found in a review of the literature. These results match those of the newer radiopharmaceuticals currently under investigation.

Topics: Bone Neoplasms; Humans; Pain; Phosphorus Radioisotopes

Radiation is an effective modality for palliation of osseous metastases. In patients with a limited number of lesions, local external beam irradiation is the most expedient method of delivering radiation therapy. Complete or partial relief of pain will occur in 80-90% of patients. When metastases are widespread or when new sites continue to appear, localized external irradiation becomes logistically difficult. In such cases, hemibody irradiation has been effective with an overall response rate of 85%. However, nausea, vomiting, diarrhea, and bone marrow and pulmonary toxicity may complicate therapy. In these cases, an effective alternative is systemic phosphorus-32 (32P) or strontium-89 (89Sr). Relief of pain in the range of 60-90% has been reported. Toxicity of 32P is largely that of bone marrow suppression, while 89Sr appears to be relatively marrow-sparing. In this review, we consider systemic 32P or 89Sr as viable options to external beam or hemibody irradiation in the presence of numerous bone metastases.

Topics: Bone Neoplasms; Humans; Palliative Care; Phosphorus Radioisotopes; Radiotherapy; Radiotherapy Dosage; Strontium Radioisotopes; Whole-Body Irradiation

Topics: Bone Neoplasms; Contrast Media; Germany; Humans; Iodine Radioisotopes; Leukemia, Radiation-Induced; Liver Neoplasms; Lung Neoplasms; Mining; Neoplasms, Radiation-Induced; Pacific Islands; Paranasal Sinus Neoplasms; Phosphorus Radioisotopes; Polycythemia Vera; Radioactive Fallout; Radiotherapy; Radium; Radon; Spondylitis, Ankylosing; Thorium; Thorium Dioxide; Thyroid Neoplasms; United States; Uranium

In normal adults, the maintenance of phosphate balance involves the reabsorption of 85-90% of filtered phosphate by the proximal tubule. At a glomerular filtration rate (GFR) of 125 ml min-1 and a plasma phosphate concentration of 1.3 mmol l-1, the filtered phosphate is approximately 235 mmol day-1. Following intravenous administration, 25-50% of 32P is excreted over 4-6 days in normal subjects. In spite of such extensive renal handling of phosphate and, therefore, of 32P, there are no data in the literature concerning possible 32P-related nephrotoxicity. Adult dosimetry values for the kidney after 32P are reported as 4.8 rad mCi-1 h-1 (0.048 mSev 37 MBq-1 h-1). The entry criteria for 32P therapy insist on a normal serum creatinine value, reflecting awareness of potential renal damage. To answer the fundamental question of whether there is demonstrable renal damage after 32P, we undertook serial measurements of GFR in patients given 32P for treatment of pain from skeletal metastases. Twenty-one patients who had normal pre-treatment renal function as shown by normal serum creatinine values were administered 32P orally in doses ranging from 277.5 to 466.2 MBq, with a mean of 425.5 MBq. Pre-treatment, GFR was estimated with 99Tcm-diethylenetriamine pentaacetate renography using the Gates protocol. Post-treatment, GFR was estimated serially as far as possible, at weeks, 1, 2, 3 and 4 and then every 4 weeks for another 3 months, at which point follow-up ceased. Serum creatinine was assessed pre-treatment and every 2 weeks until the end of follow-up, in addition to all other parameters and a clinical evaluation. Mean pre-treatment GFR was 87.5 ml min-1, with a range of 48.7-110 ml min-1. Not all patients could fulfil the entire follow-up schedule as designed, but we obtained a minimum of four follow-up tests, two before and two after 4 weeks post-treatment. GFR fell to 72% of the pre-therapy value during the first 4 weeks following therapy. By the sixteenth week, however, the mean value had returned to or exceeded the pre-treatment value. There was no change in serum creatinine values. At a time when multiple therapies are being considered, this early depression of GFR may be of importance. A closer assessment of altered renal function may be warranted and other sensitive tests of renal damage like microalbuminuria could be used.

Topics: Adult; Bone Neoplasms; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Diseases; Pain; Palliative Care; Phosphorus Radioisotopes; Time Factors

