Malignant diseases such as prostate and breast cancer can lead to very painful tumor metastasis in the skeletal system at an advanced stage. Therapeutic measures such as chemotherapy, pain therapy, hormone therapy or percutaneous radiotherapy do not always lead to sufficient pain relief.

Radiopharmaceutical therapy offers our patients an effective way of alleviating bone pain and thus improving their quality of life Unfortunately, this measure cannot cure your condition.

The aim of palliative pain therapy is to achieve the highest possible radiation dose in the bone metastases without damaging the bone marrow.

For this purpose, radionuclides with ß-radiation are administered, which have a range of only a few millimeters in the tissue, so that the radiation's effect is largely limited to the metastases. The radionuclides prefer to accumulate in the skeleton, where bone metabolism is greatly increased. This is mainly the case with so-called osteoblastic metastases.

Prerequisites

If all primary treatment options have been exhausted and a very painful, multilocular to disseminated skeletal metastasis is present, radionuclide therapy can be considered.

The prerequisite for successful therapy is scintigraphic evidence of a significant accumulation of these radionuclides in the metastases. A skeletal scintigraphy is performed on an outpatient basis for this purpose.

Before therapy, unstable vertebral bodies or pathological fractures of the vertebral bodies should be ruled out as the cause of the pain symptoms, as well as compression of the spinal cord or nerves.

Radionuclide therapy must not be carried out during pregnancy and breastfeeding, and renal insufficiency or disseminated intravascular coagulopathy (DIC) is a contraindication to treatment.

Therapy with Aredia should be interrupted for radionuclide therapy.

A current blood count is essential.

Therapy

For therapy, the radionuclide is administered intravenously once.

6 hours after the injection of Sm-153-EDTMP, a whole-body scintigram is taken to document the tracer distribution.

Treatment with Sm-153-EDTMP is carried out on an outpatient basis.

Side Effects

After therapy, white blood cells and platelets may fall by 30-70% of the initial value, with an increased risk of infection and bleeding. This bone marrow suppressive effect can be intensified by bone marrow-displacing tumor tissue, additional chemotherapy, or external radiation therapy. Radionuclide therapy should therefore not be carried out at the same time as, shortly before, or after chemotherapy or percutaneous radiotherapy with large radiation fields.

Pain-Relieving Effect

At the beginning of the treatment, the pain may temporarily increase in the first two days after the injection. If there is a response to therapy (approx. 70%), the pain gradually subsides within a few more days, but a significant improvement in pain symptoms can only be expected after 1-3 weeks.

The therapy's pain-relieving effect usually lasts for several months. It also slows down the growth of the metastases.

After three months, a skeletal scintigraphy is carried out to monitor the therapy.

Radionuclide therapy can be repeated if pain recurs or if the first therapy does not adequately respond. A stable blood count is a prerequisite.

The response rate for the second therapy is still around 50%.

Repeat therapy with Sm-153-EDTMP should be given after 4 months at the earliest.