National Cancer Institute, 22/43 Lomonosova Str., Kyiv, 03022, Ukraine.
Probl Radiac Med Radiobiol. 2021 Dec;26:562-572. doi: 10.33145/2304-8336-2021-26-562-572.
The study objective was to investigate and compare the effectiveness of different radiopharmaceuticalsin the treatment of metastatic bone disease.
Cancer patients (n = 150, average age (55 ± 11.6) years, 95 females, 55 males) having gotvarious primary tumors and metastatic bone disease were given medical treatment at the Department of NuclearMedicine of the National Institute of Cancer. The 153Sm, 32Р, and 89Sr radiopharmaceutical agents produced by the«Radiopreparats» enterprise (Republic of Uzbekistan) and Radioisotope Centre Polatom (National Centre for NuclearResearch, Poland) were administered to the patients. There were cases of breast cancer (n = 75), prostate cancer(n = 45), lung cancer (n = 10), kidney cancer (n = 4), cervical cancer (n = 5), and rectosigmoid cancer (n = 11) amongthe treated subjects. In 135 patients (90 %) the bone metastases were detected by osteoscintigraphy with 99мTc- mo-nodiphosphonate. In 15 cases the diagnosis of metastatic bone disease was verified by other radiology methods.
The pain intensity rating scale (LACOMED) was used to assay the analgesic effect of various radiopharma-ceuticals in metastatic bone disease. Results of treatment with 32P, 89Sr, and 153Sm were included in a comparativeanalysis procedure. It was established that the level of pain syndrome ranged from 7-8 points on the LACOMED scalebefore treatment. Upon administration of radionuclide therapy the level of pain was reduced down to 3-5 points,namely with 32P therapy it has decreased by 30.7 %, with 89Sr by 33.2 %, and with 153Sm by 41.5 % respectively. Timepattern of 153Sm analgesic effectiveness was studied depending on the number of treatment sessions. The best valueof analgesic effect of 153Sm was registered after the first treatment session with a tendency to decrease after the sec-ond and significantly lower analgesic effects after the third session. Tolerance of 153Sm was rated on the CTCNCA (v)4.3 scale. The best tolerance was peculiar to 153Sm corresponding to the «good» level according to a point assess-ment. When using 89Sr the drug tolerance was lower, not requiring however the drug discontinuation. The 32P radio-pharmaceutical featured the lowest tolerance approaching the «satisfactory» rating. In 11 patients upon that theside effects were found significantly impairing the patient's status, accordingly some extra measures were required.No decision to cancel the drug administration was made.
Radionuclide therapy with 153Sm-oxabiphor agent can be used in the complex treatment of metastat-ic bone disease in cancer patients having got tumors of different localization. 153Sm-oxabiphor is the most effectiveand best tolerable radiopharmaceutical agent in the pain treatment in metastatic bone disease in comparison with32P and 89Sr preparations (р < 0.05).
研究目的是调查和比较不同放射性药物在治疗转移性骨病中的疗效。
在国家癌症研究所核医学系接受治疗的癌症患者（n=150，平均年龄（55±11.6）岁，95 名女性，55 名男性）患有各种原发性肿瘤和转移性骨病。放射性药物 153Sm、32Р 和 89Sr 由乌兹别克斯坦共和国“放射制剂”企业和波兰国家核研究中心（波兰）生产，并用于治疗患者。接受治疗的患者中包括乳腺癌（n=75）、前列腺癌（n=45）、肺癌（n=10）、肾癌（n=4）、宫颈癌（n=5）和直肠乙状结肠癌（n=11）。135 例患者（90%）通过 99mTc-单磷酸盐骨闪烁显像术检测到骨转移。在 15 例患者中，通过其他影像学方法证实了转移性骨病的诊断。
采用 LACOMED 疼痛强度评分量表评估各种放射性药物在转移性骨病中的镇痛效果。32P、89Sr 和 153Sm 的治疗结果被纳入比较分析程序。结果表明，治疗前疼痛综合征的 LACOMED 评分范围为 7-8 分。核素治疗后，疼痛程度降低至 3-5 分，即 32P 治疗降低了 30.7%，89Sr 治疗降低了 33.2%，153Sm 治疗降低了 41.5%。根据治疗次数研究了 153Sm 镇痛效果的时间模式。第一次治疗后，153Sm 的镇痛效果最佳，第二次治疗后呈下降趋势，第三次治疗后镇痛效果明显降低。根据 CTCNCA（v）4.3 量表评估 153Sm 的耐受性。153Sm 的耐受性最好，对应于“良好”水平的评分。使用 89Sr 时，药物耐受性较低，但不需要停药。32P 放射性药物的耐受性最低，接近“满意”评分。在 11 名患者中，发现副作用显著影响患者的状态，因此需要采取额外措施。没有决定取消药物治疗。
在患有不同定位肿瘤的癌症患者中，用 153Sm-oxabiphor 制剂进行放射性核素治疗可用于治疗转移性骨病的综合治疗。与 32P 和 89Sr 制剂相比，153Sm-oxabiphor 在治疗转移性骨病疼痛方面是最有效和耐受性最好的放射性药物（р < 0.05）。
