strontium-radioisotopes and Liver-Neoplasms

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

This report describes the case of a 57-year-old woman with liver and bone metastases from malignant insulinoma, who was afflicted with severe hypoglycemia. Treatment of the liver metastases using octreotide, diazoxide and transarterial embolization failed to raise her blood glucose level and she required constant glucose infusion (about 1000 kcal/day) and oral feeding (about 2200 kcal/day) to avoid a hypoglycemic attack. Subsequently, 110 MBq (2.0 MBq/kg) of strontium-89 were administered by intravenous injection. Three weeks after the strontium-89 injection, we could reduce the dose of constant glucose infusion while maintaining a euglycemic status. Six weeks after the injection, the constant glucose infusion was discontinued. Although strontium-89 therapy is indicated for patients with multiple painful bone metastases, it was also useful as a means of inhibiting tumor activity and controlling hypoglycemia in this case. To our knowledge, this is the first report to provide evidence that strontium-89 can be useful in controlling intractable hypoglycemia in patients with malignant insulinoma with bone metastases.

Topics: Blood Glucose; Bone Neoplasms; Female; Humans; Hypoglycemia; Injections, Intravenous; Insulinoma; Liver Neoplasms; Middle Aged; Pancreatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Tomography, X-Ray Computed

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Strontium Radioisotopes

Conflicting results have been obtained regarding blood flow distribution to liver tumors. The emphasis on portal vein perfusion has had a great impact on the design of treatment protocols.. Double microsphere technique with reference organ sampling was used for the measurement of hepatic artery and portal vein blood flow of an implanted liver tumor in 42 rats after permanent dearterialization and repeated dearterialization (2 hours/day) compared with untreated sham-operated controls.. Portal venous blood flow constituted 16% of total tumor blood flow and slightly increased after permanent and repeat dearterializations, though the elevation was not statistically significant as compared with sham-treatment (P > 0.05). In another 3 groups, the treatment was extended to 10 days, and tumor blood flow was measured in central and peripheral parts separately. Arterial blood flow further decreased in tumor periphery and was still lower in the tumor center (P < 0.01 versus tumor periphery), and portal blood flow declined concomitantly to 4% of total tumor blood perfusion. However, no difference in portal blood flow between the tumor center and periphery could be demonstrated (P > 0.05). Furthermore, portal supply increased neither in tumor periphery nor in tumor center after both permanent and repeated dearterialization (P > 0.05).. The authors' results showed that portal blood flow did contribute to tumor circulation, but made up only 16% of blood flow when tumors were small and declined to 4% of entire tumor blood supply when tumors became large. Portal perfusion also declined as tumors grew larger and did not compensate for the withdrawal of tumor arterial blood supply after dearterialization.

Topics: Animals; Cerium Radioisotopes; Hepatic Artery; Ligation; Liver Neoplasms; Male; Microspheres; Neoplasm Transplantation; Portal Vein; Rats; Rats, Inbred WF; Regional Blood Flow; Strontium Radioisotopes

In order to elucidate the role of Kupffer cells in granuloma formation in the liver of mice under a condition of severe monocytopenia induced by administration of strontium-89, granulomas were produced by particulate glucan injection and examined histopathologically, immunohistochemically, by [3H]thymidine autoradiography, and in culture experiments. Hepatic granulomas were smaller, less numerous, and more irregularly shaped in the monocytopenic mice than in the control mice. The granulomas were composed of multinuclear giant cells, epithelioid cells, Kupffer cells, and T lymphocytes, but not monocytes or granulocytes. Kupffer cells were heavily labeled with [3H]thymidine in the monocytopenic mice, particularly just before the stage of granuloma formation, and then clustered in the liver sinusoids. At 8 days, they formed granulomas, transformed into epithelioid cells, and transformed further into multinuclear giant cells. Although the culture of liver cell suspensions prepared from the livers of monocytopenic mice sustained diffuse proliferation of macrophages on a monolayer of mouse stromal cell line (ST2), no monocyte/macrophage colonies were formed. From these results, it is reasonable to conclude that Kupffer cells alone are activated in a condition without a supply of monocytes from peripheral blood; proliferate and cluster in the hepatic sinusoids; transform into peroxidase-negative macrophages, epithelioid cells, and multinuclear giant cells; and participate in granuloma formation in loco together with T lymphocytes.