Radiation therapy plays a major role in the management of patients with either locally recurrent or metastatic carcinoma of the prostate.. In 23 patients with isolated postprostatectomy local recurrences treated with doses of 60-65 Gy, 17 (74%) had tumor control, and 45% survived relapse-free for 5 years after treatment of the recurrence. Pelvic irradiation has been used to treat patients with elevated prostate-specific antigen (PSA) levels after radical prostatectomy. This was tried, and 17 of 24 patients (70%) showed a significant decrease in PSA levels after irradiation, in five without subsequent elevation. Two of the seven patients with elevated PSA levels later had distant metastases. Local irradiation has been reported to yield excellent relief of symptoms in 100% of patients with hematuria, 80% with urinary outflow obstruction, and 50-70% with ureteral obstruction or pelvic pain secondary to locally advanced prostatic carcinoma. Reirradiation, particularly with brachytherapy (in preliminary studies combined with hyperthermia) has been used in the management of postirradiation prostatic recurrences with satisfactory tumor regression in approximately 75% of patients. The Radiation Therapy Oncology Group (RTOG) reported on the palliative effects of external irradiation on patients with bony metastasis. Approximately 54% of such patients had complete relief, and 29% had partial relief of bone pain. However, the retreatment rate of the bony metastasis was lower in the patients receiving higher doses. In a RTOG protocol in which all patients received local irradiation for osseous metastases, 77 were randomized to receive elective hemibody irradiation and 69, local treatment only. The frequency of additional treatment at 1 year was lower in the hemibody irradiation group (54% versus 78%). Occasionally, brain, mediastinal, or liver metastasis can be treated with irradiation. Radioactive phosphorus-32 or strontium-89 has been administered for disseminated bony metastasis with improvement of bone pain in approximately 70-80% of treated patients.. The role of irradiation in the treatment of spinal cord compression is discussed. Significant improvement of neurologic function has been reported in 36-60% of the patients, depending on severity of deficit and promptness in instituting emergency treatment.

Topics: Bone Neoplasms; Brachytherapy; Brain Neoplasms; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Phosphorus Radioisotopes; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radioisotopes; Radiotherapy Dosage; Rhenium; Spinal Cord Compression; Strontium Radioisotopes

The aim of this work is to evaluate the application of tissue-specific dose kernels instead of water dose kernels to improve the accuracy of patient-specific dosimetry by taking tissue heterogeneities into consideration.. Tissue-specific dose point kernels (DPKs) and dose voxel kernels (DVKs) for yttrium-90 (. The simulation results indicate that the highest differences between water and other tissue DPKs occur in bone for. A novel technique is proposed considering tissue-specific dose kernels in the dose calculation algorithm. This algorithm potentially enables patient-specific dosimetry and improves estimation of the average absorbed dose of

Topics: Algorithms; Bone Neoplasms; Computer Simulation; Humans; Liver Neoplasms; Lung Neoplasms; Lutetium; Monte Carlo Method; Organ Specificity; Phosphorus Radioisotopes; Radioisotopes; Radiometry; Radionuclide Imaging; Radiotherapy Planning, Computer-Assisted; Water; Yttrium Radioisotopes

Topics: Bone Neoplasms; Clinical Trials as Topic; Humans; Medical Oncology; Neoplasm Metastasis; Nuclear Medicine; Phosphorus Radioisotopes; Polycythemia Vera; Radiopharmaceuticals; United Kingdom

We report our experience in the use of radionuclides in the treatment of bone metastases in patients with various primary cancers: breast cancer, prostate cancer, lung cancer, etc.. Eighty-seven patients (53 women, 34 men) with bone metastases were treated for pain relief with either 32-P (71 patients) or 89-Sr (16 patients). Fifty-three of the patients had breast cancer, 27--rostate cancer, 6--lung cancer and 1--kidney cancer. The patients were examined for side effects when 32-P was administered perorally and 89-Sr injected intravenously. We also studied the changes in the levels of hemoglobin, white blood cells (WBCs) count and platelets count.. We found a significant decrease in the WBC and platelet count in the patients treated with 32-P (U = 2.20, P < 0.05 and U = 4.57, P < 0.001) one month after the therapy. These parameters showed no significant decrease in the group treated with 89-Sr. The pain, which was the rationale to use the radioactive isotopes, was relieved and the patients restored their previous mobility.. The fact that 32-P alleviated the grave symptom of pain at the relatively weak radiation dose used (2 mCi) is a strong indication that this radiopharmaceutical can be used successfully for such a purpose, although some authors argue against its use in view of the myelosuppresion it causes. This myelosuppression, however, is mild and transient even without treatment and patients could benefit from this adjuvant treatment to manage the pain syndrome. 89-Sr administered intravenously in a dose of 4mCi also relieves pain efficiently but its use is limited by the cost of the quantity needed for 1 patient and for a single dose. The National Health Insurance Fund currently reimburses for a very limited quantity of this substance which makes the cost of the procedure 15 times as expensive as that using radioactive phosphorus.. Using the radiopharmaceuticals 32-P and 89-Sr provides an additional, easy and efficacious means for palliation of cancer patients with bone metastases, especially those who are refractory to percutaneous irradiation.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Leukocyte Count; Lung Neoplasms; Male; Pain; Pain Measurement; Phosphorus Radioisotopes; Platelet Count; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome

