Phase I Trial of Vertebral Intracavitary Cement and Samarium (VICS): Novel Technique for Treatment of Painful Vertebral Metastasis
- Department of Radiation Oncology, New York Methodist Hospital, Weill Medical College, Cornell University, Brooklyn, NY (United States)
- Department of Surgery, New York Methodist Hospital, Weill Medical College, Cornell University, Brooklyn, NY (United States)
- Department of Nuclear Medicine, New York Methodist Hospital, Weill Medical College, Cornell University, Brooklyn, NY (United States)
Purpose: Kyphoplasty is an effective procedure to alleviate pain in vertebral metastases. However, it has no proven anticancer activity. Samarium-153-ethylene diamine tetramethylene phosphonate ({sup 153}Sm-EDTMP) is used for palliative treatment of bone metastases. A standard dose of 1 mCi/kg is administrated intravenously. The present study was conducted to determine the feasibility of intravertebral administration of {sup 153}Sm with kyphoplasty. Methods and Materials: A total of 33 procedures were performed in 26 patients. Of these 26 patients, 7 underwent procedures performed at two vertebral levels. The mean age of the cohort was 64 years (range, 33-86). The kyphoplasty procedure was performed using a known protocol; 1-4 mCi of {sup 153}Sm was admixed with the bone cement and administered under tight radiation safety measures. Serial nuclear body scans were obtained. Pain assessment was evaluated using a visual analog pain score. Results: All patients tolerated the procedure well. No procedure-related morbidities were noted. No significant change had occurred in the blood counts at 1 month after the procedure. One case was not technically satisfactory. Nuclear scans revealed clear radiotracer uptake in the other 32 vertebrae injected. Except for the first patient, no radiation leakage was encountered. The mean pain score using the visual analog scale improved from 8.6 before to 2.8 after the procedure (p < .0001). Follow-up bone scans demonstrated a 43% decrease in the tracer uptake. Conclusion: The results of our study have shown that the combination of intravertebral administration of {sup 153}Sm and kyphoplasty is well tolerated with adequate pain control. No hematologic adverse effects were found. A reduction of the bone scan tracer uptake was observed in the injected vertebrae. Longer follow-up is needed to study the antineoplastic effect of the procedure.
- OSTI ID:
- 21362223
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 75, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2008.11.060; PII: S0360-3016(08)03906-0; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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CEMENTS
METASTASES
PAIN
SAMARIUM
SAMARIUM 153
TRACER TECHNIQUES
UPTAKE
VERTEBRAE
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
BUILDING MATERIALS
DAYS LIVING RADIOISOTOPES
ELEMENTS
EVEN-ODD NUCLEI
INTERMEDIATE MASS NUCLEI
ISOTOPE APPLICATIONS
ISOTOPES
MATERIALS
METALS
NUCLEI
ORGANS
RADIOISOTOPES
RARE EARTH NUCLEI
RARE EARTHS
SAMARIUM ISOTOPES
SKELETON
SYMPTOMS