Biological dosimetry after radio - synoviorthesis with rhenium-186 sulphide and erbium-169 citrate

Summary

Radiosynoviorthesis (RSO) with the nuclides rhenium-186 sulphide (¹⁸⁶Re) and erbium-169 citrate (¹⁶⁹Er) is an established concept for the treatment of persistent synovitis of medium and small sized joints. The aim of the present studies was to investigate the biological radiation effect based on analysing chromosome aberrations. Patients, methods: Immediately before and 17 to 19 days (¹⁸⁶Re) or 45 to 50 (¹⁶⁹Er) days after RSO with ¹⁸⁶Re or ¹⁶⁹Er colloid and subsequent immobilisation of the treated joint, blood samples of a total of 23 patients were collected. The yield of dicentric chromosomes in lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, for ¹⁸⁶Re the activity leakage was measured three days after RSO by whole-body scintigraphy. Results: No statistically significant increase in the number of dicentric chromosomes (40 and 88 before and 59 and 105 after treatment with ¹⁸⁶Re and ¹⁶⁹Er, respectively) in a total of 47 017 cells analysed from 46 blood samples could be found as a result of RSO. For ¹⁸⁶Re an activity leakage of 3.9% ± 7% with a maximum of 23.4% corresponding to an effective dose of 2.8 ± 4.5 mSv , respectively 13.8 mSv, was determined. Also in the case of the maximum leakage no significant increase of dicentric chromosomes were detected. Conclusions: No significant biological radiation effect can be detected after RSO with ¹⁸⁶Re and ¹⁶⁹Er, also in cases of high leakage. Therefore, RSO can be classified as a save therapeutic procedure without a relevant radiation risk.

Zusammenfassung

Ziel: Die Radiosynoviorthese mit den Nukliden Rhenium-186-sulfid (¹⁸⁶Re) und Erbium-169-zitrat (¹⁶⁹Er) ist etabliert als Verfahren zur lokalen Therapie entzündlich-rheumatischer Erkrankungen mittelgroßer und kleiner Gelenke. Anhand der Auswertung von Chromosomenaberrationen soll die biologische Strahlenwirkung der Therapie untersucht werden. Patienten, Methoden: Direkt vor und 17 bis 19 Tage (¹⁸⁶Re) bzw. 45 bis 50 Tage (¹⁶⁹Er) nach RSO mit ¹⁸⁶Re und ¹⁶⁹Er sowie anschließender Ruhigstellung des behandelten Gelenks für 48 Stunden wurden bei 23 Patienten Blutproben entnommen. Die Häufigkeit dizentrischer Chromosomen in Lymphozyten in der Metaphase wurde nach der ersten Zellteilung in vitro bestimmt. Ergänzend wurde für ¹⁸⁶Re drei Tage nach RSO der Aktivitätsabtransport mittels Ganzkörperszintigraphie ermittelt. Ergebnisse: In den insgesamt 47 017 analysierten Zellen der 46 Blutproben wurde keine signifikante Zunahme der dizentrischen Chromosomen durch die RSO (40 bzw. 88 vor und 59 bzw. 105 nach der RSO mit ¹⁸⁶Re bzw. ¹⁶⁹Er) beobachtet. Bei der RSO mit ¹⁸⁶Re ergab sich ein Aktivitätsabtransport von 3,9% ± 7% entsprechend einer effektiven Dosis von 2,8 ± 4,5 mSv. Auch beim maximalen Abtransport von 23,4% (13,8 mSv) fand sich keine Zunahme der dizentrischen Chromosomen. Schluss - folgerung: Bei der RSO mit ¹⁸⁶Re und ¹⁶⁹Er findet sich, auch im Falle eines deutlichen Aktivitätsabtransportes, kein signifikanter biologischer Strahleneffekt. Insofern kann die RSO als sichere Therapie ohne relevantes Strahlenrisiko eingestuft werden.

Keywords

Rhenium-186 - erbium-169 - radiosynoviorthesis - chromosome aberration - biological dosimetry - activity leakage

Schlüsselwörter

Rhenium-186 - Erbium-169 - Radiosynoviorthese - Chromosomenaberrationen - biologische Dosimetrie - Aktivitätsabtransport

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