核医学教学课件：17-bone metastases therapy

1、 Treatment of painful bone metastases with radiopharmaceuticalDempartment of nuclear medicineDescriptionBone 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 painf

2、ul problem experienced by many cancer patients. Radiopharmaceutical Therapy for Palliation of Bone Pain from Osseous Metastases become more popular. Goals of treatmentPalliative therapy Palliation of Bone Pain and improve quanity of life Useless to primarily disease123Principle Radiopharmaceutical a

3、nalogy with bone constituents 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 effe

4、ctive half life-particle energy between 0.5 and 1.0 MeVHave a suitable range of fireAble to emit r-radiation,which can be detect by ECTIndicationhave bone pain or the pain can not relieve even with analgesicSkeletal metastasis involving above 1 site that are positive on bone scan.contraindication Ac

5、ute or chronic renal and liver failureAcute spinal cord suppressionBone marrow depression Step of therapy Have a bone scan Collect medical history Medication numerical rating scale (NRS)karnofsky performance status scaleMedicationTreated in an outpatient setting Patient is instructed about the radia

6、tion safety precautionsIntravenous injectionSide effectMost patients no reactionFew patients early reaction -Flare reaction (temporary increased pain)， nausea and vomiting，rash late reaction -temporary bone marrow depressionFollow-upBlood counts Blood counts are obtained at least weekly for the firs

7、t 6 weeks 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.89SrCl2Biologically like calcium.Localizes in areas of osteoblastic activity.Physical half-li

8、fe of 50.5 d Emits -particle with a maximum energy of 1.46 MeVaverage soft-tissue range of 2.4 mm. The usual therapeutic dose is 148 MBq (4 mCi).89SrCl2Most patients bone pain relieve 7-21days later after therapy.Analgesic effect come to peak in 1-2.5 months.Duration time is 3-12 months89SrCl2Retrea

9、t 3-6monthsBone pain relieve but not completely disappearPrevent occuring bone pain again89SrCl2Reaction mainly decrease in total blood countFlare reaction Samarium-153 Physical half-life of 1.9 d Emit and particle Phosphonate complex After intravenous injection, 1% remains in the blood at 5h. About

10、 65% of the dose remains in the skeleton. Samarium-153Retreat2-4 weekTherapy effectBone pain relieve at 7.96.8dDuration time is 2-26 weekEffective power between 85%-90%Compare with 89SrHave a shorter half lifeHave quickly effect to relieve bone painDuration time is shorter Emiting praticle ,which can be detected by ECT, in order to monitor distribution of drugs and therapeutic effectLess expense SummerayBone pain palliation therapy with radiopharmaceuticals is cost-effective systemic therapy to relieve pa