ANALGESIC EFFECT OF VARIOUS RADIOPHARMACEUTICALS IN THE COMPLEX TREATMENT OF METASTATIC BONE DISEASE

Abstract

Objective. The study objective was to investigate and compare the effectiveness of different radiopharmaceuticals in the treatment of metastatic bone disease. Materials and methods. Cancer patients (n = 150, average age (55 ± 11.6) years, 95 females, 55 males) having got various primary tumors and metastatic bone disease were given medical treatment at the Department of Nuclear Medicine of the National Institute of Cancer. The153Sm,32Р, and89Sr radiopharmaceutical agents produced by the «Radiopreparats» enterprise (Republic of Uzbekistan) and Radioisotope Centre Polatom (National Centre for Nuclear Research, Poland) were administered to the patients. There were cases of breast cancer (n = 75), prostate cancer (n = 45), lung cancer (n = 10), kidney cancer (n = 4), cervical cancer (n = 5), and rectosigmoid cancer (n = 11) among the treated subjects. In 135 patients (90 %) the bone metastases were detected by osteoscintigraphy with99м Tc-monodiphosphonate. In 15 cases the diagnosis of metastatic bone disease was verified by other radiology methods. Results. The pain intensity rating scale (LACOMED) was used to assay the analgesic effect of various radiopharmaceuticals in metastatic bone disease. Results of treatment with32P,89Sr, and153Sm were included in a comparative analysis procedure. It was established that the level of pain syndrome ranged from 7–8 points on the LACOMED scale before treatment. Upon administration of radionuclide therapy the level of pain was reduced down to 3–5 points, namely with32P therapy it has decreased by 30.7 %, with89Sr by 33.2 %, and with153Sm by 41.5 % respectively. Time pattern of153Sm analgesic effectiveness was studied depending on the number of treatment sessions. The best value of analgesic effect of153Sm was registered after the first treatment session with a tendency to decrease after the second and significantly lower analgesic effects after the third session. Tolerance of153Sm was rated on the CTCNCA (v) 4.3 scale. The best tolerance was peculiar to153Sm corresponding to the «good» level according to a point assessment. When using89Sr the drug tolerance was lower, not requiring however the drug discontinuation. The32P radiopharmaceutical featured the lowest tolerance approaching the «satisfactory» rating. In 11 patients upon that the side effects were found significantly impairing the patient’s status, accordingly some extra measures were required. No decision to cancel the drug administration was made. Conclusions. Radionuclide therapy with153Sm-oxabiphor agent can be used in the complex treatment of metastatic bone disease in cancer patients having got tumors of different localization.153Sm-oxabiphor is the most effective and best tolerable radiopharmaceutical agent in the pain treatment in metastatic bone disease in comparison with 32 P and89Sr preparations (р < 0.05).