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Nuklearmedizin 2006; 45(05): 223-228
DOI: 10.1055/s-0038-1625224
Original Articles
Schattauer GmbH

Biological dosimetry after yttrium-90 citrate colloid radiosynoviorthesis

Biologische Dosimetrie nach Radiosynoviorthese mit einem Yttrium-90-Zitratkolloid
M. Voth
1   Schering AG, Berlin
,
R. Klett
1   Schering AG, Berlin
,
P. Lengsfeld
1   Schering AG, Berlin
,
G. Stephan
3   Federal Office for Radiation Protection, Department for Radiation and Health, Oberschleißheim
,
E. Schmid
4   Radiobiological Institute, University of Munich
5   Institute of Radiobiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany
› Author Affiliations
Further Information

Publication History

Received: 02 February 2006

in revised form: 19 June 2006

Publication Date:
10 January 2018 (online)

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Summary:

Radiosynoviorthesis (RSO) with the β-particle-emitting nuclide yttrium-90 is an established concept for the treatment of persistent synovitis of the knee joint. The aim of this study was to investigate the biological radiation effect on the basis of a characteristic radiation parameter. Patients, methods: After RSO procedures with yttrium-90 citrate colloid and subsequent immobilisation of the knee, blood specimens of 10 patients were collected immediately before RSO and 11 to 13 days after the intervention. The yield of dicentric chromosomes in the lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, activity leakage was measured by wholebody bremsstrahlung-scintigraphy. Results: No statistically significant increase in the number of dicentric chromosomes (26 before treatment and 34 after treatment) in 20 192 cells analyzed from the 20 blood samples could be found as a result of RSO. However, the analysis of at least 1000 cells per blood sample demonstrates a tendency for a biological radiation effect in the blood of patients on the basis of this characteristic radiation parameter. Two of the 10 RSO patients had undergone a second RSO using yttrium- 90 citrate, whereby one patient displayed activity transport out of the knee joint, amounting to 6 MBq. Only for him a radiation effect (about 130 mGy per single RSO) could be calculated by biological dosimetry. Conclusion: Since in general, based on the analysis of dicentric chromosomes in at least 1000 lymphocytes per individual, detection limits for groups of persons after long-term exposures to low-LET radiation of 50-100 mGy are possible, we assume that RSO with yttrium-90 should be associated with a low whole-body radiation exposure.

Zusammenfassung:

Ziel: Die Radiosynoviorthese (RSO) mit dem β-strahlenden Nuklid Yttrium-90 ist ein etabliertes Verfahren zur lokalen Therapie entzündlich-rheumatischer Erkrankungen des Kniegelenkes. Wegen der Möglichkeit eines Aktivitätsabtransportes aus dem Kniegelenk wurde in dieser Studie die biologische Strahlenwirkung anhand entstandener Chromosomenschäden analysiert. Patienten, Methoden: Bei der RSO mit Yttrium-90-Zitratkolloid und anschließender Ruhigstellung des Knies wurde bei 10 Patienten direkt vor der Therapie und 11 bis 13 Tage danach Blut entnommen. Zur Analyse der Strahlenexposition wurde die Häufigkeit von dizentrischen Chromosomen in Lymphozyten der ersten Zellteilung in vitro bestimmt. Ergänzend wurde der Aktivitätsabtransport mittels Ganzkörperszintigraphie bestimmt. Ergebnis: In insgesamt 20 192 analysierten Zellen der 20 Blutproben wurde keine signifikante Zunahme der dizentrischen Chromosomen durch die RSO (26 vor und 34 nach der RSO) beobachtet. Die Chromosomenanalyse in mindestens 1000 Zellen pro Blutprobe zeigte aber eine Tendenz für einen biologischen Strahleneffekt. Zwei der 10 Patienten erhielten eine weitere RSO. Bei einem dieser Patienten wurde mittels Ganzkörper-Bremsstrahlenszintigraphie ein Aktivitätsabtransport aus dem Gelenk von ungefähr 6 MBq nachgewiesen. Nur bei ihm konnte aufgrund der erhöhten Anzahl dizentrischer Chromosomen im Blut mittels biologischer Dosimetrie ein Strahleneffekt (130 mGy pro Einzel-RSO) durch die RSO nachgewiesen werden. Schlussfolgerung: Da nach längerfristiger Einwirkung von Low-LET-Strahlung die Analyse dizentrischer Chromosomen in 1000 Zellen pro Individuum ausreicht, um im bestrahlten Kollektiv Strahlendosen von 50 bis 100 mGy nachzuweisen, zeigen unsere Befunde, dass die RSO mit Yttrium- 90 nur zu einer relativ geringen Strahlenexposition der Patienten führt.