The goals of this investigation are to determine whether commercially available dose calibrators can be used to measure the activity of beta-emitting radionuclides used in pain palliation and to establish whether manufacturer-supplied calibration factors are appropriate for this purpose.. Six types of commercially available dose calibrators were studied. Dose calibrator response was controlled for 5 gamma-emitters used for calibration or typically encountered in routine use. For the 4 most commonly used beta-emitters ((32)P, (90)Sr, (90)Y, and (169)Er) dose calibrator efficiency was determined in the syringe geometry used for clinical applications. Efficiency of the calibrators was also measured for (153)Sm and (186)Re, 2 beta-emitters with significant gamma-contributions. Source activities were traceable to national standards.. All calibrators measured gamma-emitters with a precision of +/-10%, in compliance with Swiss regulatory requirements. For beta-emitters, dose calibrator intrinsic efficiency depends strongly on the maximal energy of the beta-spectrum and is notably low for (169)Er. Manufacturer-supplied calibration factors give accurate results for beta-emitters with maximal beta-energy in the middle-energy range (1 MeV) but are not appropriate for use with low-energy ((169)Er) or high-energy ((90)Y) beta-emitters. beta-emitters with significant gamma-contributions behave like gamma-emitters.. Commercially available dose calibrators have an intrinsic efficiency that is sufficient for the measurement of beta-emitters, including beta-emitters with a low maximum beta-energy. Manufacturer-supplied calibration factors are reliable for gamma-emitters and beta-emitters in the middle-energy range. For low- and high-energy beta-emitters, the use of manufacturer-supplied calibration factors introduces significant measurement inaccuracy.

Topics: Beta Particles; Bone Neoplasms; Erbium; Humans; Palliative Care; Phosphorus Radioisotopes; Radiation Monitoring; Radioisotopes; Radiometry; Radiotherapy; Strontium Radioisotopes; Yttrium Radioisotopes

Bone pain is a common complication for terminal patients with bone metastases from prostate, lung, breast, and other malignancies. A multidisciplinary approach in treating bone pain is generally required, 1 which includes a combination of analgesic drug therapy, radiation therapy, hormonal therapy, and chemotherapy. Over the years, treatment of bone pain using bone-seeking radiopharmaceuticals has been explored extensively. Pharmaceuticals labeled with energetic 1-particle emitters such as 32p, 89Sr, 153Sm, and 186Re, in addition to the low-energy electron emitter 117mSn, have been studied for this purpose. Bone-marrow toxicity as a consequence of chronic irradiation by the energetic , particles is a general problem associated with this form of treatment. It is therefore desirable to identify radiochemicals that minimize the dose to the bone marrow and at the same time deliver therapeutic doses to the bone.. New S values (mean absorbed dose per unit cumulated activity) for target regions of human bone and marrow were used to ascertain the capacity of various radiochemicals to deliver a high bone dose while minimizing the marrow dose. The relative dosimetric advantage of a given radiopharmaceutical compared with a reference radiochemical was quantitated as a dosimetric relative advantage factor (RAF). Several radionuclides that emit energetic 1 particles (32p, 89Sr, 153Sm, 186Re, and 177Lu) and radionuclides that emit low-energy electrons or beta particles (169Er, 117mSn, and 33p) were evaluated. For these calculations, ratios of the cumulated activity in the bone relative to cumulated activity in the marrow alpha equal to 10 and 100 were used.. When the radiopharmaceutical was assumed to be uniformly distributed in the endosteum and alpha was taken as 100 for both the reference and test radiochemicals, the RAF values compared with the reference radionuclide 32p were 1.0, 1.2, 1.4, 1.6, 1.7, 1.9, and 2.0 for 89Sr, 186Re, 153Sm, 177Lu, 169Er, 117mSn, and 33P, respectively. In contrast, when the radiopharmaceutical is assumed to be uniformly distributed in the bone volume, the RAF values for these 7 radionuclides were 1.1, 1.5, 2.4, 3.2, 4.5, 5.1, and 6.5, respectively.. These results suggest that low-energy electron emitters such as 117mSn and 33P are more likely to deliver a therapeutic dose to the bone while sparing the bone marrow than are energetic beta emitters such as 32p and 89Sr. Therefore, radiochemicals tagged with low-energy electron or beta emitters are the radiopharmaceuticals of choice for treatment of painful metastatic disease in bone.

Topics: Bone Marrow; Bone Neoplasms; Humans; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Radiopharmaceuticals; Radiotherapy Dosage; Tin

Topics: Analgesics, Non-Narcotic; Animals; Bone Neoplasms; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Samarium; Strontium; Strontium Radioisotopes

