The use of 185 MBq and 740 MBq of 153‐samarium hydroxyapatite for knee synovectomy in haemophilia

Abstract

The penetration of beta energy of 153-samarium (153Sm) (0.8 MeV) is not only appropriate for synovectomy of median articulations but is possible to improve the radiobiological effect using increased activities. The aim of this study was to assess the effectiveness of 185 MBq and 740 MBq of 153-samarium hydroxyapatite (153Sm-HA) in knees of haemophilic patients. Thirty-one patients – 36 knees, 30 males, were divided into two groups without coinjection of corticosteroid: A – 14 patients (17 knees) treated with intra-articular dose of 185 MBq of 153Sm-HA, average age 23 years; B – 17 patients (19 knees) with 740 MBq of 153Sm-HA, average age 21.3 years. The evaluation before and after 1 year of synovectomy used the following criteria: reduction in the number of haemarthroses and use of the coagulation factor and improvement in articular motility. Adverse-effects occurrence was considered too. Early and late scintigraphic studies were performed after synoviorthesis and no joint immobilization was recommended. The reduction in haemarthrosis and use of coagulation factor were: group 1 – 31.3% and 25%; group 2 – 81.5% and 79% with P < 0.001 respectively; no significant improvement in knees motility was noted for both groups. Four cases of mild reactional synovitis were observed in each group. The scintigraphic control showed homogenous distribution of the radiopharmaceuticals with no articular escape; the material was considered safe by its permanence in the articulation. We have significant improvement in the synovectomy of haemophilic knees with 740 MBq of 153Sm-HA; the less penetration of its beta radiation was compensated by the increased biological effect with the higher used activity.

Synovectomy with 153Samarium Hydroxyapatite in Haemophilic Arthropathy

“…Scintigraphy showed homogenous distribution of the radioactive material with no leakage; the material was considered safe by its retention in the joint. A signiicant increment was observed in the synoviorthesis of haemophilic knees with 20 mCi of 153 Sm-HA; the lower penetration of its beta radiation was ofset by the improved radiobiological efect when higher radioactivity is used [4]. Y is the more appropriate for knee synoviorthesis, the higher radioactivity levels of 153 Sm is an alternative in locations that only produce this material [5].…”

Barium titanate microparticles as potential carrier platform for lanthanide radionuclides for their use in the treatment of arthritis

“…For long-term biodistribution studies, choice of 177 Luloaded particles was based on 6.65 days half-life of the radionuclide. 13,19,20 The percentage of activity excreted is indirectly ascertained by subtracting the activity accounted in all the organs from the total injected activity. Lutetium-177-loaded barium titanate microparticles (~2 MBq) suspended in minimum volume of normal saline (~20 μL) were injected intra-articularly into one of the knee joints of each animal.…”

“…[1][2][3][4][5][6] The key determinants for the success of RSV are the selection of an appropriate radionuclide and a biocompatible carrier platform which results in robust and irreversible binding with the radionuclide. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] This is attributed to the availability of a package of therapeutically useful radionuclides among lanthanide elements having a wide range of energy (0.34-2.28 MeV) of β − emission along with other desirable decay characteristics. 2,3,7-9 As for example, radionuclide emitting β − having maximum energy more than 1.5 MeV would be suitable for knee and hip joints, while medium energy β − emitters (maximum energy 0.5-1.0 MeV) would be suitable for ankle, elbow, and wrist joints and low energy β − emitters (maximum energy less than 0.5 MeV) for finger joints.…”

“…2,3,7-9 As for example, radionuclide emitting β − having maximum energy more than 1.5 MeV would be suitable for knee and hip joints, while medium energy β − emitters (maximum energy 0.5-1.0 MeV) would be suitable for ankle, elbow, and wrist joints and low energy β − emitters (maximum energy less than 0.5 MeV) for finger joints. 7,10,11,15,19,20 In the present work, our aim was to put forward an innovative and effective carrier platform on which lanthanide ions can be easily loaded and the loaded particles of appropriate size could be used to deliver cytotoxic dose to the diseased synovium after loco-regional administration. Based on these considerations, a plethora of therapeutic radionuclides have been proposed and clinically utilized in RSV, among which radionuclide of lanthanide elements such as 90 Y (yttrium is considered as a pseudolanthanide), 153 Sm, 165 Dy, 166 Ho, 169 Er, and 177 Lu (Table 1) are prominent ones.…”

Comparison of the effect of knee synovectomy in haemophilic patients with 153Sm‐ and 90Y ‐labelled hydroxyapatite 1 year after

“…The use of 153 Sm‐hydroxyapatite has produced good results for medium‐sized joints such as elbows and ankles, but poor results for the knees . However, employing greater activities of this material evidenced better performance in the knees , which sparked interest in a comparative study with 90 Y, considered the standard material for this joint in Europe.…”