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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 September;48(3):211-9


language: English

Palliative treatment of painful disseminated bone metastases with 186Rhenium-HEDP in patients with lung cancer

Leondi A. H. 1, Souvatzoglou M. A. 1, Rapti A. S. 2, Leontopoulou S. A. 3, Papadaki E. K. 1, Datseris E. I. 1, Anagnostopoulou U. S. 2, Zerva C. J. 1

1 Department of Nuclear Medicine Alexandra Hospital, Athens, Greece 2 Eighth Department of Chest Diseases Sotiria Hospital, Athens, Greece 3 Pain Clinic, Alexandra Hospital, Athens, Greece


Aim. The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with 186Re-HEDP and to discuss the criteria useful for selecting those patients.
Methods. Twenty-four patients were included in this study and they received 1295 MBq 186Re-HEDP. All patients underwent 99mTc-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean=18.7±17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of 186Re-HEDP and over the following 8 weeks. The possible myelotoxicity of 186Re was assessed.
Results. The mean VAS score was 6.9±2.5 before the application and 3.2±2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life.
Conclusion. The application of a standard dose of 186Re-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the 186Re-HEDP application can be expected if combined estimation of the 99mTc-MDP bone scan and the CT scan is used.

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