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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
Online ISSN 1827-1936
NUCLEAR MEDICINE APPLICATIONS FOR BONE METASTASES
Serafini A. N.
From the Division of Nuclear Medicine University of Miami School of Medicine, Miami, Florida, USA
Various radioisotopes conjugated to pyrosphosphate analogues have been developed for systemic metabolic radiotherapy. Samarium-153-EDTMP is a 1:1 complex of radioactive Samarium-153 and a Tetraphosphonate [ethylenediamine-tetramethylene phosphonic acid (EDTMP)]. Samarium Sm-153-EDTMP has a high affinity for skeletal tissue and concentrates by chemiabsorption in areas of enhanced metabolic activity, where it associates with the hydroxyappetite crystal. Samarium-153 Lexidronam [Quadramet (R)] has been approved for routine use by the FDA. This agent offers several advantages over other agents used for palliating bone pain. Due to its half-life of 46 hours and its beta emissions, a high dose rate can be delivered to regions adjacent to enhanced osteoblastic activity over a short period of time with little residual long term activity being left in the bone marrow. This paper summarizes both animal studies and clinical studies performed with this agent. Special emphasis will be given to the pivotal Phase-III clinical studies and subsequent studies performed since its approval by the FDA. Special considerations regarding appropriate selection of patients, preparation, follow-up of patients and adjustments to the usual recommended dose [1 mCi/kg (35 Mbq/kg)] will be discussed. Current and future treatment options utilizing Sm-153-EDTMP with other pharmaceuticals appear promising and will substantially extend its use into new areas. In addition, because it also emits a 103 keV gamma ray which makes it suitable for imaging and assessment of biodistribution, dosimetric applications are possible in the future.