Several bone-seeking radiopharmaceuticals, such as 32P-orthophosphate, 89Sr-chloride, 186Re-1,1 hydroxyethylidene diphosphonate (HEDP), and 153Sm-ethylene diamine tetramethylene phosphonic acid (EDTMP), have been used to treat bone pain. The major limiting factor with this modality is bone marrow toxicity, which arises from the penetrating nature of the high-energy beta particles emitted by the radionuclides. It has been hypothesized that marrow toxicity can be reduced while maintaining therapeutic efficacy by using radionuclides that emit short-range beta particles or conversion electrons. In view of the significant clinical experience with 32P-orthophosphate, and the similarity in pain relief afforded by 32P-orthophosphate and 89Sr-chloride, this hypothesis is examined in this study using 32P- and 33P-orthophosphate in a mouse femur model.. Survival of granulocyte macrophage colony-forming cells (GM-CFCs) in femoral marrow was used as a biologic dosimeter for bone marrow. 32P- and 33P-orthophosphate were administered intravenously, and GM-CFC survival was determined as a function of time after injection and, at the nadir, as a function of injected activity. The kinetics of radioactivity in the marrow, muscle, and femoral bone were also determined. The biologic dosimeter was calibrated by assessing GM-CFC survival at its nadir after chronic irradiation of Swiss Webster mice with exponentially decreasing dose rates of gamma rays (relative biologic effectiveness equivalent to that of beta particles) from a low-dose rate 137Cs irradiator. Dose-rate decrease half-times (Td) (time required for 137Cs gamma ray dose rate to decrease by one half) of 62, 255, and 425 h and infinity were used to simulate the dose rate patterns delivered by the radiopharmaceuticals as dictated by their effective clearance half-times from the mouse femurs. These data were used to experimentally determine the mean absorbed dose to the femoral marrow per unit injected activity. Finally, a theoretical dosimetry model of the mouse femur was developed, and the absorbed doses to the femoral marrow, bone, and endosteum were calculated using the EGS4 Monte Carlo code.. When the animals were irradiated with exponentially decreasing dose rates of 137Cs gamma rays, initial dose rates required to achieve 37% survival were 1.9, 0.98, 0.88, and 0.79 cGy/h for dose rate decrease half-times of 62, 255, and 425 h and infinity, respectively. The D37 values were 144 +/- 15, 132 +/- 12, 129 +/- 3, and 133 +/- 10 cGy, respectively, compared with a value of 103 cGy for acute irradiation. When 32P and 33P were administered, the injected activities required to achieve 37% survival were 313 and 2,820 kBq, respectively. Theoretical dosimetry calculations show that 33P offers a 3- to 6-fold therapeutic advantage over 32P, depending on the source and target regions assumed.. The low-energy beta-particle emitter 33P appears to offer a substantial dosimetric advantage over energetic beta-particle emitters (e.g., 32p, 89Sr, 186Re) for irradiating bone and minimizing marrow toxicity. This suggests that low-energy beta or conversion electron emitters may offer a substantial advantage for alleviation of bone pain as well as for specifically irradiating metastatic disease in bone.

Topics: Animals; Bone Marrow; Bone Neoplasms; Cell Survival; Female; Femur; Granulocyte-Macrophage Colony-Stimulating Factor; Mice; Pain; Phosphorus Radioisotopes; Radiation Dosage

32p and 89Sr have been shown to produce significant pain relief in patients with skeletal metastases from advanced cancer. Clinically significant pancytopenia has not been reported in doses up to 12 mCi (444 MBq) of either radionuclide. To date, no reports comparing the relative efficacy and toxicity of the two radionuclides in comparable patient populations have been available. Although a cure has not been reported, both treatments have achieved substantial pain relief. However, several studies have used semiquantitative measures such as "slight," "fair," "partial" and "dramatic" responses, which lend themselves to subjective bias. This report examines the responses to treatment with 32P or 89Sr by attempting a quantification of pain relief and quality of life using the patients as their own controls and compares toxicity in terms of hematological parameters.. Thirty-one patients with skeletal metastases were treated for pain relief with either 32P (16 patients) or 89Sr (15 patients). Inclusion criteria were pain from bone scan-positive sites above a subjective score of 5 of 10 despite analgesic therapy with narcotic or non-narcotic medication, limitation of movement related to the performance of routine daily activity and a predicted life expectancy of at least 4 mo. The patients had not had chemotherapy or radiotherapy during the previous 6 wk and had normal serum creatinine, white cell and platelet counts. 32P was given orally as a 12 mCi dose, and 89Sr was given intravenously as a 4 mCi (148 MBq) dose. The patients were monitored for 4 mo.. Complete absence of pain was seen in 7 of 16 patients who were given 32P and in 7 of 15 patients who were given 89Sr. Pain scores fell by at least 50% of the pretreatment score in 14 of 16 patients who were given 32P and 14 of 15 patients who were given 89Sr. Mean duration of pain relief was 9.6 wk with 32P and 10 wk with 89Sr. Analgesic scores fell along with the drop in pain scores. A fall in total white cell, absolute granulocyte and platelet counts occurred in all patients. Subnormal values of white cells and platelets were seen in 5 and 7 patients, respectively, with 32P, and in 0 and 4 patients, respectively, after 89Sr therapy. The decrease in platelet count (but not absolute granulocyte count) was statistically significant when 32P patients were compared with 89Sr patients. However, in no instance did the fall in blood counts require treatment. Absolute granulocyte counts did not fall below 1000 in any patient. There was no significant difference between the two treatments in terms of either efficacy or toxicity.. No justification has been found in this study for the recommendation of 89Sr over the considerably less expensive oral 32P for the palliation of skeletal pain from metastases of advanced cancer.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Analgesia; Blood Cell Count; Bone Neoplasms; Humans; Infusions, Intravenous; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Palliative Care; Phosphorus Radioisotopes; Quality of Life; Strontium Radioisotopes

