title: An individual dosimetric approach to 153Sm-EDTMP therapy for pain palliation in bone metastases in correlation with clinical results.
abstract: BACKGROUND
  The clinical results of therapy using 153Sm ethylenediamine-N,N,N'N'-tetrakis(methylene phosphonic acid) (153Sm-EDTMP) were correlated with radiation dose indices in metastases, with the intention of improving the therapeutic efficacy.
  
  
  METHODS
  Fifty-six patients with disseminated bone metastases were treated. Prior to therapy, whole-body scans and single photon emission computed tomography (SPECT) of the trunk were performed. Whole-body retention of 99mTc labelled phosphonates was compared with 153Sm-EDTMP retention after therapy. Estimations of the volumes of bone lesions were done by SPECT. Assuming a solid tumour but a thin metabolically active boundary zone between tumour and healthy bone that absorbed the beta radiation, we estimated an 'irradiated volume' by using a spherical shell model of 6 mm thickness. Local tracer uptake in lesions was assessed by regions of interest techniques on conjugated views of whole-body scans with homogeneous attenuation correction. Calculation of the dose index by applying the Medical Internal Radiation Dosimetry (MIRD) scheme was done retrospectively in 10 patients and prospectively in 22 cases. Depending on changes in pain/mobility scores, results were classified as 'very good', 'good' and 'no response'.
  
  
  RESULTS
  A mean dose index > or =10 per lesion was estimated under the condition of a homogeneous uptake within the idealized, spherical, tumour volume. Assuming that the uptake of the radiopharmaceutical occurs mostly within an outer shell of the tumour, dose indices to this 'irradiated volume' can increase to more than twice that value.
  
  
  CONCLUSIONS
  Very good clinical results for bone pain palliation by using 153Sm-EDTMP therapy could be found in patients receiving a dose index >15 per lesion. Even this approximate dosimetric approach, considering the individual differences in tumour spread and the varying intensity of 153Sm uptake, could improve the impact of 153Sm-EDTMP for pain control in cancer patients.
authors.affiliation: Department of Nuclear Medicine, University of Innsbruck, Austria. Dorota.Kendler@uibk.ac.at
authors.forename: Dorota
authors.initials: D
authors.lastname: Kendler
authors.forename: Eveline
authors.initials: E
authors.lastname: Donnemiller
authors.forename: Michael
authors.initials: M
authors.lastname: Oberladstätter
authors.forename: Hermann
authors.initials: H
authors.lastname: Erler
authors.forename: Michael
authors.initials: M
authors.lastname: Gabriel
authors.forename: Georg
authors.initials: G
authors.lastname: Riccabona
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy*; D001842:Bone and Bones; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009942:Organometallic Compounds / Q000627:therapeutic use*; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D010146:Pain / Q000532:radiotherapy*; D010166:Palliative Care; D011874:Radiometry / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D009942:Organometallic Compounds; D009943:Organophosphorus Compounds; C061972:samarium Sm-153 lexidronam