A strontium-89 injection: a simple treatment of painful bone metastases in patients with prostate cancer unresponsive to hormonal treatment]

Four patients (men aged 75, 67, 65 and 69 years) with painful osseous metastases from prostate cancer were treated by intravenous radionuclide therapy using Strontium-89. All had secondary progression after initially successful hormonal treatment. Three of these four had good responses lasting from 5 to 9 months. One patient with rapidly progressive disease did not respond. Second and third injections were successful in two patients. Mild bone marrow suppression was observed in all, but was not clinically significant. The 70-80% chance of long-lasting pain alleviation through a single injection of Strontium-89 is a valuable addition in the treatment of painful bone metastases from prostate cancer, and probably also in such metastases from breast cancer.     

Systemic radionuclide therapy in pain palliation

Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate (186Re-HEDP), and strontium-89 (89Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with 188Re-HEDP (3194 +/- 387 MBq), 15 patients with 186Re-HEDP (1358 +/- 158 MBq), and 18 patients with 89Sr (152 +/- 19 MBq). The 188Re-HEDP group included six breast cancer patients and 25 prostate cancer patients; the 186Re-HEDP group included three breast cancer patients and 12 prostate cancer patients; and the 89Sr group included three breast cancer patients and 15 prostate cancer patients. All subjects participated in an interview using a standardized sets of questions before and after the 12-week term of therapy. Blood counts were taken weekly for six weeks and after 12 weeks. Results showed that 77 percent of patients reported pain relief after treatment with 188Re-HEDP, 67 percent after treatment with 186Re-HEDP, and 72 percent after treatment with 89Sr. Sixteen percent of patients treated with 188Re-HEDP, 13 percent treated with 186Re-HEDP, and 17 percent treated with 89Sr were able to discontinue their analgesics and were pain-free. Patients described an improvement on Karnofsky performance status (KPS) from 73 +/- 7 percent to 85 +/- 8 percent 12 weeks after 188Re-HEDP (p < 0. 05), from 72 +/- 13 percent to 79 +/- 12 percent after 186Re-HEDP (p = 0.251), and from 62 +/- 14 percent to 69 +/- 16 percent after 89Sr (p = 0.415). Only three patients undergoing 188Re-HEDP therapy, one undergoing 186Re-HEDP therapy, and three undergoing 89Sr therapy had thrombocytopenia (platelet count below 100 x 10(3)/microl) following treatment. The maximum nadir of platelet and leukocyte counts was observed between the second and fifth week after treatment for all radionuclides and was reversible within 12 weeks. The nadir was earlier for 188Re-HEDP with a shorter physical half-life compared with 89Sr. There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after 188Re-HEDP was the only statistically significant finding (p = 0.001).     

Clinical experience with rhenium-188 HEDP therapy for metastatic bone pain

Rhenium-188 hydroxyethylidene diphosphonate (Re-188 HEDP) is a new radiopharmaceutical for treatment of metastatic bone pain. Re-188 is a generator-produced radionuclide emitting high energy beta and gamma rays and having a relative short physical half-life makes it of especially interesting for therapeutic purpose. Seven patients (pts) with multiple painful bone metastases were treated with Re-188 HEDP. Five pts with prostate cancer and 2 pts with breast cancer received a fixed activity of 3000 MBq of Re-188 HEDP intravenously in two steps. Complete blood counts were determined, blood chemistry examinations and urine-analysis were performed before and 1, 2, 3, 4, 6, 8, 12 weeks following the treatment. A visual analogue score, a verbal rating scale, the Spitzer index and the Karnofsky score were used to assess pain and performance status. Three hours after Re-188 HEDP administration at 1 m from the anterior mid-trunk of the pts gamma and at the patient body surface beta-radiation dose measurements were made, together with urine radioactivity measurements. Three pts become pain-free, 2 pts exhibited partial pain improvement and 1 patient gave no response to the Re-188 HEDP therapy. In 1 patient due to central nervous system metastasis the modification of the pain intensity could not be evaluated. Three pts displayed a flare reaction within 1 week after the treatment. Transient decreases in platelet and white blood cell counts were observed. There were no significant changes in the liver and renal functions. Radiation dose rate values of 6.3 +/- 1.0 microSv/h for gamma, and of 183 +/- 40 s-1 for beta-radiation were found. 25-32% of the administered dose was eliminated via the urinary tract in the first three hours. The preliminary data suggests that Re-188 HEDP is an effective radiopharmaceutical in treatment for metastatic bone pain. An administered activity of 3000 MBq can bring about a pain reduction without causing any clinically significant bone marrow toxicity.     

