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DOI: 10.1055/s-0032-1321794
Therapie mit offenen Radionukliden bei multilokulärer Skelettmetastasierung
Radionuclide Therapy of Multilocular Bone MetastasesPublikationsverlauf
Publikationsdatum:
11. September 2012 (online)
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Zusammenfassung
Die nuklearmedizinische palliative Schmerztherapie stellt eine nebenwirkungsarme, ergänzende Behandlungsoption im Gesamtspektrum der Schmerztherapie bei Patienten mit einer multilokulär osteoblastischen Metastasierung vieler Primärtumoren dar. Sie zeichnet sich durch einen raschen Einsatz der Schmerzlinderung und durch lang anhaltende Wirkung aus. Vorläufige Berechnungen weisen auf eine günstige Kosten-Nutzen-Relation hin. Durch die nuklearmedizinische palliative Schmerztherapie bessert sich bei Patienten mit metastasiertem Mamma- oder Prostatakarzinom die Schmerzsymptomatik in 70–80%, bei anderen Primärtumoren weniger häufig [7] [10]. Völlig schmerzfrei werden nur wenige Patienten. Eine medikamentöse Basistherapie ist bei den meisten Tumorpatienten weiterhin erforderlich. Insgesamt zeichnet sich die Therapie durch eine hohe Akzeptanz bei den Patienten aus, da es sich bei der Verwendung von 89Strontium oder 153Samarium um eine einmalige intravenöse Applikation handelt. Aktuelle Studien zum kombinierten Einsatz von Radionukliden und Chemotherapie bzw. die klinischen Daten der Anwendung von 223Radium belegen weitere Entwicklungsmöglichkeiten der systemischen Radionuklidtherapie von einer rein palliativen Behandlung hin zu tumoriziden Effekten mit signifikanter Lebensverlängerung der betroffenen Patienten.
Abstract
Pain palliation therapy using radionulides is a safe, additive therapeutic procedure in the spectrum of effective treatment in patients with multilocular mainly osteoblastic skeletal metastases from different primaries. The radionulide therapy is characterized by fast pain palliation and long-term symptom benefit in 70–80% of patients suffering from breast or prostate cancer. Lower response rates are observed in other primaries. Only few patients are becoming totally pain free, most patients have to continue basal therapy with pain medication.
The single intraveneous administration is well tolerated and accepted by most patients. Recent studies administering combination therapy of radionuclides and chemotherapy show promising effects on tumoricity. Also preliminary results of trials using 223Radium, an alpha emitter show good pain symptom control and significantly prolonged survival.
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Literatur
- 1 Brucher M. A chronology of nuclear medicine. St. Louis: Heritage Publications; 1990
- 2 Chatterjee A, Mambo E, Sidransky D. Mitochondrial DNA mutations in human cancer. Oncogene 2006; 25: 4663-4674
- 3 Coleman RE, Smith P, Rubens RD. Clinical course and prognostic factors following bone recurrence from breast cancer. Br J Cancer 1998; 77: 336-340
- 4 Coleman RE. Metastatic bone disease: clinical features pathophysiology and treatment strategies. Cancer Treat Rev 2001; 27: 165-176
- 5 Collins C, Eary JF, Donaldson G et al. Samarium-153 EDTMP in bone metastases of hormone refractory prostate carcinoma: a phase I/II trial. J Nucl Med 1993; 34: 1839-1844
- 6 De Puy V, Anstrom KJ, Castel LD et al. Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer. Support Care Cancer 2007; 15: 869-876
- 7 Elgazzar AH, Maxon HR. Radioisotope therapy of cancer related bone pain. In: Limouris GS, Shukla SK. (eds.). Radionuclides for therapy. Athen: Mediterra Publishers; 1993: 111-116
- 8 Fischer M. Leitlinie für die Radionuklidtherapie bei schmerzhaften Knochenmetastasen. Nuklearmedizin 1999; 38: 270-272
- 9 Fischer M, Kampen WU. Radionuclide therapy of bone metastases. Breast Care 2012; 7: 100-107
- 10 Fuster D, Herranz R, Vidal-Sicart S et al. Usefulness of strontium-89 for bone pain palliation in metastatic breast cancer patients. Nucl Med Commun 2000; 21: 623-626
- 11 Geldof AA, de Rooij L, Versteegh RT et al. Combination 186-Re-HEDP and cistplatin supraadditive treatment effects in prostate cancer cells. J Nucl med 1999; 40: 667-671
