Tripathi M, Singhal T, Chandrasekhar N, Kumar P, Bal C, Jhulka P K, Bandopadhyaya G, Malhotra A
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian J Cancer. 2006 Apr-Jun;43(2):86-92. doi: 10.4103/0019-509x.25890.
Systemic therapy with radionuclides may be used for the treatment of patients with painful skeletal metastases owing to its efficacy, low cost and low toxicity. Imported radionuclides for pain palliation, like Strontium-89 are expensive; particularly for developing countries. In the Indian scenario, Samarium-153 (Sm-153) is produced in our own reactors and as a result, it is readily available and economical.
We undertook this study to determine the efficacy and toxicity of single-dose Sm-153 ethylenediamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases.
Eightysix patients with painful skeletal metastases from various primaries, were treated with Sm-153 EDTMP at a dose of 37 MBq/kg. The effects were evaluated according to change in visual analogue pain score, analgesic consumption, Karnofsky performance score, mobility score and blood count tests, conducted regularly for 16 weeks.
Repeated measures analysis.
The overall response rates were 73%, while complete response was seen in 12.4%. Reduction in analgesic consumption with improvement in Karnofsky performance score and mobility score, was seen in all responders. Response rates were 80.3 and 80.5% in breast and prostate cancer, respectively. One case, each of Wilms tumor, ovarian cancer, germ cell tumor testis, multiple myeloma, primitive neuroectodermal tumor and oesophageal cancer, did not respond to therapy. No serious side-effects were noted, except for fall in white blood cell, platelet and haemoglobin counts, which gradually returned to normal levels by six-eight weeks.
Sm-153 EDTMP provided effective palliation in 73% patients with painful bone metastases: the major toxicity was temporary myelosuppression.
放射性核素全身治疗因其疗效、低成本和低毒性，可用于治疗伴有疼痛的骨转移患者。用于缓解疼痛的进口放射性核素，如锶-89，价格昂贵；尤其对于发展中国家而言。在印度的情况下，钐-153（Sm-153）是在我们自己的反应堆中生产的，因此，它很容易获得且经济实惠。
我们进行这项研究以确定单剂量Sm-153乙二胺四亚甲基膦酸盐作为伴有疼痛的骨转移姑息治疗的疗效和毒性。
86例来自各种原发肿瘤的伴有疼痛的骨转移患者，接受了剂量为37 MBq/kg的Sm-153 EDTMP治疗。根据视觉模拟疼痛评分的变化、镇痛药消耗量、卡氏功能状态评分、活动能力评分和血细胞计数测试来评估效果，定期进行16周。
重复测量分析。
总体缓解率为73%，完全缓解率为12.4%。所有缓解者均出现镇痛药消耗量减少，同时卡氏功能状态评分和活动能力评分得到改善。乳腺癌和前列腺癌的缓解率分别为80.3%和80.5%。各有1例肾母细胞瘤、卵巢癌、睾丸生殖细胞瘤、多发性骨髓瘤、原始神经外胚层肿瘤和食管癌患者对治疗无反应。除白细胞、血小板和血红蛋白计数下降外，未观察到严重副作用，这些指标在6-8周时逐渐恢复正常水平。
Sm-153 EDTMP为73%伴有疼痛的骨转移患者提供了有效的姑息治疗：主要毒性为暂时性骨髓抑制。
