Introduction of a new semi-quantitative index with predictive implications in patients with painful osseous metastases after (186)Re-HEDP therapy.
OBJECTIVE
In this study, a new method has been used to predict pain response to (186)Re-HEDP therapy in patients suffering from painful osseous metastases, on the basis of a modified bone scan index and pre-therapy pain scoring.


METHODS
Forty five patients received a total of 73 doses of (186)Re-HEDP during a period of pain relapse without extra-osseous disease progression. All patients were under stable regimen of zoledronic acid, far off other therapeutic manipulations. Imaging studies regarding a modified estimation of bone scan index, were applied; the value of the largest bony lesion (called mBSI), provided that it also corresponded to the most prominent site of osseous pain was taken into account, and a new semi-quantitative index called Double Product Value (DPV), equal to pre-therapy pain score times mBSI was entered in the result analyses, to investigate any possible correlations with response endpoints.


RESULTS
Favourable response occurred in 35/47 evaluated therapeutic doses of (186)Re-HEDP (74.5%; excellent response in 12 doses, 25.5%). Responders had significantly lower DPV (3.4 ± 2.3 vs. 10.2 ± 6.2, P=0.0029, for non-responders). Patients with pre-therapy DPV <or =4, had higher probability for considerably better (HR 2.29; P<0.0001) and excellent (HR 7.46; P=0.009) pain response versus those with DPV>4, and also a longer median period of pain relief (respective mean values 5.9 versus 2.1 months, HR 2.82; P=0.0001).


CONCLUSIONS
DPV, as developed and implemented in this study proved a valuable and reproducible pre-therapy tool for assessing degree and duration of pain response after (186)Re-HEDP therapy.
Department of Nuclear Medicine, Army Hospital of Athens, Athens, Greece. epiphany@in.gr
A
A
Zafeirakis
A
A
Zissimopoulos
N
N
Baziotis
G S
GS
Limouris
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000503:physiopathology / Q000532:radiotherapy; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010146:Pain / Q000503:physiopathology / Q000532:radiotherapy; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000532:radiotherapy; D011868:Radioisotopes / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012211:Rhenium / Q000627:therapeutic use*
D009942:Organometallic Compounds; D011868:Radioisotopes; D019275:Radiopharmaceuticals; C101598:rhenium-186 HEDP; D012211:Rhenium; D012968:Etidronic Acid