The role of phosphorus-32 (32P) was evaluated in patients experiencing pain due to skeletal metastases from prostate cancer and refractory to other modes of treatment. Twenty patients received 185 MBq (5 mCi)32P intravenously; 12 patients received a single dose each, five patients were injected twice and three patients three times at 3-month intervals. A blood count and clinical assessment for bone pain, tender sites, mobility and analgesic intake were performed before and 4, 8 and 12 weeks after the administration of 32P. A bone scan was performed before and 12 weeks after therapy. The results showed a significant decrease in pain at 4 weeks and a palliative response persisted for up to 12 weeks. Analgesic medication intake decreased significantly (F = 13.2213, P < 0.0001) and mobility improved after therapy. Quantitative analysis of the bone scans showed a statistically significant reduction in osteoblastic activity in metastatic lesions after therapy (t = -3.80, P < 0.001). Transient myelosuppression after 4 weeks, which was statistically significant for WBC and platelet counts only (F = 3.0226, P = 0.0358; F = 6.2514, P = 0.0009 respectively), returned within normal limits by 8 weeks. We conclude that 32P is an effective and safe therapy for pain palliation.

Topics: Aged; Bone Marrow; Bone Neoplasms; Humans; Male; Middle Aged; Pain; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Safety

The results of radiphosphotherapy in 20 patients with iodine-negative metastases of thyroid cancer in the lung and bones have been analyzed. The treatment was carried out in two stages: radical surgery and 32P therapy of metastases. A dose of 100-185 MBq of the radionuclide was administrated weekly (total dose-300-700 MBq). As a result, improvement in treating stage IV thyroid tumor was registered.

Topics: Adult; Aged; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Phosphorus Radioisotopes; Radiotherapy Dosage; Thyroid Neoplasms; Treatment Outcome

In search of a predictable experimental model for the study of therapeutic modalities for osteosarcoma, a group of rats had injections of phosphorus-32 (P-32) colloid subperiostally and were followed for the occurrence of malignant bone tumors until death or for 18 months. Of 50 rats, 26 died of unrelated causes and only 24 were included in the study. Two cases of osteosarcomas, one occurring in month 16 and the other at month 18 were induced; one case demonstrated multiple lung metastases. Clear evidence of the sarcoma inducing effect of P-32 has been obtained in this study. However, a high yield experimental osteosarcoma model was not produced.

Topics: Animals; Bone Neoplasms; Male; Neoplasms, Radiation-Induced; Osteosarcoma; Phosphorus Radioisotopes; Rats; Rats, Wistar; Time Factors

Although multiple bony metastases from carcinoma of the prostate are common, widespread pain is a much less frequent complication but one which nevertheless presents considerable difficulties in management. Pain may be severe requiring large doses of narcotic analgesics and may render the patient virtually immobile. A total of 53 treatments with radioactive phosphorus-32 were assessed in 46 patients; in addition, five patients died before response was assessable. A worthwhile response in terms of pain reduction and improved mobility was obtained in 87%. Response was subdivided into good and moderate, with response rates of 53% and 34% respectively. The mean age of patients at treatment was 64.6 years, the median 65 years, and 30% of treated patients were 60 years or under. Median survival in the good, moderate and no response groups was 8, 6.5 and 4.5 months respectively. These differences in survival are not statistically significant. Five-year survival was 4.3%. The treatment is not intended to improve survival but with 87% of patients achieving pain relief, 32P should be considered for the treatment of severe bony pain when other options are limited by the widespread nature of the disease.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Pain Management; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Animals; Bone Neoplasms; Dogs; Lung Neoplasms; Microspheres; Organophosphorus Compounds; Phosphorus Radioisotopes; Radioisotopes; Samarium

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms

We report a retrospective study of 15 patients with prostate carcinoma and diffuse bone metastases treated with sodium 32P for palliation of pain at Downstate Medical Center and Kings County Hospital from 1973 to 1978. The response rates, duration of response, and toxicities are compared with those of other series of patients treated with 32P and with sequential hemibody irradiation. The response rates and duration of response are similar with both modalities ranging from 58 to 95% with a duration of 3.3 to 6 months with 32P and from 75 to 86% with a median duration of 5.5 months with hemibody irradiation. There are significant differences in the patterns of response and in the toxicities of the two treatment methods. Both methods cause significant bone marrow depression. Acute radiation syndrome, radiation pneumonitis, and alopecia are seen with sequential hemibody irradiation and not with 32P, but their incidence can be reduced by careful treatment planning. Hemibody irradiation can provide pain relief within 24 to 48 h, while 32P may produce an initial exacerbation of pain. Lower hemibody irradiation alone is less toxic than either upper hemibody irradiation or 32P treatment.

