Phosphorous-32 and Yttrium-90 as options in the treatment of metastatic bone pain

Main Article Content

Alejandro Alberti Ramírez
Enrique García Rodríguez
Jorge Cruz Arencibia
José Morín Zorrilla

Abstract

In this paper the prevalence of metastatic bone pain is estimated in our country in no less than 3 750 patients. Moreover, the role of -phosphate, which effectiveness is comparable to other radiopharmaceuticals, and the possible return to its previous general use, as it is cheaper, is examined. The fact that is considered more radiotoxic doesn’t invalidate it as a treatment option, which is also evidenced by the Cuban experience. The Center of Isotopes (Centis) has established a production line of up to 37 GBq (1 Ci) per week of high quality . The fact of its being obtained through a radionuclide generator by electrochemical separation from makes the import of radioactive raw material practically not required for indefinite time. This implies that the radionuclide could be available in a sustainable way. By having the greater ?- emission energy, it might be more radiotoxic than . Nevertheless, some evidences show that in the form of orthophosphate is more radiotoxic than 90Y citrate. In Europe, a radiopharmaceutical consisting of a lyophilized kit of EDTMP and Chloride solution was able to relief pain in 191 patients. Centis has registered the chloride solution for labeling. Then the task is to introduce in the market a radiopharmaceutical with this radioactive precursor and the imported lyophilized kit in order to increase the treatment to an important number of patients that, as a result, could be benefitted.

Article Details

How to Cite
Alberti Ramírez, A., García Rodríguez, E., Cruz Arencibia, J., & Morín Zorrilla, J. (1). Phosphorous-32 and Yttrium-90 as options in the treatment of metastatic bone pain. Nucleus, (60). Retrieved from http://nucleus.cubaenergia.cu/index.php/nucleus/article/view/631
Section
Ciencias Nucleares

