肿瘤负荷和骨内代谢活性作为转移性前列腺癌患者放射性核素治疗期间骨髓衰竭的预测指标。

Tumor Burden and Intraosseous Metabolic Activity as Predictors of Bone Marrow Failure during Radioisotope Therapy in Metastasized Prostate Cancer Patients.

机构信息

Nuclear Medicine Unit, Department of Radiology, University of Tübingen, Tübingen, Germany.

Department of Internal Medicine, University of Genoa, Genova, Italy.

出版信息

Biomed Res Int. 2017;2017:3905216. doi: 10.1155/2017/3905216. Epub 2017 Dec 25.

RATIONALE

Radium-223-Dichloride (Ra-223) is an alpha-emitter, used to treat bone metastases. Patients with high metastatic burden and/or with increased trabecular bone uptake could present a higher incidence of hematologic toxicity. We hypothesized that these two factors are predictors of bone marrow failure.

MATERIAL AND METHODS

A computer algorithm discriminated between trabecular bone () and tumor metastases () within pretherapeutic whole-body skeletal SPECT/CT ( = 47). The program calculated the metastatic invasion percent (INV%) as the /( + ) ratio and extracted the mean counts. counts were correlated to % drop of hemoglobin (Hb), leukocytes (WBC), and platelets (PLT) after 3/6 Ra-223 cycles. Patient-specific and computational-derived parameters were tested as predictors of hematologic toxicity with MANOVA.

RESULTS

counts correlated with drop of Hb ( = 0,65, < 0.01) and PLT ( = 0,45, < 0.01). Appendicular counts showed a better correlation ( < 0.05, < 0.01, and < 0.001 for Hb, WBC, and PLT, resp.). INV% directly correlated with counts ( = 0.68, < 0.001). At MANOVA, grade III/IV toxicity was predicted by INV% ( < 0.01), by long-bone invasion ( < 0.005), and by counts ( < 0.05).

CONCLUSIONS

In patients with significant bone tumor burden, degree of bone invasion and trabecular bone uptake are predictors of subsequent bone marrow failure.

背景

镭-223 二氯化物（Ra-223）是一种α发射体，用于治疗骨转移。高转移负荷和/或骨小梁摄取增加的患者可能会出现更高的血液学毒性发生率。我们假设这两个因素是骨髓衰竭的预测因素。

材料和方法

计算机算法在治疗前全身骨骼 SPECT/CT 中区分出小梁骨（）和肿瘤转移灶（）（=47）。该程序计算了转移性侵袭百分比（INV%），即/（+）比值，并提取了平均计数。计数与 3/6 Ra-223 周期后血红蛋白（Hb）、白细胞（WBC）和血小板（PLT）的下降百分比相关。用 MANOVA 检验患者特定和计算衍生参数作为血液学毒性的预测因子。

结果

计数与 Hb 下降相关（=0.65，<0.01）和 PLT 下降相关（=0.45，<0.01）。四肢计数显示出更好的相关性（<0.05，<0.01，<0.001，分别用于 Hb、WBC 和 PLT）。INV%与计数直接相关（=0.68，<0.001）。在 MANOVA 中，III/IV 级毒性由 INV%（<0.01）、长骨侵袭（<0.005）和计数（<0.05）预测。