Topics: Bone Neoplasms; Humans; Male; Pain; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Radiotherapy; Retrospective Studies; Whole-Body Irradiation

1 An attempt was made to produce a model of osteogenic sarcoma using 32P transplacentally. 2 Fetal tissues appeared to be resistant to irradiation as no tumour was induced at an increased frequency in treated animals. 3 Tumours that normally occur in our strain (Sprague-Dawley rats) showed a clear tendancy to occur earlier in post-natal life in treated animals compared with controls.

Topics: Animals; Bone Neoplasms; Dose-Response Relationship, Radiation; Female; Fertility; Fetus; Male; Neoplasms, Radiation-Induced; Osteosarcoma; Phosphorus Radioisotopes; Pregnancy; Rats; Rats, Inbred Strains; Sarcoma, Experimental

In the urological department of the Wilhelminenspital altogether 22 patients with incurable bone pains in metastasizing carcinoma were treated with radioisotopes between 1976 and 1980. 32P and 89Sr were used in a dosage of 3 times 3 mCi and once 1 mCi. A reaction to the therapy could be proved in 46%, in 23% the success could be estimated as very good. Clinic and therapy were discussed with the help of own cases and literature.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Carcinoma; Female; Humans; Kidney Neoplasms; Male; Neoplasm Staging; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Strontium Radioisotopes

Osseous deposits secondary to advanced carcinoma of the prostate are a common feature of the disease. These deposits are most often seen in the lumbar spine and pelvis and cause severe and intractable pain, often requiring large quantities of strong analgesia for alleviation of pain. Relief of pain can be achieved by external irradiation of these deposits, but this relief may not be permanent and the disease may be so widespread that it is impracticable to treat all the deposits by irradiation. Deposits from carcinoma of the prostrate are usually multiple and all may cause pain at the same time. A method of delivering the radiation to all the deposits at the same time has been sought. Previous studies have shown that radioactive phosphorus (P32) can be used to obtain this localisation of radioactivity at sites of osseous activity. In this study 24 patients with bone metastases from carcinoma of the prostate were treated with radiophosphorus and methyl testosterone, or radiophosphorus with parathormone and calcium. An overall response rate of 58% shows this to be an effective palliative treatment. The results suggest there is a greater response when P32 is used in conjunction with parathormone and calcium, than with methyl testosterone.

Topics: Bone Neoplasms; Calcium; Humans; Male; Methyltestosterone; Phosphorus Radioisotopes; Prostatic Neoplasms

Radioactive phosphorus effected substantial palliation of intractable bone pain in 17 of 33 (51.5%) women with metastatic carcinoma of the breast and in 14 of 15 (93.3%) men with metastatic carcinoma of the prostate. No significant difference in the overall response rate was found between androgen and parathormone priming prior to radiophosphorus therapy. The degree of response was not dependent on total dose of 32P within the range of 9--18 mCi (333--666 MBq). Myelosuppression was a transient complication in 9 of 33 patients with metastatic breast carcinoma and in 7 of 15 patients with metastatic prostate carcinoma. Symptomatic hypercalcemia was an infrequent complication of radiophosphorus therapy irrespective of the priming regimen.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluoxymesterone; Humans; Male; Middle Aged; Palliative Care; Parathyroid Hormone; Phosphorus Radioisotopes; Prostatic Neoplasms

The administration of radioactive phosphorus (P-32) for the treatment of pain in metastatic bone lesions from breast cancer shows palliative effects lasting three to nine months. The evolution of the disease is not modified.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Pain; Palliative Care; Phosphorus Radioisotopes; Testosterone; Time Factors

Eight patients with persistent pain due to disseminated bone metastases from mammary carcinoma were given about 370 MBq (10 mCi) of 32P-pyrophosphate on 10 occasions. All but one of the patients experienced alleviation of pain lasting 1 to 4 months. The side effects, which derived mainly from haematopoetic tissue, prevent the routine use of this compound.

