1、 Treatment of painful bone metastases with radiopharmaceuticalDempartment of nuclear medicineDescription Goals of treatmentPalliative therapy Palliation of Bone Pain and improve quanity of life Useless to primarily disease123Principle lRadiopharmaceutical analogy with bone constituents llocalizes in
2、 areas of osteoblastic(成骨细胞）成骨细胞）activity.lThe ionising effect of-radiation lead to DNA damage.Ideal Radiopharmaceutical lMost of drugs accumulate in cancer leision,less of them accumulate in normal bone tissue or it can be quickly clear up.lHave a suitable effective half lifel-particle energy betwe
3、en 0.5 and 1.0 MeVlHave a suitable range of firelAble to emit r-radiation,which can be detect by ECTIndicationlhave bone pain or the pain can not relieve even with analgesiclSkeletal metastasis involving above 1 site that are positive on bone scan.contraindication lAcute or chronic renal and liver f
4、ailurelAcute spinal cord suppressionlBone marrow depression Step of therapy l Have a bone scan l Collect medical history l Medication numerical rating scale(NRS)karnofsky performance status scaleMedicationTreated in an outpatient setting Patient is instructed about the radiation safety precautionsIn
5、travenous injectionSide effectlMost patients no reactionlFew patients early reaction -Flare reaction(temporary increased pain)，nausea and vomiting，rash late reaction -temporary bone marrow depressionFollow-upBlood counts Blood counts are obtained at least weekly for the first 6 weeks and more freque
6、ntly if there is evidence of toxicity.Bone scan Retreate Patients whose blood counts do return to pretreatment values may be retreated.Different agents have different retreat time.89SrCl2Biologically like calcium.Localizes in areas of osteoblastic activity.Physical half-life of 50.5 d Emits -particl
7、e with a maximum energy of 1.46 MeVaverage soft-tissue range of 2.4 mm.The usual therapeutic dose is 148 MBq(4 mCi).89SrCl2Most patients bone pain relieve 7-21days later after therapy.Analgesic effect come to peak in 1-2.5 months.Duration time is 3-12 months89SrCl2Retreat 3-6monthsBone pain relieve
8、but not completely disappearPrevent occuring bone pain again89SrCl2Reaction mainly decrease in total blood countFlare reaction Samarium-153 Physical half-life of 1.9 d Emit and particle Phosphonate complex After intravenous injection,1%remains in the blood at 5h.About 65%of the dose remains in the s
9、keleton.Samarium-153Retreatl2-4 weekTherapy effectlBone pain relieve at 7.96.8dlDuration time is 2-26 weeklEffective power between 85%-90%Compare with 89Sr Have a shorter half life Have quickly effect to relieve bone pain Duration time is shorter Emiting praticle,which can be detected by ECT,in orde
10、r to monitor distribution of drugs and therapeutic effect Less expense SummerayBone pain palliation therapy with radiopharmaceuticals is cost-effective systemic therapy to relieve pain from bone metastases and improve quality of life;Advantages:the ability to treat multiple sites of disease,ease of administration and no unduly toxic.Thank you!
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