Radionuclide therapy for metastatic bone cancer

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Many malignant tumors to a certain stage of disease may be transferred, malignant tumors can metastasize to various organs of the body, such


Many malignant tumors to a certain stage of disease may be transferred, malignant tumors can metastasize to various organs of the body, such as brain, liver, lung, kidney and so on, when the tumor metastasis to the bone, leading to bone tumor growth, called bone metastasis. According to the study, some bone metastasis of malignant tumor incidence is very high, such as breast cancer, prostate cancer, lung cancer, bone metastasis rate up to 50~85%, the other is nasopharyngeal cancer, bladder cancer, kidney cancer, cervical cancer, pancreatic cancer, bone metastasis may happen.

Bone metastases often cause severe pain, fractures, bone marrow failure, walking difficulties, and nerve compression symptoms. Pain is the most prominent of many patients, this is due to the tumor innervation rich periosteal involvement. The results may also be due to mechanical compression, tumor cause thinning of bone tissue and bone tumors from spreading to the nerve tissue caused by. An important reason for nerve endings is caused by the pain of chemical substances released by the stimulation of bone destruction. Because of the severe pain, the patient suffering, life quality severely reduced.

There are two therapeutic targets for bone metastases: one is to relieve pain; the other is to reduce the number of lesions. Only eliminate and reduce the focus, in order to achieve the purpose of pain. At present, commonly used treatment methods include surgery, radiotherapy, chemotherapy and the application of various analgesics. These treatments have clinical value for different parts of patients with different clinical stages, but they have some limitations and shortcomings. For example: surgery and radiotherapy are often incapable of action of extensive bone metastasis; chemotherapy toxicity is more serious; some painkillers are addictive. At present, domestic and foreign medical experts are studying and looking for new and effective treatment methods. Radionuclide therapy is one of the most important results of this study. Including 89Sr treatment and 153Sm-EDTMP treatment of two methods.

Indications for radionuclide therapy are:

1 clear diagnosis of bone metastases, especially those with extensive bone metastases.

2 radionuclide bone imaging showed that the bone metastasis was significantly absorbed, so bone imaging is the necessary preparation before treatment.

3 due to severe pain of bone metastasis, chemotherapy, radiotherapy is invalid, although some patients have bone metastases but no pain, radionuclide therapy can prevent pain.

4 white blood cells > 3.5 * 109/L, platelet > > 80 * 109/L.

89Sr (89 Sr) in the treatment of metastatic bone cancer

89Sr, a pure beta emitting radionuclide, was used in the treatment of metastatic bone cancer in 1942. Strontium is congeners with calcium in the periodic table, the metabolism and calcium are similar, mainly concentrated in the skeletal system and other body organs distribution less.

89Sr after intravenous injection into the body, 90% concentrated in the skeletal system, only 10% excreted by the kidney, bone metastasis in 89Sr accumulation is 2~25 times of normal bone, the bone pain has very good analgesic effect.

The half-life of 89Sr is relatively long, up to 50.5 days after injection, fast uptake by bone metastases in the biological half-life of more than 50 days, in the normal bone biological half-life of 14 days, metastases of 89Sr stay for a long time, may be released from the normal bone in the recycling of 89Sr. 90 days after the injection, the 89Sr retention in the metastatic site was still up to 20%~88%, which could maintain the long-term efficacy. Therefore, 89Sr treatment for every March treatment.

Some patients were followed up regularly. The results showed that with the extension of the time after 89Sr intravenous injection, the abnormal thickening of the film was reduced, weakened and even disappeared.

89Sr can also reduce alkaline phosphatase and prostaglandin (PEG) level, will help reduce the osteoporosis, bone repair, and reduce the level of calcium to reach pain.

The main treatment effect of 89Sr is to improve the patient's pain, quality of life, reduce the pain. According to the report, 79%~92% prostate cancer and breast cancer patients after 89Sr treatment of pain and quality of life improvement. At present, most scholars believe that 89Sr has the best effect on the bone metastasis caused by these two kinds of cancer, the total effective rate is 80%~90%, 10%~18% of patients with pain completely disappeared. 89Sr also has been used for the treatment of lung cancer, kidney cancer, pain caused by bone metastasis of nasopharyngeal cancer.

Another purpose is to make the 89Sr for the treatment of bone metastasis were reduced or disappeared, prolong patient life to alleviate the condition. B rays can kill tumor cells, so 89Sr can also be used to treat bone metastases in addition to analgesia. At present, some scholars will be 89Sr for the treatment of pain without bone metastasis, to prevent or delay the onset of pain.

153Sm (SM 153) -EDTMP in the treatment of metastatic bone cancer

Department of nuclear medicine, West China Hospital of Sichuan University, successfully developed the first in China to guide bone tumor radiotherapy drug, 153Sm- EDTMP (ethylenediamine tetramethylene phosphonic acid), commonly known as the treatment of bone tumor biological missile, also is the radionuclide therapy of bone cancer. The drug after intravenous injection of bone, especially bone tumors have a higher affinity for bone in drug concentration is 4000 times larger than the muscles, bone lesions compared with normal bone drug concentration 18~32 times, therefore, can make use of radionuclide 153Sm released by B ray inhibit the growth of tumor cells and prevent the development of disease, and induce tumor cell degeneration and death, so as to eliminate and reduce pain and disease treatment.

The advantages of 153Sm-EDTMP treatment are:

1 treatment method is simple: a course of treatment only one intravenous injection, half to January, as the case may be repeated treatment, no serious adverse reactions.

2 good analgesic effect: according to the data in our hospital, according to the judgment standard of internationally recognized classification and WHO cancer pain effect, 153Sm analgesic effect on bone total effective rate was 93%. In general 2~7 days after injection pain disappeared or significantly reduced, can be maintained for 1~6 months, up to 1 years.

3 metastatic carcinoma of bone to eliminate and reduce the effect: according to our statistics and eliminate the reduction rate of about 30%.

4 of the important organs without obvious damage; for 1 hours after 153Sm injection, basically completely removed from the blood, in addition to more than 50% to bones and lesion treatment, the rest quickly from the urine discharge, so the damage to other organs and organizations will not.

5 no serious bone marrow inhibition: according to the data in our hospital, 153Sm before the treatment not received other treatment or radiotherapy only, no significant difference before and after treatment of blood, a minority of patients with platelet and leukocyte reduced, but in general can recover in the short term.

Because of the above advantages, domestic and foreign experts believe that the success of this method of treatment, to create a new way of radionuclide therapy of bone tumors, nuclear technology and the peaceful use of the benefit of mankind is another fruitful. Therefore, in 1995 won the first prize of scientific and technological progress in Sichuan. And many times in the domestic and foreign academic exchanges, access to wide acclaim and praise.

It must be pointed out that any malignant tumor is not a localized disease, but a systemic disease. The complexity and systemic nature of malignant tumors determine the multidisciplinary nature of treatment. In addition to surgery, radiotherapy and chemotherapy, and immune therapy, endocrine therapy, Chinese medicine treatment, heat therapy, laser therapy, interventional therapy and so on, these methods all have their advantages and disadvantages and indications, radionuclide therapy and other treatment if scientific arrangements, should be comprehensive, will achieve better curative effect.

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