Radioactive synovectomy with ⁹⁰yttrium and ¹⁵³samarium hydroxyapatite in haemophilic joints: preliminary study on radiation safety

Abstract

Most countries still do not achieve 1 IU of factor VIII/capita sufficient for survival. Although primary prophylaxis prevents synovitis, is not universally used. Chronic synovitis is treated with arthroscopy at expense of considerable amount of coagulation factors, and specialized surgeons. Radioactive synovectomy (RS) is a minimally invasive and cost effective alternative to arthroscopy, often considered first the option for persistent synovitis. Even without established causation with cancer, RS is avoided by some, due to this concern. We aim contributing to the understanding of RS safety regarding malignancy, presenting a large number of treated patients, and a single case of cancer. Three centres in Brazil applied RS with (90) Yttrium Citrate, (90) Yttrium hydroxyapatite or (153) Samarium hydroxyapatite in haemophilic joints and performed a survey addressing cancer in these patients. Four hundred and eighty eight patients (ages 3-51) received 1-3 RS (total 842) and follow-up was 6 months to 9 years. One patient aged 14 years presented Ewing sarcoma, 11 months after RS. The tumour was treated successfully with surgery and chemotherapy. Causality of cancer by RS is improbable in this case. Accordingly, latency here is far below minimum 5-10 years for radio-induction of solid tumours. Moreover, ES is not a typically radio-induced tumour, even at high doses. In agreement with others, though recognizing limitations, this study suggests RS is safe regarding cancer induction. Synovitis is a known burden for patients. The decision of making reasonable usage of RS should be outweighed with the risks of leaving synovitis untreated.

Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia

“…Recently, in a preliminary study by Thomas et al 19 on 408 patients (842 radioisotope synoviorthesis) between 3 and 51 years of age, in order to assess the safety of radiosinoviortesis, they found only one case of Ewing's sarcoma in a patient aged 14, 11 months after the radioisotope synoviorthesis. However, it must be born in mind that Ewing's sarcoma is not a radiation-induced tumor, even at high doses and also the time until its appearance is far below the minimum of 5-10 years for radiation-induced solid tumors.…”

Radionuclide synovectomy/synoviorthesis (RS) in persons with bleeding disorders: A review of impact of national guidance on frequency of RS using the ATHNdataset

“…1 Numerous patients with bleeding disorders have had RS with various isotopes, since this procedure was first described in 1963 with Phosphocol P32 (chromic phosphate P32 suspension), the most commonly utilized isotope in the US. [1][2][3][4][5][6][7][8] issued a MedWatch regarding the use of P32 for intra-articular use indicating that P32 may increase the risk for leukaemia in certain situations and stating that it was not indicated in the intraarticular treatment of hemarthrosis. 12 Subsequently in 2012 a large Canadian retrospective cohort study of cancer incidence after RS did not identify a correlation between RS and cancer.…”

Nanostructured Platforms for the Sustained and Local Delivery of Antibiotics in the Treatment of Osteomyelitis

“…209,210 Hydroxyapatite labeled with 99 Tm, 125 I, 90 Yt, 153 Sm, or 3 H radionuclides could also be considered for simultaneous bone substitution and imaging applications. 211–213 Doping hydroxyapatite with alkaline earth metals and magnetic elements, such as cobalt 214 or iron, 215–217 yielded other impure forms of calcium phosphate that have been intensively researched for their unique bioactive properties. 218–220 Superparamagnetic hydroxyapatite obtained by doping with approximately 10 wt% Fe 2+ /Fe 3+ was hailed as a far less toxic alternative to magnetite when used as a heating material for hyperthermia-based bone cancer therapies.…”