- 12 Gerlinger M, Rowan AJ, Horswell S et al. Intratumor heterogenety and branched evolution revealed by multiregion sequencing. N Engl J Med 2012; 366: 883-892
- 13 Inoue T, Segawa T, Kamba T et al. Prevalence of skeletal complications and their impact on survival of hormone refractory prostate cancer patients in Japan. Urology 2009; 73: 1104-1109
- 14 Kampen WU, Czech N, Fischer M. Nuklearmedizinische Schmerztherapie. In: Baron R, Koppert W, Strumpf M, Willweber-Strumpf A. Hrsg Praktische Schmerztherapie. Springer; Heidelberg: 2007: 207-215
- 15 Krishnamurthy GT, Krishnamurthy S. Invited commentary: Radionuclides for metastatic bone pain palliation: a need for rational re-evaluattion in the new millennium. J Nucl Med 2000; 41: 688-691
- 16 Liepe K, Kotzerke J. A comparative study of 188Re-HEDP, 186Re-HEDP, 153Sm-EDTMP and 89 Sr in the treatment of painful skeletal metastases. Nucl Med Commun 2007; 28: 623-630
- 17 Loeb KR, Loeb LA. Significance of multiple mutations in cancer. Carcinogenesis 2000; 21 (03) 379-385
- 18 Marcus CS, Saeed S, Mlikotic A et al. Lack of effect of a bisphosphonate (pamidronate disodium) infusion on subsequent skeletal uptake of Sm-153-EDTMP. Clin Nucl Med 2002; 27: 427-430
- 19 McEwan AJB. Palliation of bone pain. In: Murray IPC, Ell PJ. Hrsg Nuclear medicine in Clinical Diagnosis and Treatment. Churchill Livingston; Edinburgh: 1994: 877-892
- 20 Mend Y, Bushnell DL, Williams RD et al. Efficacy and safety of repeated Samarium-153 Lexidrnam treatment in a patient with prostate cancer and metastatic bone pain. Clin Nucl Med 2000; 25: 698-700
- 21 Minutoli F, Herberg A, Spadaro P et al. [186Re]HEDP in the palliation of painful bone metastases from cancers other than prostate and breast. Q J Nucl Med Mol Imaging 2006; 50: 355-362
- 22 Nilsson S, Parker C, Tyrell C et al. Bone-targeted radium-223 in symptomatic, hormone-refractory prostate cancer: a randomised, multicentre, placebo-controlled phase II study. Lancet Oncol 2007; 8: 587-594
- 23 Nørgaard M, Jensen AØ, Jacobsen JB et al. Skeletal related events, bone metastases and survival of prostate cancer: a population based cohort study in Denmark (1999 to 2007). J Urol 2010; 184: 162-167
- 24 Paes FM, Serafini AN. Systemic metabolic raqdiopharmaceutical therapy in the treatment of metastatic bone pain. Semin Nucl Med 2010; 40: 89-104
- 25 Parker C et al. Role of Radium-223 in the treatment of advanced prostate cancer. Poster Presentation ECCO ESMO 2011
- 26 Pecher C. Biological investigations with radioactive calcium and strontium: preliminary report on the use of radioactive strontium in the treatment of metastatic bone cancer. Univ Calif Pub Pharmacol 1942; 2: 117-149
- 27 Porter AT, McEwan AJB, Powe JE et al. Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Rad Oncol Biol Phys 1993; 25: 805-813
- 28 Quattrocchino CC, Piciucchi S, Sammarra M et al. Bone metastases in breast cancer: higher prevalence of osteoblastic lesions. Radiol Med 2007; 112: 1049-1059
- 29 Resche I, Chatal JF, Pecking A et al. A dose controlled study of Sm-153 ethylenediaminetetramethylenephosphate in the treatment of patients with painful metastases. Eur J Cancer 1997; 33: 1583-1591
- 30 Sartor O, Hoskin P, Bruland OS. Targeted radio-nuclide therapy of skeletal metastases. Cancer Treat Rev 2012; http://dx.doi.org/10.1016/j.ctrv2012.03.006
- 31 Sciuto R, Festa A, Rea S et al. Effects of low-dose cisplatin on 89-Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med 2002; 43: 79-86
- 32 Suomine MI, Rissanen JK, Käkönen R et al. Alpharadin inhibits osteoclast differentiation in vitro and progression of established breast cancer bone metastases in vivo. Am Ass Cancer Research Annual Meeting 2011; abstr. 2664
- 33 Tu SM, Delpass ES, Jones D et al. Strontium-89 combined with doxorubicin in the treatment of patients with androgen independent prostate cancer. Urol Oncol 1997; 2: 191-197
- 34 World Health Organisation . Cancer pain relief and palliative care. WHO Technical Report Series 1990; 804: 7-73