Background & Aims
Bone metastases represent complications associated with various osteophilic cancers, posing a significant challenge in oncological practice. Effectively managing these metastases is a major concern in oncology. Internal metabolic radiotherapy offers a viable solution for alleviating pain and enhancing the quality of life in affected patients. Leveraging beta-emitting radiopharmaceuticals, such as Samarium-153 EDTMP, this therapeutic approach facilitates the reduction of neoplastic cell proliferation and bone pain, and in some instances, complete elimination. The selective concentration and direct in situ irradiation of the target tissue characterize the action of 153Samarium-EDTMPThis study aims to evaluate the effectiveness of Samarium-153 EDTMP metabolic radiotherapy in bone metastases arising from prostate adenocarcinoma.
Methods
This retrospective descriptive study, conducted over 15 months, involved sixteen patients discussed in multidisciplinary tumor boards and subsequently referred to the nuclear medicine department for palliative analgesic treatment of painful bone metastases. The average age was 63 years, with 62.5% having Prostatic Adenocarcinoma, 31.25% presenting breast neoplasms, and 6.25% manifesting Urothelial Carcinoma of the Non-Transitional Type (UCNT). All patients underwent 99mTc-HMDP bone scintigraphy, a clinical consultation with pain assessment using a verbal rating scale (VRS)ranging from 0 to 4, and laboratory evaluations. The treatment protocol involved intravenous administration of Samarium-153 EDTMP, with monitoring in a lead-shielded day hospital room. Whole-body scans were conducted 6 hours post-injection, followed by weekly post-therapeutic clinical and laboratory monitoring for two months.
Results
No adverse reactions were observed following the administration of the radiopharmaceutical.
The therapeutic intervention (Samarium) demonstrated efficacy in 14 patients (87.5%), with analgesic effectiveness classified as follows:
Complete response: 3 patients (18.75%), achieving a Verbal Rating Scale (EVS) score of 0.
Partial response: 11 patients (68.75%), exhibiting a decrease > 20% in EVS.
No response: 2 patients (12.5%).
Exacerbation of pain (flare-up) occurred in three patients within 72 hours post-injection, with the pain being reversible within the subsequent three days.
Analgesic consumption displayed a declining trend across all medication tiers.
Conclusions
The entirety of our sample results unequivocally supports the efficacy of 153Sm-EDTMP in managing highly painful bone metastases. Its analgesic effect presents the advantages of a straightforward implementation, easy monitoring, and notably, the rarity and safety of side effects. It facilitates a reduction in other analgesic medications, particularly morphine-based ones. However, it is essential to note that this treatment should not be considered as a last-resort solution.
References
https://dx.doi.org/10.1016/j.mednuc.2014.12.003; 21 refs.
Maini CL, Bergomi S, Romano L, Sciuto R. 153 Sm-EDTMP for bone palliation in skeletal metastasis. Eur J Nucl Med Mol Imaging 2004;31(Suppl 1):S171–8.
Bayouth JE, Macey DJ, Kasi LP, Fossella FV. Dosimetry ad toxicity of samarium-153-EDTMP administered for bone pain due to skeletal metastases. J Nucl Med 1994;35:63–9.