Topics: Animals; Antibodies, Monoclonal; B-Lymphocytes; Blood Cell Count; Cell Division; DNA; Female; Glucans; Granuloma; Immunohistochemistry; Kupffer Cells; Liver Neoplasms; Macrophages; Mice; Mice, Inbred ICR; Microscopy, Electron; Monocytes; Strontium Radioisotopes; T-Lymphocytes

A nonparametric hazard-function (HP) method for generating monotonically increasing incidence vs dose curves after long-term exposure to a toxic agent (e.g. radiation or chemical carcinogens) is described in detail in this paper. Here, incidence refers to the response-probability estimate that is adjusted for competing risks. The maximum likelihood principle was used to arrive at an appropriate point estimate of the cumulative hazard function (i.e. the negative natural logarithm of the proportion of the nonresponders) and the response probability for an array of doses that depends on the data set to be analyzed. The resultant point estimates can be used to develop or select an appropriate model for risk vs dose assessment. As an example of the application of the HF method, data for liver neoplasms caused by long-term exposure of mice to 2-acetylaminofluorene and data for radiation pneumonitis and pulmonary fibrosis caused by long-term exposure of dogs to ionizing radiation are analyzed.

Topics: 2-Acetylaminofluorene; Animals; Dogs; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Female; Liver Neoplasms; Mice; Neoplasms, Experimental; Pneumonia; Pulmonary Fibrosis; Risk; Strontium Radioisotopes; Time Factors

The intravenous application of 89-strontium for the relief of pain in 43 patients with breast cancer, bronchogenic cancer, carcinoma of the prostate, hypernephroma and lymphoma with generalized bone metastases is reported. A remarkable clinical improvement was achieved in 33 (76.7%) patients. In four patients a transient analgesic effect was observed. In six cases no response could be achieved. The therapeutic effect usually was long-lasting. At the same time, an increase of alkaline phosphatase was observed, which was interpreted as an indication for the stimulation of osteoblasts and osteoid peripheral zones owing to beta-emission of the radioisotope in the affected areas. There was a significant correlation between the concentration of 85Sr in the bone scan and the therapeutic result of 89Sr-therapy. The indication for such therapy and possible late adverse effects of bone-seeking isotopes are discussed.

Topics: Bone and Bones; Bone Neoplasms; Half-Life; Humans; Liver Neoplasms; Neoplasm Metastasis; Pain, Intractable; Radionuclide Imaging; Strontium Radioisotopes

In a series of related experiments to evaluate the relative toxicity of inhaled radionuclides, beagles were exposed to aerosols containing relatively soluble (chloride) or relatively insoluble (fused clay) forms of 144-Ce and 90Sr. With the solubled 144-CeCl3, significant radiation doses were delivered to the lungs, liver, and skeleton whereas, after 90-SrCl2 exposure, the radiation dose was delivered predominantly to the skeleton. In dogs exposed to 144-Ce and 90-Sr in fused clay particles, radiation doses were delivered mostly to the lungs and tracheobronchial lymph nodes. In most dogs dying within 2 years after exposure, deaths were attributable to nonneoplastic radiation-induced lesions in the target organ systems. At later times after exposure, neoplasms were the major cause of death, again occurring mostly in target organs or the adjacent tissues. Lung liver, and bone-related neoplasms, including five hepatic hemangiosarcomas, developed after 144-CeCl3 exposure. Among the bone-related sarcomas seen in dogs exposed to 144-CeC3 or 90-SrC2, the incidence of hemangiosarcomas was over 40%. Among the 20 dogs dying with pulmonary neoplasms after exposure to 144-Ce or 90Sr in fused clay particles, all had hemangiosarcomas and several also had other neoplasms. This high after exposure and differs from results in other laboratories where beagles have been exposed to both alpha and beta-emitting radionuclides.

Topics: Aerosols; Animals; Bone and Bones; Bone Neoplasms; Cesium Radioisotopes; Dogs; Hemangiosarcoma; Humans; Infant, Newborn; Liver; Liver Neoplasms; Lung; Lung Neoplasms; Neoplasms, Experimental; Neoplasms, Radiation-Induced; Radiation Dosage; Radioisotopes; Strontium Radioisotopes; Time Factors

Topics: Adenocarcinoma; Carcinoma, Bronchogenic; Gallium; Humans; Liver Neoplasms; Male; Mediastinal Neoplasms; Middle Aged; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes

Topics: Colonic Neoplasms; Humans; Liver Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes