Nuklearmedizinische Schmerztherapie von Skelettmetastasen

Zusammenfassung.

Patienten mit schmerzhaften Knochenmetastasen sind ein häufig zu beobachtendes Phänomen in vielen onkologischen Abteilungen. Neben der medikamentösen Schmerztherapie und perkutanen Strahlentherapie stellt die nuklearmedizinsche Schmerztherapie mit Samarium-153 EDTMP, Rhenium-186 HEDP und Strontium-89 ein effektives Therapieverfahren in der Behandlung von Patienten mit multilokulärer osteoblastischer Metastasierung und ausgeprägter Schmerzsymptomatik dar. Bei richtiger Indikationsstellung und Durchführung weist dieses palliative Verfahren eine hohe Ansprechrate mit Schmerzlinderung und Verbesserung der Lebensqualität auf.

Radionuclide therapy in metastatic bone disease.

In a high number of patients bone pain from osteoblastic metastases is a frequently observed problem at an Oncology Department. Besides medical treatment and percutaneous irradiation, systemic radionuclide therapy is an effective treatment for patients with cancer metastatic to bone which presents with progressive pain. Used in the appropriate setting, this form of palliative therapy in patients with painful osteoblastic metastases can be of great benefit to a large number of patients by pain relief and increase of life quality.

Schlüsselwörter:

Radionuklid-Therapie - Skelettmetastasen - ⁸⁹Sr - ¹⁸⁶Re-HEDP - ¹⁵³Sm-EDTMP

Key words:

