Comparative analysis of the use of radiopharmaceuticals in the treatment of bone metastases
Summary. The purpose of the work: to improve the effectiveness of treatment and determine the place of radionuclide therapy with radiopharmaceuticals in the treatment of metastatic bone lesions in malignant tumors of various localization. Materials and methods. According to the research design and research objectives, the results of 175 patients treated in the Department of Nuclear Medicine of the National Cancer Institute with various primary tumors and metastatic bone lesions with the help of samarium 153 oxabifor were analyzed. Among the treated patients: 75 — breast cancer, 45 — prostate cancer, 20 — lung cancer, 15 — kidney cancer, 20 — colon cancer. Among the treated were 105 women and 70 men, aged from 32 to 78 years, average age (55±11.6) years. In 145 patients (90.0%), the presence of bone metastases was determined using osteoscintigraphy with 99mTs-MDP. In 30 patients, the diagnosis of metastatic bone lesions was verified by other radiological diagnostic methods. Treatment with samarium 153Sm oxabifor was carried out according to European protocols in nuclear medicine adapted and approved in Ukraine (2018), according to which the drug was administered intravenously followed by scanning in the «whole body» mode on a single-photon emission computer tomography (SPECT, Siemens, Germany) 1 hour after the introduction of radiopharmaceuticals. The results. It was established that 153Sm oxabifor can be used in the complex treatment of bone metastases, as it is characterized by a high level of RPF accumulation in the metastatic focus with minimal side effects. It was shown that 153Sm oxabifor is the most effective compared to 32P and 89Sr in the treatment of bone metastases, in terms of analgesic effect and tolerability of the drug (p<0.05). When comparing the effectiveness of the complex treatment of lesions of the bone system with the help of radionuclide and remote radiation therapy, it was proven that at the observation stage after treatment with 153Sm oxabifor in 42.0% of patients, new bone foci were not detected according to diagnostic scanning. At the same time, in the group of patients who underwent remote radiation therapy after consolidation of small foci with 153Sm oxabifor, no new metastatic foci were observed during the observation period in 82.0%. Conclusions. It has been proven that before the treatment, the intensity of the pain syndrome (according to the LAKOMED scale) corresponded to 7–9 points in the vast majority of patients. After the 153Sm treatment, the pain intensity was 2–4 points (р<0.05). The conducted tolerability study of 153Sm according to the CTCNCA (v) 4.3 scale found that it corresponds to 3 points «good» and did not require withdrawal of the drug. It was shown that 153Sm oxabifor is the most effective in the treatment of bone metastases in terms of analgesic effect and tolerability of the drug (p<0.05) compared to 32P and 89Sr. As a result of the complex treatment of bone lesions with 153Sm oxabifor radionuclide therapy, no new bone lesions were detected in 42.0% of patients according to the diagnostic scan. At the same time, external beam radiation therapy after the use of 153Sm oxabifor ensured the absence of new foci in 82.0% of patients.
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