strontium-radioisotopes and Hematologic-Diseases

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

93 patients with hormone refractory metastatic prostate cancer were entered on a prospective study to measure reduction in pain and changes in quality of life (QoL) after the administration of 150 MegaBequerel (MBq) Strontium-89 (Sr-89). QoL was assessed using a validated instrument, the Functional Living Index - Cancer (FLIC) questionnaire. Pain response was measured using the Radiation Therapy Oncology Group scoring system. Overall there was limited QoL improvement over 3 months following Sr-89. However, in the 53 patients (63%) achieving pain responses, QoL did significantly improve within 6 weeks of receiving Sr-89 compared to patients with stable or worsening bone pain, and this was independent of other parameters that might influence QoL outcomes, such as performance status, baseline PSA and extent of skeletal disease (P = 0.004). PSA 'response' occurred in 30 patients (37%) over 4 months after Sr-89. This did not appear to correlate with clinical improvement. This study supports the presumption that improvement in pain following Sr-89 is accompanied by better QoL. The lack of correlation of PSA response and clinical parameters indicates that in the palliative setting, PSA may not provide a useful surrogate for treatment outcome.

Topics: Bone Neoplasms; Diarrhea; Follow-Up Studies; Hematologic Diseases; Humans; Male; Nausea; Neoplasm Metastasis; Pain; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Quality of Life; Spinal Cord Compression; Strontium; Strontium Radioisotopes; Surveys and Questionnaires; Treatment Outcome; Vomiting

Bone metastases are observed in 30-70% of patients with cancer. Painful bone metastases require regular control and treatment. Systemic palliative radiotherapy using beta-emitting radionuclides is an alternative method to analgesics and external beam radiotherapy. The aim of the study was to establish the efficacy and risk of side effects of radionuclide therapy in patients with bone metastases.. Strontium-89 (Sr-89) therapy was performed in 49 patients, 14 women and 35 men, aged 42-82 (mean 62) years with bone metastases confirmed by MDP-Tc99m whole body scan. The primary tumour was prostate cancer in 28 patients, breast cancer in 14, bladder cancer in 2, lung cancer in 2, gastric cancer in 2, and renal cancer in 1 patient. Intravenous injection of 150 MBq of Sr-89 was given and patients were observed for at least 3 months. Blood count, intensity of pain, drugs intake, life activity, and duration of effect were assigned 0-3 points. The overall response index was very good when the points totalled 10-12, good - 7-9, satisfactory - 4-6, poor - 2-3 and no response 0-1 points. Haemotoxicity was evaluated according to the Common Toxicity Criteria of the World Health Organisation (WHO).. We found a very good response in 10 (20%) patients, good in 20 (41%), satisfactory in 8 (16%), poor in 2 (4%), and no response in 9 (19%) patients. Transient haemotoxicity of the Sr-89 therapy was observed in 39 (80%) patients. The mean decrease in platelets and leukocytes was 33-35%, but the haemoglobin concentration was reduced by only 15% in comparison to baseline values. The majority of patients did not require any treatment for haematologic side effects. Hospitalization was necessary in only 2 patients with grade 4 CTC WHO.. Palliative radionuclide treatment of painful bone metastases with Strontium-89 in various primary tumours is in most cases an effective therapy with limited haemotoxicity.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Hematologic Diseases; Humans; Male; Middle Aged; Pain Measurement; Palliative Care; Strontium Radioisotopes

We present dosimetry for spinal metastases and red bone marrow in two patients who received 89Sr therapy for disseminated prostatic carcinoma. Absorbed dose to metastases was estimated by combining 85Sr gamma camera studies with computed tomographic measurements of bone mass, and doses of 20 cGy/MBq and 24 cGy/MBq were found for vertebral metastases that uniformly involved the bodies of L3 and D12 respectively. Absorbed dose to red bone marrow was estimated from total body strontium retention studies using the ICRP model for bone dosimetry, and a ratio of metastatic to marrow dose of around 10 was found in each patient. Although they received comparable treatment activities of around 200 MBq, the patients showed markedly different haematological response, this difference being confirmed when each received a second 89Sr treatment 6 months after the first. As a result, clinically significant thrombocytopenia occurred in one patient which prevented further radiostrontium therapy being given.

Topics: Adenocarcinoma; Aged; Bone Marrow Diseases; Brachytherapy; Energy Transfer; Follow-Up Studies; Hematologic Diseases; Humans; Male; Prostatic Neoplasms; Radiotherapy Dosage; Spinal Neoplasms; Strontium Radioisotopes; Tomography, X-Ray Computed; Whole-Body Counting

Topics: Acid Phosphatase; Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Bone Resorption; Breast Neoplasms; Female; Hematologic Diseases; Humans; Injections, Intravenous; Male; Middle Aged; Movement; Multiple Myeloma; Neoplasm Metastasis; Pain, Intractable; Radionuclide Imaging; Remission, Spontaneous; Strontium Radioisotopes; Urinary Bladder Neoplasms; Uterine Neoplasms