Key words:

Yttrium-90 - radiosynoviorthesis - radiation protection - chromosome aberration - biological dosimetry

Schlüsselwörter:

Yttrium-90 - Radiosynoviorthese - Strahlenschutz - Chromosomenaberration - biologische Dosimetrie
 

  • References

  • 1 Bauchinger M. Quantification of low-level radiation exposure by conventional chromosome aberration analysis. Mutat Res 1995; 339: 177-89.
    CrossrefPubMedGoogle Scholar
  • 2 Bauchinger M, Schmid E, Braselmann H. et al. Time-effect relationship of chromosome aberrations in peripheral lymphocytes after radiation therapy for seminoma. Mutat Res 1989; 211: 265-72.
    CrossrefPubMedGoogle Scholar
  • 3 Bridgman JF, Bruckner F, Eisen V. et al. Irradiation of the synovium in the treatment of rheumatoid arthritis. Q J Med 1973; 42: 357-67.
    Google Scholar
  • 4 Delbarre F, Le Go A, Menkes C. et al. Double blind statistical study of therapeutic effect of a radioactive yttrium (90Y) charged colloid on rheumatoid arthritis of the knee. C R Acad Sci Hebd Seances Acad Sci D 1974; 279: 1051-4.
    PubMedGoogle Scholar
  • 5 Doyle DV, Glass JS, Gow PJ. et al. A clinical and prospective chromosomal study of yttrium-90 synovectomy. Rheumatol Rehabil 1977; 16: 217-22.
    CrossrefPubMedGoogle Scholar
  • 6 Edmonds J, Smart R, Laurent R. et al. A comparative study of the safety and efficacy of dysprosium- 165 hydroxide macro-aggregate and yttrium- 90 silicate colloid in radiation synovectomy-- a multicentre double blind clinical trial. Australian Dysprosium Trial Group. Br J Rheumatol 1994; 33: 947-53.
    CrossrefPubMedGoogle Scholar
  • 7 Falcon de Vargas V, Fernandez-Palazzi F. Cytogenetic studies in patients with hemophilic hemarthrosis treated by 198Au, 186Rh, and 90Y radioactive synoviorthesis. J Pediatr Orthop 2000; B (Suppl. 09) 52-4.
    Google Scholar
  • 8 Farahati J, Schulz G, Wendler J. et al. Multivariate analysis of factors influencing the effect of radiosynovectomy. Nuklearmedizin 2002; 41: 114-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Fernandez-Palazzi F, Caviglia H. On the safety of synoviorthesis in haemophilia. Haemophilia 2001; 7 (Suppl. 02) 50-3.
    CrossrefPubMedGoogle Scholar
  • 10 Gumpel JM, Stevenson AC. Chromosomal damage after intra-articular injection of different colloids of yttrium 90. Rheumatol Rehabil 1975; 14: 7-12.
    CrossrefPubMedGoogle Scholar
  • 11 International Atomic Energy Agency (IAEA). Biological dosimetry: Chromosomal aberration analysis for dose assessment. Technical Reports 1986, Series No. 260, 1-68.
    Google Scholar
  • 12 International Commission on Radiological Protection (ICRP) Relative biological effectiveness (RBE), quality factor (Q), and radiation weighting factor (wR). Annals of the ICRP 2003, Publication 92, Vol. 33.
    Google Scholar
  • 13 Jahangier ZN, Moolenburgh JD, Jacobs JW. et al. The effect of radiation synovectomy in patients with persistent arthritis: a prospective study. Clin Exp Rheumatol 2001; 19: 417-24.
    PubMedGoogle Scholar
  • 14 Johnson LS, Yanch JC. Absorbed dose profiles for radionuclides of frequent use in radiation synovectomy. Arthritis Rheumatol 1991; 34: 1521-30.
    PubMedGoogle Scholar
  • 15 Klett R, Puille M, Matter HP. et al. Activity leakage and radiation exposure in radiation synovectomy of the knee: influence of different therapeutic modalities. Z Rheumatol 1999; 58: 207-12.
    CrossrefPubMedGoogle Scholar