Topics: Blood Cell Count; Bone Neoplasms; Breast Neoplasms; Diphosphates; Female; Humans; Male; Palliative Care; Phosphorus Radioisotopes

The physiological effects of parathyroid hormone (PTH) in bone are mediated at least in part by cyclic AMP. The biochemical events subsequent to this step have not been well characterized in this tissue. Giant cell tumors of bone (GT) increase cyclic AMP in response to PTH. This response can be inhibited by an analogue of bovine PTH, [Nle8, Nle18, Tyr34] bPTH-(3-34) amide (PTH-Inh). Cyclic AMP content and cyclic AMP-dependent protein kinase (cAMP-PK) were assayed in fresh tumors and cells in culture incubated with 1 microgram/ml of bPTH and/or PTH-Inh. PTH fully activated cAMP-PK in GT, and PTH-Inh completely inhibited PTH-stimulated increases in cyclic AMP content and cAMP-PK activity. When endogenous protein substrates were sought for cAMP-PK, three phosphoproteins of 55,000, 43,000, and 38,000 mol wt maximally increased their phosphorylation by 30% after 12-min incubation with bPTH. Dephosphorylation of proteins of 200,000 and 120,000 mol wt was also observed. These data are consistent with the hypothesis that PTH action in bone is mediated by the phosphorylation and dephosphorylation of specific substrates.

Topics: Bone Neoplasms; Cells, Cultured; Cyclic AMP; Giant Cell Tumors; Humans; Parathyroid Hormone; Phosphorus Radioisotopes; Protein Kinases; Proteins

Topics: Bone Neoplasms; Humans; Iodine Radioisotopes; Lung Neoplasms; Phosphorus Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Thyroid Neoplasms

The short range tissue destruction of beta-emitting radioisotopes can be utilized in painful metastatic disease of the skeleton by employing a radionuclide that is specifically metabolized in or adjacent to these lesions. Sodium phosphate P 32 has been used for this purpose for the past 25 yr. It uptake in skeletal tumor and in osteoblastic new bone adjacent to tumor can be markedly increased by pharmacologic stimulation using androgenic steroids, or during rebound deposition after a course of parathyroid hormone. Although efficacy in terms of subjective pain relief is high, more objective signs of success are often lacking, and survival, while more confortable, is not prolonged. Marrow depression is the most significant side effect. A beta-emitting, bone-seeking isotope, 89Sr, may have a better therapeutic/toxic ratio, and should receive further trial. Radiation-induced necrosis has also been applied, though more hesitantly, to the proliferative, destructive, but nonmalignant synovium in rheumatoid disease. Here, a number of colloidal preparations, most commonly 198Au, have been employed. Again, relief of symptoms, particularly recurrent joint effusions, is quite high, although the basic disease process is not reversed. The major hazard here appears to be leakage of material to regional lymph nodes, resulting in irradiation of circulating lymphocytes. Although chromosomal damage can be detected when such cells are then cultured, the actual consequences of this, if any, are not presently known. Both shorter-lived (165Dy) and longer-lived (32P) larger-size colloids are being evaluated, which may prove safer in this regard than 198Au.

Topics: Bone Marrow; Bone Neoplasms; Gold Radioisotopes; Humans; Joint Diseases; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Radiation Dosage; Radioisotopes; Strontium Radioisotopes; Synovial Membrane

Topics: Animals; Bone and Bones; Bone Diseases; Bone Neoplasms; Fluorine; Gallium Radioisotopes; History, 20th Century; Humans; Nuclear Medicine; Phosphorus Radioisotopes; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Thirty-four patients with cancer of the breast and 12 with cancer of the prostate were treated with testosterone and 32P-sodium phosphate for relief of pain from bony metastases. Thirty received chemotherapy as well, and 34 received external radiation to single ports for localized pain. Of the 46 patients, 34 had good results, 6 fair, and 6 were failures. Ten patients needed transfusion for marrow depression; no other side effect was observed.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Pain Management; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Bone Neoplasms; Gold Colloid, Radioactive; Humans; Hyperthyroidism; Injections, Intra-Articular; Iodine Radioisotopes; Myeloproliferative Disorders; Neoplasm Metastasis; Phosphorus Radioisotopes; Radioisotopes; Radiotherapy; Thyroid Neoplasms

In an initial safety study, phosphorus-32 (as diphosphonate) was administered intravenously to five patients with painful bone metastases from prostatic carcinoma; two patients received 9 mCi and three were given 3 mCi. Hematological, biochemical, ECG, x-ray, bone-scan data, and clinical observation, were followed for 2 mo. At both dose levels, bone-marrow depression was noted. One of the patients, who received 9 mCi, had only a slight dip in the levels of circulating white blood cells and platelets. The other 9-mCi patient was the only one with discrete metastases by bone scan; he had bone-marrow depression, from which he recovered, and was the only one of the five who had relief of bone pain.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Etidronic Acid; Humans; Male; Middle Aged; Neoplasm Metastasis; Phosphorus Radioisotopes; Prostatic Neoplasms; Radiotherapy Dosage

Thirty-three patients with intractable pain caused by diffuse osteoblastic metastases from carcinoma of the prostate were treated with phosphorus-32 (32P) therapy either androgen priming, parathormone rebound, or a combination of both priming methods. Significant response to pain was achieved in 12 of 19 patients receiving testosterone-potentiated therapy, 0 of 5 patients treated with parathormone alone, and 6 of 9 patients receiving a combination of both priming modalities. It is concluded that androgen priming alone is the simplest and most effective method to be used when 32P therapy is being considered for palliative control of pain in patients with carcinoma of prostate.