Licensee over-reliance on conservatisms in NRC guidance regarding the release of patients treated with 131I

Medical licensees are required to comply with U.S. Nuclear Regulatory Commission (NRC) regulations pertaining to the release of patients administered radioactive material. However, use of the associated NRC guidance expressed in NUREG-1556, Volume 9, is completely optional and has been shown to be overly conservative. Rigid adherence to the guidance recommendations has placed an undue burden on nuclear medicine therapy patients and their families, as well as licensees responsible for ensuring compliance with NRC requirements. More realistic guidance has been published by other responsible professional societies and will be presented in this work. These more realistic calculations allow for higher releasable activity levels than the widely adopted NUREG levels, particularly for thyroid cancer patients. The guidance-suggested releasable activity limit is similar to our calculational result for hyperthyroid patients, 2.1 GBq (57 mCi) compared to 2.3 GBq (62 mCi), but is significantly lower for thyroid cancer patients, 6.6 GBq (179 mCi) vs. 16.9 GBq (457 mCi) using the regulatory definition of the total effective dose equivalent (TEDE). Higher limits are both possible and reasonable, if the permissible extra-regulatory definition of the TEDE is used in which the effective dose equivalent (EDE), rather than the deep-dose equivalent (DDE), is determined. We maintain that professionals evaluating compliance with the NRC requirements for patient release, pursuant to 10 CFR 35.75, should use the procedures presented here and not rely automatically on the NUREG.     

锶-89联合热疗治疗骨转移癌的疗效观察

目的 探讨锶-89联合热疗治疗骨转移癌的疗效。方法 将70例患者随机分为两组,实验组(35例)接受锶-89联合热疗治疗,对照组(35例)接受锶-89治疗,观察治疗2周后两组的镇痛疗效及体力情况。结果 治疗2周后实验组的癌痛缓解率为82.8%,对照组为60%,两组比较差异有统计学意义(P < 0.05)。实验组和对照组KPS改善率分别为57.1%和31.4%,差异有统计学意义(P < 0.05)。结论 锶-89联合热疗可以控制骨转移癌引起的疼痛;锶-89联合热疗可作为临床治疗骨痛的一种较理想的选择。     

综合治疗中晚期前列腺癌的疗效分析

目的探讨一种对中晚期前列腺癌较理想的治疗方法。方法回顾性分析2001年3月~2005年1月收治的前列腺癌临床病例78例,采用综合治疗:经尿道等离子束腔内微创手术加双侧睾丸白膜下切除去势,术后应用抗雄激素药物阻断治疗,对伴有骨转移者同时行核素89Sr内放射治疗。与同期用单纯膀胱造瘘加双侧睾丸切除的45例病人进行比较。结果随访3~48个月,综合治疗后下尿路梗阻症状明显改善,血清PSA水平下降,骨痛缓解,生活质量显著提高,生存时间明显延长。结论对于中晚期前列腺癌采取积极的综合治疗可取得较好的疗效,是一种较为理想的治疗手段。     

~(89)SrCl_2联合云克、美施康定治疗骨转移瘤疼痛的临床疗效评价

目的观察89SrCl2联合云克与美施康定在治疗多发性骨转移瘤、缓解重度骨痛、改善生活质量等方面的疗效比较。方法对84例骨转移瘤重度疼痛的病人分别用89SrCl2、美施康定治疗,并对照观察疗效。结果89SrCl2治疗组,有效率为94%;美施康定治疗组,有效率为76%。结论89SrCl2联合云克比美施康定在治疗骨转移瘤重度骨痛、改善病人生活质量方面有更佳的疗效。     