Radionuclide therapy - Skeletal metastases - ⁸⁹Sr - ¹⁸⁶Re-HEDP - ¹⁵³Sm-EDTMP

Literatur

• 1 Zykla-Menhorn. . Zeitbombe des Alterns.  Deutsches Ärztebl. 2000;  97 (6) 253
• 2 Twycross R G, Fairfielda S. Pain in far-advanced cancer.  Pain. 1982;  14 303-310
• 3 Nielsen O D, Munro A J, Tannock I F. Bone metastases: physiology and management policy.  J Clin Oncol. 1991;  9 509
• 4 Hortobagyi G N. Bone metastases in breast cancer patients.  Semin Oncol. 1991;  18 11
• 5 CIS Bio International . Metastases osseuses: prise en charge de la doulur metastatique.  Internal Report. 1993;  14
• 6 Coleman R E, Rubens S. The clinical course of bone metastases from breast cancer.  Br J Cancer. 1987;  55 61
• 7 McEwan A J. Palliation of bone pain. In: Murray IPC, Ell PJ (eds) Nuclear medicine in Clinical Diagnosis and Treatment. Edinburgh; Churchill Livingston 1994: 877-892
• 8 Averbuch S D. New bisphosphonates in the treatment of bone metastases.  Cancer. 1993;  72 3443-3452
• 9 Fischer M, Böhme K. Nuklearmedizinische Schmerztherapie bei metastasiertem Prostatakarzinom.  Der Nuklearmediziner. 1996;  5 (19) 339-344
• 10 Heoderath A, Schüle-Hein K, Sack H. Palliative Strahlentherapie. In: Scherer E, Ack H (Hrsg) Strahlentherapie: Radiologische Onkologie. Berlin, Heidelberg; Springer 1996: 897-920
• 11 World Health Organization. Cancer pain relief Geneva; World Health Organization 1991
• 12 Hoskin P J. Radiotherapy in the management of bone metastases. In: Rubens, Fogelman (eds) Bone metastases. London; Springer 1991: 171-185
• 13 Mertens W C, Reid R H, Porter A T, Powe J E. Recent advances in radionuclide therapy of bone metastases. In: Freeman LM (ed) Nuclear medicine annual. New York; Raven Press 1992: 69-89
• 14 Pons F, Herranz R, Garcia A, Vidal-Sicart S, Conill C, Grau J J, Alcover J, Fuster D, Setoain J. Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer.  Eur J Nuc Med. 1997;  24 1210-1214
• 15 Silberstein E B. Systemic radiopharmaceutical therapy of painful osteoblastic metastases.  Semin Radiat Oncol. 2000;  10 240-249
• 16 Silberstein E B, Eugene L, Saenger S R. Painful osteoblastic metastases: the role of nuclear medicine.  Oncology. 2001;  15 157-163
• 17 Pecher C. Biological investigations with radioactive calcium and strontium.  Proc Soc Exp Biol Med. 1941;  46 86-91
• 18 Blake G M, Zivanovic M A, McEwan A J, Ackery D M. Sr-89 therapy: Strontium kinetics in disseminated carcinoma of the prostate.  Eur J Nuc Med. 1986;  12 447-454
• 19 Kasalicky J, Krajska V. The effect of repeated strontium-89 chloride therapy on bone pain palliation in patients with skeletal cancer metastases.  Eur J Nuc Med. 1998;  25 1362-1367
• 20 Nair N. Relative efficacy of 32P and 89Sr in palliation in skeletal metastases.  J Nuc Med. 1999;  40 256-261
• 21 Bolger J J, Dearnaley D P, Kirk D, et al. Strontium-89 (Metastron) versus external beam radiotherapy in patients with painful bone metastases secondary to prostatic cancer: preliminary report of a multicenter trial. UK Metastron investigators group.  Semin Oncol. 1993;  20 32-33
• 22 Quilty P M, Kirk D, Bolger J J, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer.  Radiother Oncol. 1994;  31 33-40
• 23 Kaplan E, Fels I G, Kotlowski B R. Therapy of carcinoma of the prostate metastatic to bone with P-32-labeled condensed phosphate.  J Nuc Med. 1960;  1 1-13
• 24 Kutzner J, Dahnert W, Schreyer T. Yittrium-90 zur Schmerztherapie von Knochenmetastasen.  Nuc Med. 1981;  20 229-235
• 25 Han S H, Zonnenberg B A, De Klerk J MH, Qurijnen J MSP, Van Het Ship A D, Van Dijk A, Blijham G H, Van Rijk P P. 186 Re-Etidronat in breast cancer patients with metastatic bone pain.  J Nuc Med. 1999;  40 639-642
• 26 Preston D F, Baxter K G. Therapy for painful skeletal metastases. In: Henkin RE (ed) Nuclear medicine. St. Louis; Mosby 1996: 1583-1593
• 27 Maxon H R, Deutsch E A, Thomas S R, Libson K. Re-186 HEDP for treatment of multiple metastatic foci in bone: human biodistribution and dosimetric studies.  Radiology. 1988;  166 501-507
• 28 Farhanghi M, Holmes R A, Volkert W A, Logan W, Singh A. Samarium-153-EDTMP: Pharmacokinetic, toxicity and pain response using an escalating dose schedule in treatment of metastatic bone cancer.  J Nuc Med. 1992;  33 1451-1458
• 29 Bayouth J E, Macey D J, Kasi L P, Fosella F V. Dosimetry and toxicity of Samarium-153-EDTMP administered for bone pain due to skeletal metastases.  J Nuc Med. 1994;  35 63-69
• 30 Resche I, Chatal J F, Pecking A, et al. A dose-controlled study of 153-Sm-Ethylenediaminetetramethylenphosphonate (EDTMP) in the treatment of patients with painful bone metastases.  Eur J Cancer. 1997;  33 1583-1591
• 31 Serafini A N, Houston S, Resche I, et al. Palliation of pain associated with metastatic bone cancer using Samarium-153 Lexidronam: a double-blind placebo-controlled clinical trial.  J Clin Oncol. 1998;  16 1574-1581
• 32 Tian J, Zhang J, Hou Q, et al. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China.  Eur J Nuc Med. 1999;  26 2-7
• 33 Singh A, Holmes R A, Farhangi M, Volkert W A. Human pharmacokinetics of Samarium-153 EDTMP in metastatic cancer.  J Nuc Med. 1989;  30 1814-1818
• 34 Geldof A A, De Rooij L, Versteegh R T, Newling D WW, Teule G JJ. Combination 186Re-HEDP and Cisplatin supra-additive treatment effects in prostate cancer cells.  J Nuc Med. 1999;  40 667-671
• 35 Geldof A A, Van den Tillaar P LM, Newling D MW, Teule G JJ. Radionuclide therapy for prostate cancer lumbar metastasis prolongs symptom-free survival in a rat model.  Urology. 1997;  49 795-801
• 36 Palmedo H, Grünwald F, Wagner U, Köhler S, Krebs D, Biersack H J. Remission of bone metastases after combined chemotherapy and radionuclide therapy with Re-186-HEDP.  Clin Nuc Med. 1998;  23 (8) 501-504
• 37 McCready R, Al-Deen A, Treleaven J, Dearnalay D. Response of skeletal metastases to high activities of Rhenium-186-HEDP.  Eur J Nuc Med. 1999;  26 (9) PS-642