References

[1] MERCADANTE S. Malignant bone pain: pathophysiology and treatment. Pain. 1997; 69(1-2): 1-18.
[2] MUNDY GR. Metastasis to bone: causes, consequences and therapeutic opportunities. Nat. Rev. Cancer. 2002; 2(8): 584-593.
[3] International Atomic Energy Agency. Criteria for palliation of bone metastases-clinical applications. IAEA-TECDOC 1549. Vienna: IAEA, 2007. ISBN 92-0-104507-7.
[4] SCHULMAN KL, KOHLES J. Economic burden of metastatic bone disease in the US. Cancer. 2010; 109(11): 2334-2342.
[5] LI S, PENG Y, WEINHANDL ED, et. al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012; 4: 87-93.
[6] YU HH, TSAI YY, HOFFE SE. Overview of diagnosis and management of metastatic disease to bone. Cancer Control. 2012; 19(2): 84-91.
[7] ZHU XC, ZHANG JL, GE CT, et. al. Advances in cancer pain from bone metastasis. Drug Des Devel Ther. 2015; 18(9): 4239-4245.
[8] PANDIT-TASKAR N, BATRAKI M, DIVGI CR. Radiopharmaceutical therapy for palliation of bone pain from osseous metastases. J. Nucl. Med. 2004; 45(8): 1358-1365.
[9] IBRAHIM T, MERCATALI L, AMADORI D. A new emergency in oncology: bone metastases in breast cancer patients (review). Oncol Lett. 2013; 6(2): 306-310.
[10] TAYLOR DW. Economic and clinical net benefitsfrom the use of samarium Sm-153 lexidronam injection in the treatment of bone metastases. Intern J Tumor Therapy. 2013; 2(1): 10-17.
[11] KIROU-MAURO AM, HIRD A, WONG J, et. al. Has pain manaagement of painful bone metastases with an emphasis on radionuclide therapy. J. Natl Med Assoc. 2007; 99(7): 785-794.
[13] TOMBLYN M. The role of bone-seeking radionuclides in the palliative treatment of patients with painful osteoblastic skeletal metas-tases. Cancer Control. 2012; 19(2): 137-144.
[14] SILBERSTEIN EB. Teletherapy and radiopharmaceutical therapy of painful bone metastasis. Semin. Nucl. Med. 2005; 35(2): 152-158.
[15] PAUWELS EKJ, STOKKEL MP. Radiopharmaceuticals for bone lesions. Imaging and therapy in clinical practice. Q J Nucl. Med. 2001; 45(1): 18-26.
[16] LEWINGTON VJ. Bone-Seeking radionuclides for therapy. J. Nucl. Med. 2005; 46(suppl. 1): 38S-47S.
[17] GUPTA M, CHOUDHURY PS. Systemic radionuclide therapy for bone pain palliation in cancer patients. Cancer News. 2014, 8(2): 12-14. http://www.rgcirc.org/UserFiles/cancer-news-june-2014.pdf
[18] KRISHNAMURTHY G, KRISHNAMURTHY S. Radionuclides for metastatic bone pain palliation: a need for rational revaluation in the new millennium. J. Nucl. Med. 2000; 41(4): 688-691.
[19] SERAFINI AN. Therapy of Metastatic Bone Pain. J. Nucl. Med. 2001; 42(6): 895-906.
[20] SILBERSTEIN EB, ELGAZZAR AH, KAPILIVSKY A. Phosphorus-32 radiopharmaceuticals for the treatment of painful osseous metastases. Semin. Nucl. Med. 1992; 22(1): 17-27.
[21] SILBERSTEIN EB. The treatment of painful osseous metastases with 32P- labeled phosphates. Semin. Oncol. 1993; 20(3) suppl2: 10-21.
[22] SILBERSTEIN EB. Advances in our understanding of the treatment of painful bone metastases. J. Nucl. Med. 2000; 41(4): 655-657.
[23] BOUCHET LG, BOLCH WE, MURTY GS, et. al. Considerations of radiopharmaceuticals for palliation of bone pain from metastatic osseous lesions. J. Nucl. Med. 2000; 41(4): 682-687.
[24] SRIVASTAVA SC. Treatment of bone and join pain with electron emitting radiopharmaceuticals. Indian J. Nucl. Med. 2004; 19(3): 89-97.
[25] FETTICH J, PADHY A, NAIR N. Comparative clinical efficacy and safety of phosphorous-32 and Strontium-89 in the palliative treatment of metastatic bone pain: results of an IAEA coordinated research Project. World J. Nucl. Med. 2003; 2(3): 226-231.
[26] KHAN AU, KHAN SU, IQBAl M, KHAN A, SHAHID S. Metastatic bone pain palliation with P-32 in combination with vitamin D, Our preliminary experience. http://www.iaea.org/inis/collection/NCL-CollectionStore/_Public/43/005/43005480.pdf
[27] PORTILLA I, ALSINA S. de la C, OLIVA JP, et. al. P-32 en el tratamiento de las metástasis óseas por carcinoma prostático. Revista Cubana de Oncología. 2000; 16(1): 44-47.
[28] GARCÍA E, ALBERTI A, CRUZ J, MORIN J. Radiofármacos en el tratamiento del dolor por metástasis óseas. Nucleus. 2012; (52): 50-53.
[29] ALBERTI A, CRUZ A, MORIN J. Itrio 90 como radionúclido para terapia. Nucleus. 2012; (52): 62-67.
[30] GODDU SM, BISHAYEE A, BOUCHET LG, et. al. Marrow toxiciy of 33P-versus 32P-Orthophosphate: implications for therapy of bone pain and bone metastases. J. Nucl. Med. 2000; 41 (5): 941-951.
[31] MALJA S, SCHOMACKER K, MALJA E. Preparation of 90Y by the 90 Sr-90Y generator for medical purpose. J Radioanal Nucl Chemistry. 2000; 245(2): 403-406.
[32] RÖSCH F, HERZOG H, PLAG C, et. al. Radiation doses of yttrium-90 citrate and yttrium-90 EDTMP as determined via analogous yttrium-86 complexes and positron emission tomography. Eur. J. Nucl. Med. 1996; 23(8): 958-966.
[33] BALOGH I, GALLER Z, LANDHERR L. Do we really have to be cautious of repeating the Y-90-EDTMP therapy for bone pain palliation? J. Nucl. Med. 2013; 54 (suppl 2): 1405.