核素153Sm、89Sr和化疗治疗多发性骨转移癌疗效对比

目的观察化学疗法及核素153Sm-EDTMP、89SrCl2治疗骨转移癌的疗效。方法对骨转移癌患者分别予以化学疗法及核素153Sm-EDT-MP、89SrCl2治疗,观察不同方法的疗效。结果化学疗法治疗组中骨痛的缓解率分别是完全缓解(CR)0%,部分缓解(PR)8.3%;骨显像的变化是CR0%,PR7.7%,稳定0%;而核素治疗骨转移癌的疗效明确,骨痛的缓解率达到70.3%,骨显像异常浓聚点虽然CR为0%,但PR为45.9%,稳定为43.3%。结论核素153Sm-EDTMP、89SrCl2治疗骨转移疗效明确,其中153Sm-EDTMP疗效更优于89SrCl2。     

服用不同剂量的~(131)I治疗甲状腺癌后辐射剂量率的测定

目的了解甲状腺癌患者服用不同剂量的131I治疗后辐射剂量率的变化及意义。方法对32例服用131I〔剂量3.7～7.4Bq(100～200mCi)〕治疗的甲状腺癌患者进行1和2m距离不同时间的辐射剂量率的测定,连测6d。结果不同剂量的辐射剂量率在服药后1h均达到高峰,随后下降,剂量越大下降越快。2m距离的辐射剂量率较1m距离明显偏低(P0.01),下降曲线相似。1m距离第6天、2m距离第5天不同剂量的辐射剂量率与本底相比,差异无统计学意义(P0.05)。结论甲状腺癌患者服用不同剂量的131I后,辐射剂量率的升高和下降与剂量有明显关系,但随时间延长辐射剂量率均逐渐减少,至第五六天与本底值已无差异。     

A solitary sternal lesion found by skeletal scintigraphy following treatment for breast carcinoma

Breast carcinoma frequently metastasises to bone, most often to the thoracic and lumbosacral spine. 3 women, aged 66, 47 and 54 years, who had been previously treated for breast cancer presented with sternal pain. Bone scintigraphy revealed a solitary sternal hot spot in all 3 patients. In the final diagnosis, 1 patient had nonmalignant reactive changes, which required no further therapy; 1 patient had a bone metastasis, which was treated with radiation therapy and tamoxifen; and 1 patient had radionecrotic tissue, which was treated with hyperbaric oxygen therapy. Symptoms resolved in all 3 patients. Skeletal scintigraphy is the most sensitive method for detecting bone metastases, but it is not specific. Bone metastases are usually multifocal, but sometimes a solitary bone lesion is found. A solitary sternal metastasis must be differentiated from other sternal disorders. Various treatment options exist for patients who are ultimately diagnosed with a solitary sternal metastasis.     

芬太尼透皮贴剂治疗中重度癌痛的疗效观察及安全评估

目的观察芬太尼透皮贴剂治疗中重度癌痛的近期疗效和不良反应。方法内脏痛、骨转移痛、侵犯和压迫神经痛、皮肤黏膜痛等慢性癌性疼痛42例,应用芬太尼透皮贴剂治疗,记录疗效及治疗期间便秘、恶心呕吐、嗜睡、头晕、呼吸抑制等不良反应出现的情况。结果总有效率为90．4％（38／42）,不良反应有便秘4例（9．5％）,恶心呕吐4例（9．5％）,其他有嗜睡、头晕、胃部不适、呼吸抑制,但发生率均〈5％。结论使用芬太尼透皮贴剂治疗中重度癌痛安全有效,可作为癌痛治疗的首选药物可作为癌痛治疗的首选药物。     

Palliative treatment of bone metastases with bone-seeking radionuclides

The skeleton is a common site for metastases in patients with prostate and breast cancer. Beside analgesic therapy and external beam radiotherapy, the use of bone-seeking radiopharmaceuticals gives pain relief. Analogues of these pharmaceuticals are also applied in skeletal scintigraphy. They accumulate at the site of high osteoblast activity and in this way they exert a local favourable influence on metastases through their radiation (beta particles or conversion electrons). The bone-seeking radiopharmaceuticals include strontium-89 chloride and rhenium-186 hydroxyethylidenediphosphonate. The main adverse reaction that has been observed is myelosuppression.     