Topics: Aged; Bone Neoplasms; Drug Therapy, Combination; Humans; Male; Middle Aged; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Parathyroid Hormone; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Animals; Bone Neoplasms; Cats; Neoplasm Metastasis; Osteosarcoma; Phosphorus Radioisotopes; Rats; Technetium

22 patients suffering from breast neoplasia with particularly painful bone metastasis were treated with radiophosphorus. Only occasionally was an evident recalcification condition encountered and survival, although exceptional in some cases, did not deviate from normal. On the basis, also, of clinical and experimental observations reported in the literature, it is held that the use of 32P in metabolic radiotherapy of bone metastases is worthwhile and is justified because of the encouraging successes obtained, especially in pain remission.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Humans; Middle Aged; Neoplasm Metastasis; Phosphorus Radioisotopes; Radiography; Radionuclide Imaging

Topics: Aged; Bone Neoplasms; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Adenocarcinoma; Bone Neoplasms; Hematocrit; Humans; Iodine Radioisotopes; Phosphorus Radioisotopes; Thyroid Neoplasms

Topics: Acid Phosphatase; Aged; Alkaline Phosphatase; Bone Neoplasms; Calcium; Drug Therapy, Combination; Humans; Male; Middle Aged; Neoplasm Metastasis; Palliative Care; Parathyroid Hormone; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Female; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Palliative Care; Phosphates; Phosphorus Radioisotopes; Technetium; Thyroid Neoplasms

Topics: Blood Platelets; Bone Neoplasms; Breast Neoplasms; Calcium; Female; Follow-Up Studies; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Parathyroid Hormone; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Bone Neoplasms; Drug Combinations; Drug Evaluation; Humans; Injections, Intravenous; Male; Neoplasm Metastasis; Pain; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Administration, Oral; Aged; Bone Neoplasms; Female; Hematopoiesis; Humans; Injections, Intravenous; Male; Middle Aged; Neoplasm Metastasis; Phosphorus Radioisotopes; Prostatic Neoplasms; Spinal Cord Compression; Spinal Neoplasms; Testosterone; Thrombocytopenia

Topics: Adolescent; Adult; Bone Neoplasms; Child; Electromagnetic Phenomena; Extremities; Humans; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Osteomyelitis; Osteosarcoma; Phosphorus Radioisotopes

Topics: Bone Neoplasms; Humans; Male; Neoplasm Metastasis; Parathyroid Hormone; Phosphorus Radioisotopes; Prostatic Neoplasms; Radiotherapy Dosage

Topics: Bone Neoplasms; Humans; Male; Neoplasm Metastasis; Parathyroid Hormone; Phosphorus Radioisotopes; Prostatic Neoplasms

Topics: Bone and Bones; Bone Neoplasms; Breast; Breast Neoplasms; Humans; Neoplasms; Phosphorus; Phosphorus Radioisotopes

Topics: Bone and Bones; Bone Neoplasms; Breast; Breast Neoplasms; Humans; Nandrolone; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Testosterone

Topics: Bone and Bones; Bone Neoplasms; Humans; Joints; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Sarcoma

Topics: Bone and Bones; Bone Neoplasms; Breast; Breast Neoplasms; Humans; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes

Topics: Bone and Bones; Bone Neoplasms; Hodgkin Disease; Humans; Leukemia; Multiple Myeloma; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Plasma Cells; Polycythemia Vera; Radioactivity

Topics: Bone and Bones; Bone Neoplasms; Dose Fractionation, Radiation; Humans; Incidence; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Radioactivity

Topics: Bone and Bones; Bone Neoplasms; Carcinoma; Humans; Male; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms

Topics: Bone and Bones; Bone Neoplasms; Breast; Breast Neoplasms; Humans; Male; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms; Testosterone

Topics: Adrenal Glands; Adrenalectomy; Bone Neoplasms; Breast; Breast Neoplasms; Humans; Phosphorus; Phosphorus Radioisotopes

Topics: Bone Marrow Diseases; Bone Neoplasms; Breast Neoplasms; Humans; Phosphorus; Phosphorus Radioisotopes

Topics: Animals; Bone Neoplasms; Mice; Neoplasms; Neoplasms, Experimental; Osteosarcoma; Phosphorus; Phosphorus Radioisotopes; Sarcoma

Topics: Bone Neoplasms; Breast Neoplasms; Humans; Phosphorus; Phosphorus Radioisotopes; Skin Neoplasms

Topics: Bone Neoplasms; Neoplasms; Osteosarcoma; Phosphorus; Phosphorus Radioisotopes; Propiophenones; Radioisotopes

Topics: Bone Neoplasms; Breast; Carcinoma; Humans; Neoplasms; Phosphorus; Phosphorus Radioisotopes