核医学课件：Bone metastases therapy

1、Treatment of painful bone metastases with radiopharmaceutical,Description,Bone metastases occur in more than 50% of cancer patients.,Up to 80% of breast,prostate and lung cancer patients will develop skeletal metastases.,Bone metastases are a very common and often painful problem experienced by many

2、 cancer patients.,Radiopharmaceutical Therapy for Palliation of Bone Pain from Osseous Metastases become more popular.,Goals of treatment,Palliative therapy,Palliation of Bone Pain and improve quanity of life,Useless to primarily disease,1,2,3,Principle,Radiopharmaceutical analogy with bone constitu

3、ents localizes in areas of osteoblastic(成骨细胞） activity. The ionising effect of -radiation lead to DNA damage.,Ideal Radiopharmaceutical,Most of drugs accumulate in cancer leision ,less of them accumulate in normal bone tissue or it can be quickly clear up. Have a suitable effective half life -partic

4、le energy between 0.5 and 1.0 MeV Have a suitable range of fire Able to emit r-radiation,which can be detect by ECT,Indication,have bone pain or the pain can not relieve even with analgesic Skeletal metastasis involving above 1 site that are positive on bone scan.,contraindication,Acute or chronic r

5、enal and liver failure Acute spinal cord suppression Bone marrow depression,Step of therapy,Have a bone scan Collect medical history Medication,numerical rating scale (NRS),karnofsky performance status scale,Medication,Treated in an outpatient setting Patient is instructed about the radiation safety

6、 precautions Intravenous injection,Side effect,Most patients no reaction Few patients early reaction -Flare reaction (temporary increased pain)， nausea and vomiting，rash late reaction -temporary bone marrow depression,Follow-up,Blood counts Blood counts are obtained at least weekly for the first 6 w

7、eeks and more frequently if there is evidence of toxicity. Bone scan Retreate Patients whose blood counts do return to pretreatment values may be retreated. Different agents have different retreat time.,89SrCl2,Biologically like calcium. Localizes in areas of osteoblastic activity. Physical half-lif

8、e of 50.5 d Emits -particle with a maximum energy of 1.46 MeV average soft-tissue range of 2.4 mm. The usual therapeutic dose is 148 MBq (4 mCi).,89SrCl2,Most patients bone pain relieve 7-21days later after therapy. Analgesic effect come to peak in 1-2.5 months. Duration time is 3-12 months,89SrCl2,

9、Retreat 3-6months Bone pain relieve but not completely disappear Prevent occuring bone pain again,89SrCl2,Reaction mainly decrease in total blood count Flare reaction,Samarium-153,Physical half-life of 1.9 d Emit and particle Phosphonate complex After intravenous injection, 1% remains in the blood a

10、t 5h. About 65% of the dose remains in the skeleton.,Samarium-153,Retreat 2-4 week Therapy effect Bone pain relieve at 7.96.8d Duration time is 2-26 week Effective power between 85%-90%,Compare with 89Sr,Have a shorter half life Have quickly effect to relieve bone pain Duration time is shorter Emiting praticle ,which can be detected by ECT, in order to monitor distribution of drugs and therapeutic effect Less expense,Summeray,Bone pain palliation therapy with radiopharmaceuticals is cost-effective systemic therapy to relieve p