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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

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A Journal on Nuclear Medicine and Molecular Imaging
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The Quarterly Journal of Nuclear Medicine 2001 March;45(1):100-107

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Radionuclide therapy for painful bone metastases. An Italian Multicentre Observational Study

Piffanelli A., Dafermou A., Giganti M., Colamussi P., Pizzocaro C., Bestagno M.

From the Service of Nuclear Medicine University of Ferrara *Spedali Civili, Brescia, Italy


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Background. It has ­been ­affirmed ­that obser­va­tion­al stud­ies ­give anal­o­gous ­results to ran­dom­ised con­trolled ­ones.
Methods. A mul­ti­cen­tre obser­va­tion­al ­trial was con­duct­ed ­between 1996-1998 in ­order to eval­u­ate the effi­ca­cy of pal­li­a­tive radio­nu­clide ther­a­py for ­bone metas­ta­ses in a ­large num­ber of ­patients. An eval­u­a­tion was ­made on 510 ­patients ­with pros­tate can­cer and pain­ful ­bone metas­ta­ses, treat­ed ­with a sin­gle i.v. ­dose of 89Sr-chlo­ride (527 treat­ments) or 186Re-­HEDP (83 treat­ments), in 29 Italian Nuclear Medicine Departments. Eighty-one ­patients ­received up to ­five injec­tions, total­ling 100 retreat­ments. Patients ­were fol­lowed up for a peri­od of 3 ­months-2 ­years. Results ­were ­expressed at ­four lev­els of ­response: excel­lent, ­good, ­mild, and nil.
Results. Responses ­were excel­lent in 26.4%, ­good in 33.3%, ­mild in 21.3% and nil in 19% of all treat­ments, ­while ­good and excel­lent respons­es ­were ­obtained in 48% of retreat­ments. No sta­tis­ti­cal­ly sig­nif­i­cant cor­re­la­tions ­were ­found ­between ­response and age of ­patients, skel­e­tal exten­sion of ­tumour, prether­a­peu­tic PSA lev­els, evi­dence of non-­bony metas­ta­ses, pre­vi­ous chem­o­ther­a­py and/or exter­nal-­beam radio­ther­a­py; oste­o­lyt­ic ­lesions respond­ed ­worse ­than oste­o­blas­tic or ­mixed ­ones. Hematological tox­ic­ity (­mild to mod­er­ate), main­ly affect­ing plate­lets, was ­observed in 25.5% of all treat­ments and in 38.9% of retreat­ments. No ­clear dif­fer­enc­es ­were ­found ­between the two radio­phar­ma­ceu­ti­cals ­employed.
Conclusions. Bearing in ­mind ­that obser­va­tion­al stud­ies can pro­vide ­just as accu­rate ­results as ran­dom­ised con­trolled ­trials, ­this ­study con­firms the ­main find­ings of var­i­ous lim­it­ed mono­cen­tre ­trials.

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