Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy

Abstract

PURPOSE:The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment.METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg) were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10) before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data.RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%), with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%), 10 (14%), and 7 (10%) patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer). Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4).CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures. KEYWORDS: Samarium. Pain. Scintigraphy. Palliative. Care. Neoplasm. Metastasis.Bone metastases are common in the progression of various tumors such as prostate, breast, and lung carcinoma, and they often entail an occurrence of progressive pain. 1 Control of pain and its consequences (eg, depression, movement constraint, and dependence) are important goals in oncological treatment requiring a multidisciplinary approach to the patient.The use of ionizing radiation is one of the alternatives for pain treatment, together with the administration of drugs (eg, anti-inflammatories, opioids, chemotherapeutic drugs, receptor blockades, phosphonates) and surgical interventions. Local radiotherapy results in a good clinical response in approximately 80% of the cases (complete in 30% to 60%) lasting for over 4 months, although with an effect confined to the irradiated site. 2,3 Hemibody radiotherapy (isolated or sequential) may be used in patients with widespread metastases, resulting in a complete response in approximately 20% of the cases, and a partial one for 50% to 100%. Radiation on wide areas is limited by hematopoietic, pulmonary, and gastrointestinal toxicity produced by the high radiation absorbed dose. 2,3 The irradiation of multiple bone lesions can also be achieved by the intravenous administration of beta-emitting isotopes with a high affinity for

Role of samarium-153-ethylene diamine tetramethylene phosphonate radionuclide bone pain palliation in patients with metastatic bone disease

“…11 It has favourable pharmacokinetics All data are presented as mean ± standard deviation KPS = Karnofsky performance score; VAS = visual analogue score with good target to background activity ratio and rapid clearance. It also emits 103 KeV gamma ray (20% abundance) which facilitates post-therapy bone scintigraphy to document its localization to osteoblastically active lesions.…”

Quantitative assessment of radionuclide pain palliaton: case report

“…Sm-153 EDTMP metastatik kemik ağrısı palyasyonu için değerli bir yöntemdir. [23,24] Sm-153 tedavisinin etkinliğinin araştırıldığı bir çalışmada; genel yanıt oranları %73 ve tam yanıt oranı %12.4 olarak bulunmuştur. Karnofsky performans skoru ve mobilite skorunda iyileşme ile birlikte analjezik tüketiminde azalma saptanmıştır.…”

The Role of Bone-Seeking Radionuclides in the Palliative Treatment of Patients with Painful Osteoblastic Skeletal Metastases

“…Several studies have shown the radionuclide to be effective at palliating pain from bone metastases. [37][38][39][40][41] Palliation of pain occurs in approximately 60% to 80% of patients within 1 week of administration of 53 Sm, with a clear dose response in dose escalation studies. 42 A randomized trial using 0.5 mCi/kg vs 1.0 mCi/kg of 153 Sm in patients with bone metastases from a variety of primary tumors showed signifi cant pain improvement with the higher dose as well as superior survival in the patients with breast cancer treated with the higher dose.…”