Research ArticleIMAGING

Phase 2 Study of a High Dose of 186Re-HEDP for Bone Pain Palliation in Patients with Widespread Skeletal Metastases

Elahe Pirayesh, Mahasti Amoui, Hamid Reza Mirzaee, Faraj Tabei, Afshin Rakhsha, Bagher Aziz Kalantari, Babak Shafiei, Majid Assadi and Isa Neshandar Asli
Journal of Nuclear Medicine Technology September 2013, 41 (3) 192-196; DOI: https://doi.org/10.2967/jnmt.113.124297

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    A 50-y-old man with prostate cancer in whom abnormal foci of increased radiotracer uptake were seen in clavicles, sternum, ribs, spine, sacroiliac joints, and pelvis on 99mTc-methylene diphosphonate (MDP) and 186Re-HEDP scans. In addition, significant uptake resulting from liver involvement is seen on both 99mTc-methylene diphosphonate and 186Re-HEDP scans. Patient showed complete response to therapy and flare reaction after receiving 2,960 MBq of 186Re-HEDP.

Tables

  • TABLE 1

    Patient Demographics

    Patient no.SexAge (y)Tumor siteDose (MBq)FlareBSITreatment efficacy
    1F45Breast2,960No8CR
    2M63Kidney3,330No4PR
    3M31Synovium1,480Yes7NR
    4M64Colon2,960Yes4NR
    5F65Breast2,960Yes2MR
    6F52Breast2,590No8PR
    7M50Prostate2,960Yes4MR
    8M74Prostate2,960No10CR
    9F62Breast3,700Yes8PR
    10F42Breast3,700Yes3CR
    11F30Breast3,700Yes5CR
    12M64Colon2,960Yes4NR
    13F68Neuroendocrine3,700Yes4CR
    14M75Prostate3,330Yes6CR
    15F54Breast1,480No7CR
    16F61Breast1,480No9PR
    17F40Breast3,330Yes7NR
    18F50Breast2,960No9CR
    19M63Prostate2,960Yes9CR

    • BSI = bone scan index; CR = complete response; PR = partial response; NR = no response; MR = minimal response.

  • TABLE 2

    Clinical and Hematologic Effects of 186Re-HEDP Before and After Treatment

    ParameterBefore treatment (mean ± SD)After treatment (mean ± SD)P
    Response (first week)
     Pain score9.10 ± 1.335.31 ± 3.24<0.05
     Analgesic score5.65 ± 3.982.73 ± 4.18<0.05
    Hematologic toxicity (fifth to sixth weeks)
     Platelet count316,000 ± 285,000115,000 ± 6,100>0.05
     Leukocyte count6,055 ± 3,2004,800 ± 2,800>0.05
     Hemoglobin11.75 ± 1.8111.21 ± 2.36>0.05
  • TABLE 3

    Efficacy of 186Re-HEDP in Patients with Painful Bone Metastases

    Pain responsen
    Complete response9 (47.4%)
    Partial response4 (21.1%)
    Minimal response2 (10.5%)
    No response4 (21.1%)
    Duration of response
     <4 wk6 (21.1%)
     4–8 wk2 (10.5%)
     ≥8 wk7 (36.8%)
    Flare response
     Yes12 (63.2%)
     No7 (36.8%)
  • TABLE 4

    Side Effects of 186Re-HEDP in Patients with Painful Bone Metastases

    Hematologic toxicityPlatelet (n)White blood cell (n)Hemoglobin (n)
    Grade 03 (18.8%)7 (44%)5 (31%)
    Grade 16 (37.5%)8 (50%)6 (37.5%)
    Grade 23 (18.8%)1 (6.2%)2 (12.5%)
    Grade 34 (25%)03 (18.8%)
    Grade 4000
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