SPECT全身骨显像联合肿瘤标志物检测用于老年肺癌骨转移患者的临床诊断价值研究

目的:分析研讨SPECT全身骨显像联合肿瘤标志物检测用于老年肺癌骨转移患者的临床诊断价值。方法:随机从本院2016年5月~2018年12月收治的老年肺癌骨转移患者中抽取80例进行讨论,均分别接受全身骨显像、肿瘤标志物检测以及联合检测,分析检测结果,如准确度、特异性、敏感性等。结果:全身骨显像和肿瘤标志物联合检测的准确性为91.25%、敏感度为97.33%、特异度为80%,均高于全身骨显像及肿瘤标志物单独检测的准确度、特异性、敏感性,差异较大(P<0.05)。结论:临床诊断老年肺癌骨转移时可采用全身骨显像联合肿瘤标志物方式,诊断准确性、特异性、敏感性均较高,可更为准确地判定肺癌是否出现骨转移状况。     

肺癌骨转移单光子发射计算机断层显像术放射性核素骨显像特点分析

目的 分析肺癌核素骨显像的影像特征,评估单光子发射计算机断层显像术(SPECT)放射性核素骨显像诊断肺癌骨转移的临床价值.方法 177例确诊为肺癌的患者进行99mTc-MDP骨显像检查,对骨转移的症状、部位、数量与病理类型进行回顾性分析.结果 肺癌骨转移发生率为45.8%(81/177),其中多发性骨转移69例,占骨转移者的85.2%(69/81).腺癌骨转移发生率为69.0%(40/58),鳞癌为41.3%(19/46),小细胞癌为32.5%(13/40),未分化癌为27.3%(9/33),腺癌骨转移发生率与其他类型癌骨转移发生率比较差异有统计学意义(P＜0.05);共发现转移灶526处,部位以胸部为最多,共212处(40.3%),其他依次为脊柱168处(31.9%)、盆腔73处(13.9%)、四肢62处(11.8%)、颅骨11处(2.1%).结论 肺癌骨转移以多发病灶较为常见,部位以胸部、脊柱多发.腺癌骨转移发生率最高.肺癌患者应常规进行放射性核素骨显像,这对疾病的分期、治疗方案的选择、预后评估均有重要意义.     

Radiotherapy for bone pain.

Painful bone metastases are a common problem for cancer patients. Although current evidence supports the use of a single fraction of radiotherapy as the treatment of choice, many radiotherapists, for a variety of reasons, continue to use fractionated regimens. Over one six month period 105 patients received external beam irradiation for painful bone metastases at the Royal London Hospital (RLH). Thirty-one per cent of the patients were aged 70 or over. The treatment of 97 of these patients was assessed. They had a total of 280 sites treated over the course of their disease. Fifty-nine per cent of sites treated received a fractionated course of radiotherapy. Site significantly influenced fractionation. Overall response rates of 82% were achieved. Fractionation did not appear to influence this. Ten patients received large field irradiation. Fifteen patients had five or more sites irradiated, of whom only one received hemibody irradiation.     

Radiopharmaceuticals for palliation of painful osseous metastases

Bone metastases represent the most common etiology of pain for patients with advanced cancer In the United States, the most common treatment for pain caused by bone metastases in late-stage cancer cases is external beam radiotherapy in conjunction with opioids. An alternative or adjuvant to external radiotherapy is intravenous radiopharmaceutical treatment. This review explores the pros and cons of different radiopharmaceutical options, their advantages over traditional external beam radiotherapy, and the conditions for optimal efficacy.     

