title: Impact of ¹⁸F-fluoride PET-CT on implementing early treatment of painful bone metastases with Sm-153 EDTMP.
abstract: This study evaluated the diagnostic impact of using skeletal (18)F-fluoride PET/CT on patients with painful bone metastases to schedule an early palliative radionuclide treatment.
  
  
  METHODS
  The skeletal involvement from prostate cancer metastases was assessed by both (99m)Tc-diphosphonate bone scan (BS) and (18)F-fluoride PET/CT within four weeks in 24 patients (67.7 ± 5.1 years) suffering from a borderline degree of bone pain for which radionuclide palliation was not shortly planned for administration. The BS and (18)F-fluoride PET/CT results were compared, assessing the number and extension of the skeletal sites involved. Afterward, the patients were randomly assigned either to the study group (N=12) receiving radionuclide therapy (Samarium-153 EDTMP) or to the control group (N=12) not receiving radionuclide therapy. The short-term results from the radionuclide palliation group (evaluated with a visual analogue scale) were compared with the controls.
  
  
  RESULTS
  Overall, at BS, 7.6 ± 1.4 sites were considered metastatic, involving at least 5 ± 1 body regions. At (18)F-fluoride PET/CT, 116 ± 19 sites presented metastatic involvement with 12/12 body regions concerned. No differences were found in regards to either the number of metastatic sites or regions at both BS and (18)F-fluoride PET/CT between the study group and controls (p=ns). At CT, 88 blastic metastases were identified, whereas 110 were mainly lytic. Most of mainly lytic lesions were not detectable at BS. The reduction in total discomfort and bone pain in the study group was significantly greater than in the controls (p<0.0001).
  
  
  CONCLUSIONS
  Sm-153 EDTMP therapy should be considered for patients with early bone pain from prostate cancer even if their BS only indicates a few metastases before the initiation of a severe pain syndrome. (18)F-fluoride PET/CT may be helpful in deciding if the implementation of bone pain palliation using bone-seeking radionuclides at pain onset is necessary.
authors.affiliation: IRCCS, CROB, Rionero in Vulture, Italy. giosto24@hotmail.com
authors.forename: Giovanni
authors.initials: G
authors.lastname: Storto
authors.forename: Rosj
authors.initials: R
authors.lastname: Gallicchio
authors.forename: Teresa
authors.initials: T
authors.lastname: Pellegrino
authors.forename: Anna
authors.initials: A
authors.lastname: Nardelli
authors.forename: Serena
authors.initials: S
authors.lastname: De Luca
authors.forename: Daniela
authors.initials: D
authors.lastname: Capacchione
authors.forename: Cesare
authors.initials: C
authors.lastname: Sirignano
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pace
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary*; D005459:Fluorides; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D009942:Organometallic Compounds / Q000627:therapeutic use*; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D010146:Pain / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D010147:Pain Measurement; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000473:pathology; D011877:Radionuclide Imaging; D013997:Time Factors
chemical_list: D005462:Fluorine Radioisotopes; D009942:Organometallic Compounds; D009943:Organophosphorus Compounds; C061972:samarium Sm-153 lexidronam; D005459:Fluorides