Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

Poel, Henk G. van der; Antonini, Ninja; Hoefnagel, C.A.; Horenblas, Simon; Olmos, Renato A. Valdés

doi:10.1159/000092935

Cited by 14 publications

(13 citation statements)

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“…To the best of our knowledge, the impact of hypoxia on tumor response in patients treated by internal radiotherapy has never been directly addressed. Only the effect of Hb level on global symptoms, i.e., pain or cumulative survival, was reported in the treatment for painful osseous metastases in prostate cancer with 186 Re-hydroxyethylidene-diphosphonate and 89 Sr [19,20]. The demonstration of a significant impact of anemia on tumor response in internal radiotherapy should allow improvements by considering strategies under intensive development in EBRT [21-26] but, as of today, totally ignored in internal radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin level significantly impacts the tumor cell survival fraction in humans after internal radiotherapy

et al. 2012

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BackgroundAnemia is usually not taken into account in internal radiotherapy. We investigated whether the hemoglobin (Hb) level could have an impact on the tumor response, as observed in external beam radiotherapy (EBRT).MethodsAbsorbed doses of 25 hepatic metastatic sites in eight patients who underwent a liver selective internal radiotherapy (SIRT) were computed by a 3D convolution of a dose deposition kernel with the 90Y time-of-flight positron emission tomography (TOF-PET) images acquired following therapy. Early tumor response was assessed by comparing a follow-up FDG TOF-PET scan with a baseline scan. Hb level was measured on the day of the SIRT procedure.ResultsAll patients displayed early tumor response increasing with the tumor-absorbed dose. Significant differences between patients were noted, the response slope correlating with the Hb level. After applying a global fit on all metastases using a tumor radiosensitivity modulated by a Hb enhancement factor (HEF) linearly dependent on the Hb level, a strong correlation (R = 0.96) was observed between the early response and the absorbed dose. Hb level had a major impact on tumor response by modulating HEF by a factor 6.ConclusionsThese results prove the significant impact of Hb level on the tumor response and support the study of methods for correcting tumor hypoxia, such as intensively performed in EBRT. The quantitative analysis of the relationship between tumor doses and early response has the power to allow fast screening of such correction methods in limited patient series. Internal radiotherapy could be more efficient if performed earlier in the therapy line, when the disease- and treatment-related anemia remains limited.

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Section: Introductionmentioning

confidence: 99%

Hemoglobin level significantly impacts the tumor cell survival fraction in humans after internal radiotherapy

et al. 2012

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“…This finding could explain why a better response is seen in patients who have received higher doses (19)(20)(21). On the other hand, it might be a reasonable justification for a good response in patients with few metastatic lesions treated with a lower administered activity (22)(23)(24).…”

Section: Discussionmentioning

confidence: 96%

“…Patient showed complete response to therapy and flare reaction after receiving 2,960 MBq of 186 Re-HEDP. bone markers, hemoglobin level, and previous treatments (14,23,24,36), but highly controversial issues remain. Although several studies have demonstrated that earlier treatment in patients in better clinical condition may improve the response rate (22)(23)(24), unfortunately radionuclide therapy is underutilized in Iran.…”

Section: Discussionmentioning

confidence: 99%

“…bone markers, hemoglobin level, and previous treatments (14,23,24,36), but highly controversial issues remain. Although several studies have demonstrated that earlier treatment in patients in better clinical condition may improve the response rate (22)(23)(24), unfortunately radionuclide therapy is underutilized in Iran. This underutilization could be a result of limited referrals due to specialists' inadequate knowledge and misconceptions about adverse effects or to the restricted availability and expense of bone painpalliating radionuclides.…”

Section: Discussionmentioning

confidence: 99%

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Phase 2 Study of a High Dose of 186Re-HEDP for Bone Pain Palliation in Patients with Widespread Skeletal Metastases