  • 16 Klett R, Puille M, Steiner D. et al. Radiation synovectomy of the knee joint. Evaluation of bremsstahlung- detection by using a corpse phantom. Nuklearmedizin 2006; 45: 57-61.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kresnik E, Mikosch P, Gallowitsch HJ. et al. Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints. Nucl Med Commun 2002; 23: 683-8.
    CrossrefPubMedGoogle Scholar
  • 18 Krogh Jensen M, Nyfors A. Cytogenetic effect of methotrexate on human cells in vivo: Comparison between results obtained by chromosome studies on bone-marrow cells and blood lymphocytes and by the micronucleus test. Mutat Res 1979; 64: 339-43.
    CrossrefPubMedGoogle Scholar
  • 19 Lloyd DC, Reeder EJ. Chromosome aberrations and intra-articular yttrium-90. Lancet 1978; 1: 617.
    PubMedGoogle Scholar
  • 20 Löbrich M, Rief N, Kühne M. et al. In vivo formation and repair of DNA double-strand breaks after computed tomography examinations. PNAS 2005; 102: 8984-9.
    CrossrefPubMedGoogle Scholar
  • 21 Menkes CJ. Is there a place for chemical and radiation synovectomy in rheumatic diseases?. Rheumatol Rehabil 1979; 18: 65-77.
    CrossrefPubMedGoogle Scholar
  • 22 Mondello C, Giorgi R, Nuzzo F. Chromosomal effects of methotrexate on cultured human lymphocytes. Mutat Res 1984; 139: 67-70.
    CrossrefPubMedGoogle Scholar
  • 23 Prosser JS, Izard BE, Brown JK. et al. Induction of micronuclei in peripheral blood lymphocytes of patients treated for rheumatoid or osteo-arthritis of the knee with dysprosium-165 hydroxide macroaggregates or yttrium-90 silicate. Cytobios 1993; 73: 7-15.
    PubMedGoogle Scholar
  • 24 Prosser JS, Moquet JE, Lloyd DC. et al. Radiation induction of micronuclei in human lymphocytes. Mutat Res 1988; 199: 37-44.
    PubMedGoogle Scholar
  • 25 Rizzo E, Marchisio S, Bigatti P. et al. Long-term chromosomal effects of radiation synovectomy in rheumatoid arthritis patients. Med Sci Res 1998; 26: 53-5.
    Google Scholar
  • 26 Schmid E, Bauchinger M, Streng S. et al. The effect of 220 kVp X-rays with different spectra on the dose response of chromosome aberrations in human lymphocytes. Radiat Environ Biophys 1984; 23: 305-9.
    CrossrefPubMedGoogle Scholar
  • 27 Schmid E, Selbach HJ, Voth M. et al. The effect of the β-emitting yttrium-90 citrate on the dose response of dicentric chromosomes in human lymphocytes: a basis for biological dosimetry after radiosynoviorthesis. Radiat Environ Biophys. 2006: 45 DOI 10.1007/S00411-006-0045-4.
    PubMedGoogle Scholar
  • 28 Schütte H, Rau R. Results of radiosynoviorthesis with yttrium 90 in chronic synovitis: a long-term prospective study. II. Effect of general disease parameters. Z Rheumatol 1983; 42: 271-9.
    PubMedGoogle Scholar
  • 29 Shabat S, Kollender Y, Merimsky O. et al. The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints. Rheumatology (Oxford) 2002; 41: 1113-8.
    CrossrefPubMedGoogle Scholar
  • 30 Stephan G, Pressl S. Chromosomal aberrations in peripheral lymphocytes from healthy subjects as detected in first cell division. Mutat Res 1999; 446: 231-7.
    CrossrefPubMedGoogle Scholar
  • 31 Trepel F. Kinetik lymphatischer Zellen. In: Lymphozyt und klinische Immunologie. In: Themel H, Begemann H. (eds). Berlin: Springer; 1975: 16-26.
    CrossrefGoogle Scholar
  • 32 Urbanová Z, Gatterová J, Olejárová M. et al. Radiosynoviorthesis with Y-90. Results of a clinical study. Èes Revmatol 1997; 5: 140-2.
    Google Scholar
  • 33 Wilcoxon F. Individual comparisons by ranking methods. Biometrics 1945; 1: 80-3.
    Google Scholar