Medical Radiology and Radiation Safety. 2014. Vol. 59. No. 6. P. 54-62
NUCLEAR MEDICINE
V.V. Krylov, T.U. Kochetova
Radionuclide Therapy with Rhenium-188-HEDP for the Treatment of Patients with Bone Metastases Medical Radiology Centre of Hertsen FMRC MH RF
Medical Radiology Centre of Hertsen FMRC MH RF. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Radionuclide therapy is one of the effective treatment modalities to palliate painful bone metastases, improving this kind of therapy is an important task. 188Re-HEDP is one of safe and effective bone-seeking radiopharmaceuticals; moreover, it is very convenient in clinical practice. It has been used in the world practice since 1998; clinical studies of Russian analogue were finished in 2013. 188Re is a powerful β-emitter, presence of γ-rays allows facile visualization of its distribution in human body using simple bone scan. 188Re is convenient because it can be obtained from in-house 188W/188Re generator. Multiple clinical studies confirmed that 188Re-HEDP is effective and safe in dosage of 2.6–3.3 GBq. The main side effect is decrease of platelet and white blood cell count grade I–II, 3–5 weeks after injection. Its efficacy is similar to other bone-seeking radiopharmaceuticals and can attain 80 % after single injection. Prospective randomized trial demonstrated benefits of repeated bone targeted therapy in hormone-resistant prostate cancer patients. The group of patients received two injections with 8 weeks interval showed increase in palliative efficacy from 60 % to 90 %; furthermore, there was benefit in overall survival (12.7 months compared to 7.0 months in the single injection group) and time to progression (7.0 months compared to 2.3 months). In addition, there was antitumoral effect, in repeated treatment group more often lasting 50 % PSA decrease (39 % and 7 % respectively) and bone scan regression was found. 188Re-HEDP can be affective in combination with other treatment modalities. Some treatments protocols of serial chemotherapy and 188Re-HEDP radionuclide therapy were designed. Further investigation may show the influence of these schedules on patients’ survival. In conclusion, 188Re-HEDP may become useful and convenient treatment modality in Russian clinical practice.
Key words: bone metastases, radionuclide therapy, rhenium-188 HEDP, pain syndrome, palliation therapy