Pirayesh

Amoui

Mirzaee

et al. 2013

Journal of Nuclear Medicine Technology

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186 Re-1-hydroxyethylidene-1,1-diphosphonate (HEDP) is an attractive radiopharmaceutical for the treatment of bone pain arising from skeletal metastatic lesions. Currently, 186 Re-HEDP is most commonly used in European countries. The aim of this study was to investigate the palliative efficacy and adverse effects of 186 Re-HEDP in patients with different types of cancers and skeletal bone pain. Methods: Nineteen (8 male, 11 female) patients with various cancers (breast, prostate, renal cell carcinoma, colon, and neuroendocrine tumors) and painful bone metastases were included in the study. A dose of 1,480-3,330 MBq (40-90 mCi) of 186 Re-HEDP was administered intravenously. The patients' level of pain relief was assessed by the Visual Analog Scale for 8 wk after treatment and by a weekly blood cell count to evaluate for hematologic toxicity. Results: The overall response rate was 89.5%, and the mean pain score assessed by the Visual Analog Scale was reduced from 9.1 to 5.3 after 1 wk (P 5 0.003). No adverse effects were reported by patients during intravenous administration or for up to 24 h after administration. A flare reaction was seen in 63.2% of patients, mainly during days 1-3, and lasted for 2-4 d. There was no significant correlation between the response to therapy and the flare reactions (P . 0.05). The nadir of platelet reduction occurred at the fourth or fifth week and led to platelet infusion in only 4 patients with a low baseline platelet count and diffuse skeletal metastases. Bone marrow suppression occurred in patients receiving higher doses, but no clinical problems were seen except in 2 patients who required packed cell transfusion similar to their prior transfusions. Conclusion: 186 Re-HEDP is an effective radiopharmaceutical for the palliative treatment of metastatic bone pain and has minimal adverse effects.Key Words: rhenium 186(tin) etidronate; pain palliation; bone metastasis Nucl Med Technol 2013; 41:192-196 DOI: 10.2967/jnmt.113.124297 The skeleton is the most common site of metastatic disease, and tumors arising from the breast, prostate, lung, thyroid, and kidney commonly spread to bone. The frequency of bone metastases has been estimated at 65%-75% in patients with breast and prostate cancer (1,2) and about 30%-40% in those with lung cancer (3). Bone pain, as the main symptom of skeletal metastases and the most common type of cancer-related pain, obviously has a negative impact on quality of life (4). Currently, the factors contributing to cancer pain are not completely understood (5,6), and metastatic bone pain might be poorly localized for external radiation therapy (7). Various modalities have been introduced for the treatment of bone metastases, including analgesics, hormone therapy, cytotoxic drugs, biphosphonates, and surgery; however, they are not effective in all patients with painful refractory skeletal metastases. An alternative approach is systemic administration of radiopharmaceuticals, which is a valuable and effective method for relieving bone pain in patients with ...

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“…A recent report [46] suggested a relationship between serum haemoglobin levels and the chances of response to strontium-89 and rhenium-186. Recent trials suggested increased benefit in terms of pain palliation by using a combination of a radiopharmaceutical agent with chemotherapy [47,48] or bisphosphonates [49 ,50].…”

Section: Radioisotopesmentioning

confidence: 99%

Management of painful bone metastases

Mercadante

Fulfaro

2007

Current Opinion in Oncology

131

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According to new preclinical data, treatment of bone cancer pain requires multidisciplinary therapies such as radiotherapy applied to the painful area along with systemic treatment (hormone therapy or chemotherapy) and supportive care (analgesic therapy and bisphosphonates). In some selected cases use of radioisotopes and other noninvasive or minimally invasive techniques may be useful in the management of metastatic bone pain. The treatment should be individualized according to the patient's clinical condition, life expectancy, and quality of life.

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Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

Cited by 14 publications

References 47 publications

Hemoglobin level significantly impacts the tumor cell survival fraction in humans after internal radiotherapy

Hemoglobin level significantly impacts the tumor cell survival fraction in humans after internal radiotherapy

Phase 2 Study of a High Dose of 186Re-HEDP for Bone Pain Palliation in Patients with Widespread Skeletal Metastases

Management of painful bone metastases

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