唑来膦酸联合化疗治疗晚期非小细胞肺癌骨转移的临床观察

目的：探讨唑来膦酸联合化疗治疗晚期非小细胞肺癌骨转移的临床疗效。方法：本院收治的晚期非小细胞肺癌骨转移患者62例。给予唑来膦酸治疗,1次,3周,3周为一疗程。分析治疗前、后患者的骨转移灶、疼痛缓解情况。结果：经治疗骨转移灶改善的总有效率为61．3％。54例疼痛症状明显的患者经治疗1周后缓解率为75．9％,6周后缓解率为83．3％。治疗1周、6周后的NRS评分、KPS评分与治疗前比较差异均有统计学意义（P〈O．05）。结论：唑来膦酸联合化疗的临床疗效确切,止痛效果好,给药方便,值得临床推广。     

心理干预对肝癌粒子植入术后疼痛的影响

目的主要分析心理干预对肝癌放射性碘125粒子植入术后疼痛的影响,为未来临床改进护理手段寻找新的方向。方法选取本院于2018年1月-2019年2月收治的88例接受放射性碘125粒子植入术治疗的肝癌患者为观察对象,随机将其分为观察组(44例)、对照组(44例),分别实施心理干预与常规护理干预,评价心理干预的临床应用价值。结果统计两组患者护理后的疼痛情况,观察组患者的数据优于对照组,P<0.05,差异有统计学意义;统计两组患者对护理的满意度数据,发现观察组患者对护理的满意度达到95.45%(42/44),优于对照组的81.82%(36/44),P<0.05,差异有统计学意义。结论对肝癌放射性碘125粒子植入术患者实施科学有效的心理干预,可以显著缓解患者术后疼痛情况,并赢得患者认可。     

Palliation in patients with metastatic breast cancer often better with antitumour treatment than with only symptomatic treatment

Two women, aged 57 and 55 years, with metastatic breast cancer were admitted for uncontrolled pain due to bone metastases. Despite the fact that progressive disease was evident, a change in antitumour therapy had not been recommended. The pain control was optimised in both patients. In one patient, palliative chemotherapy was installed, combined with trastuzumab because of HER2/neu overexpression. She was still alive after one and a half year of treatment. The other patient could not adjust mentally to the fact that her palliative therapy was changed to antitumour therapy; she died one month later. It is important to be aware of the various kinds of therapy in metastatic breast cancer because palliative treatment is more than just symptomatic treatment. Systemic antitumour therapy includes hormone therapy, chemotherapy and targeted therapy. Furthermore, in patients with bone metastases, radiotherapy combined with bisphosphonates results in pain relief and can reduce skeletal complications. Because of the ensuing complexity of the treatment of metastatic breast cancer, these patients should be regularly managed by a breast-cancer care team in order to improve the quality of care.     

Radiotherapy of brain metastases in lung cancer

Therapeutical approach in brain metastases still remains the major problem in many cancer patients, especially in those with primary lung lesion. The aim of the present study was to test the tolerance to a whole brain telegammatherapy with a daily dose of 2 Gy in patients with lung cancer, to evaluate the improvement of sensory and motor deficits, and to define the more appropriate total dose (20 or 30 Gy) with regard to the patient survival. MATERIAL AND METHODS: Thirty nine patients with lung cancer and verified brain metastases underwent a whole brain telegammatherapy to a total dose of 20-30 Gy. Solitary metastases were found in 45 percent of the patients but all were defined as inoperable cases. The other patients had two or more brain lesions. RESULTS: All patients tolerated well the fraction and the total dose. The mean survival of the patients was 6.6 months with confidence interval 5.8-7.4 months. The survival difference between treatments with 20 and 30 Gy total dose did not reach statistical significance. Significant improvement was found in the Karnofsky index, intracranial pressure, headache, and neurologic symptoms after radiotherapy. CONCLUSION: Radiation therapy in patients with brain metastases from lung cancer is well tolerated and improves the quality of life.