Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

Document Type : Original Article

Authors
Narjess Ayati 1
Kamran Aryana 1
Amir Jalilian 2
Toktam Hoseinnejad 1
Ali Bahrami Samani 2
Zahra Ayati 3
Farzane Shariati 1
Seyed Rasoul Zakavi 1
1 Nuclear Medicine Research Center, Mashhad University of Medical Science, Faculty of Medicine, Mashhad, Iran
2 Radiopharmaceutical Research & Development Laboratory (RRDL), Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
3 School of pharmacy, Mashhad University of Medical Science, Mashhad, Iran
10.7508/aojnmb.2013.01.006
Abstract
Objective(s): Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases.
Methods: 28 patients (14 males and 14 females) aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed.
Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8). 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%). The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the 6th week for WBCs and PLTs. No one experienced hematological toxicity induced problems.
Conclusion:  Sm-153 lexidronam is an effective treatment for painful bone metastases. The complication rate is low and the quality of life of the patients after treatment would be significantly improved.
Keywords
Radionuclide therapy
Samarium
153Sm-EDTMP
Painful bone metastasis
  1. Saarto T, Janes R, Tenhunen M, Kouri M. Palliative radiotherapy in the treatment of skeletal metastases. Eur J Pain. 2002;6(5):323-30.
  2. Mhiri A, Hassad R, Sellem A, Bahri H, Diakite R, Slim I, et al. [Treatment of painful bony metastases with Samarium 153-EDTMP in prostate carcinoma]. Tunis Med. 2007 Jul;85(7):580-5.
  3. Bauman G, Charette M, Reid R, Sathya J. Radiopharmaceuticals for the palliation of painful bone metastasis-a systemic review. Radiother Oncol. 2005 Jun;75(3):258-70.
  4. Roque IFM, Martinez-Zapata MJ, Scott-Brown M, Alonso-Coello P. Radioisotopes for metastatic bone pain. Cochrane Database Syst Rev. 2011(7):CD003347.
  5. Baczyk M. Radioisotope therapy of bone metastases. Nucl Med Rev Cent East Eur. 2011;14(2):96-104.
  6. Sideras PA, Stavraka A, Gouliamos A, Limouris GS. Radionuclide Therapy of Painful Bone Metastases--A Comparative Study Between Consecutive Radionuclide Infusions, Combination With Chemotherapy, and Radionuclide Infusions Alone: An In Vivo Comparison of Their Effectiveness. Am J Hosp Palliat Care. 2012 Dec 21.
  7. Ferreira S, Dormehl I, Botelho MF. Radiopharmaceuticals for bone metastasis therapy and beyond: a voyage from the past to the present and a look to the future. Cancer Biother Radiopharm. 2012 Nov;27(9):535-51.
  8. Lam MG, de Klerk JM, Zonnenberg BA. Treatment of painful bone metastases in hormone-refractory prostate cancer with zoledronic acid and samarium-153-ethylenediaminetetramethylphosphonic acid combined. J Palliat Med. 2009 Jul;12(7):649-51.
  9. Salo D, Eget D, Lavery RF, Garner L, Bernstein S, Tandon K. Can patients accurately read a visual analog pain scale? Am J Emerg Med. 2003 Nov;21(7):515-9.
  10. Nikoletti S, Porock D, Kristjanson LJ, Medigovich K, Pedler P, Smith M. Performance status assessment in home hospice patients using a modified form of the Karnofsky Performance Status Scale. J Palliat Med. 2000 Fall;3(3):301-11.
  11. Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer. 1996 Jun;32A(7):1135-41.
  12. Dolezal J. Efficacy and toxicity of 153samarium-EDTMP in painful breast cancer bone metastases. Onkologie. 2009 Feb;32(1-2):35-9.
  13. Coronado M, Redondo A, Coya J, Espinosa E, Couto RM, Zamora P, et al. Clinical role of Sm-153 EDTMP in the treatment of painful bone metastatic disease. Clin Nucl Med. 2006 Oct;31(10):605-10.
  14. Baczyk M, Czepczynski R, Milecki P, Pisarek M, Oleksa R, Sowinski J. 89Sr versus 153Sm-EDTMP: comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma. Nucl Med Commun. 2007 Apr;28(4):245-50.
  15. Liepe K, Kotzerke J. A comparative study of 188Re-HEDP, 186Re-HEDP, 153Sm-EDTMP and 89Sr in the treatment of painful skeletal metastases. Nucl Med Commun. 2007 Aug;28(8):623-30.
  16. Dolezal J, Vizda J, Odrazka K. Prospective evaluation of samarium-153-EDTMP radionuclide treatment for bone metastases in patients with hormone-refractory prostate cancer. Urol Int. 2007;78(1):50-7.
  17. Dolezal J, Vizd’a J, Cermakova E. [Myelotoxicity after systemic radionuclide therapy of painful bone metastases with 153Samarium-EDTMP ]. Vnitr Lek. 2003 Mar;49(3):189-93.
  18. Dolezal J. Systemic radionuclide therapy with Samarium-153-EDTMP for painful bone metastases. Nucl Med Rev Cent East Eur. 2000;3(2):161-3.