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Research ArticleRADIONUCLIDE THERAPY

177Lu-EDTMP for Treatment of Bone Pain in Patients with Disseminated Skeletal Metastases

Ajit S. Shinto, Deepu Shibu, Koramadai Karuppusamy Kamaleshwaran, Tapas Das, Sudipta Chakraborty, Sharmila Banerjee, Palanisamy Thirumalaisamy, Pravin Das and Ganesh Veersekar
Journal of Nuclear Medicine Technology March 2014, 42 (1) 55-61; DOI: https://doi.org/10.2967/jnmt.113.132266
Ajit S. Shinto
1Nuclear Medicine Department, KMCH, Coimbatore, Tamil Nadu, India
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Deepu Shibu
1Nuclear Medicine Department, KMCH, Coimbatore, Tamil Nadu, India
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Koramadai Karuppusamy Kamaleshwaran
1Nuclear Medicine Department, KMCH, Coimbatore, Tamil Nadu, India
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Tapas Das
2Isotope Applications and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
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Sudipta Chakraborty
2Isotope Applications and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
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Sharmila Banerjee
2Isotope Applications and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
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Palanisamy Thirumalaisamy
3Coimbatore Urology Clinic, Coimbatore, Tamil Nadu, India
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Pravin Das
4Karuna Medical College, Palakkad, Kerala, India; and
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Ganesh Veersekar
5KMCH, Coimbatore, Tamil Nadu, India
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  • FIGURE 1.
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    FIGURE 1.

    Individual bone-specific pain scores for 10 patients with skeletal metastases before and after treatment with 177Lu-EDTMP.

  • FIGURE 2.
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    FIGURE 2.

    Comparison of mean pain score of study group.

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    FIGURE 3.

    Comparison of mean mobility score of study group.

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    FIGURE 4.

    Comparison of mean Karnofsky performance score of study group.

  • FIGURE 5.
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    FIGURE 5.

    99mTc-methylene diphosphonate bone scan (A) and corresponding 177Lu-EDTMP scan (B) showing excellent tracer localization in osteoblastic areas. A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.

  • FIGURE 6.
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    FIGURE 6.

    99mTc-methylene diphosphonate scan (A) and corresponding 177Lu-EDTMP images (B–D) of same patient.

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    FIGURE 7.

    177Lu-EDTMP image (B) demonstrating biologic distribution similar to 153Sm-EDTMP (A) in same patient.

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    TABLE 1

    Demographic and Clinical Parameters in the 10 Patients of the Study Population

    ParameterData
    Median age (y)68.5 (range, 52–78)
    Mean duration of cancer (mo)30 (range, 3–120)
    Type of cancer (n)
     Lung4
     Prostate3
     Breast2
     Esophagus1
    Prior radiotherapy (n)6 (60%)
    Median time since last radiotherapy (mo)8 (range, 4–10)
    Prior chemotherapy (n)4 (40%)
    Median time since last chemotherapy (mo)18 (range, 2–34)
    Prior radionuclide therapy (n)6 (60%)
    Median time since last radionuclide therapy (mo)8 (range, 5–27)
    Median baseline scores
     Skeleton-based pain8.44 (range, 7.2–9.8)
     Mobility2.99 (range, 2–4)
     Karnofsky performance45 (range, 40–50)
    Median 4-wk scores
     Skeleton-based pain5.73 (range, 4.8–6.9)
     Mobility1.3 (range, 1–2)
     Karnofsky performance69 (range, 60–80)
    Median 8-wk skeleton-based pain score3.82 (range, 3.3–4.8)
    Median 12-wk skeleton-based pain score1.71 (range, 1.2–2.2)
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    TABLE 2

    Comparison of Mean Scores

    Paired differences
    Type of scoreMeanSD95% confidence interval of differenceP
    Mean pain (baseline) – mean pain (week 4)2.71.21.8 to 3.6<0.001
    Mean pain (baseline) – mean pain (week 8)4.61.13.8 to 5.4<0.001
    Mean pain (baseline) – mean pain (week 12)6.71.35.8 to 7.7<0.001
    Karnofsky (baseline) – Karnofsky (week 4)−246.9−29 to −18.9<0.001
    Mobility (baseline) – mobility (week 4)1.60.61.1 to 2.1<0.001
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    TABLE 3

    Toxicity of 177Lu-EDTMP for Painful Bone Metastases

    GradeHGBPLTLEU
    I02 (20)4 (40)
    II01 (10)2 (20)
    III000
    IV000
    • HGB = hemoglobin (× g/L); PLT = platelets (× 109/L); LEU = leukocytes (× 109/L).

    • Data are number followed by percentage.

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Journal of Nuclear Medicine Technology: 42 (1)
Journal of Nuclear Medicine Technology
Vol. 42, Issue 1
March 1, 2014
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177Lu-EDTMP for Treatment of Bone Pain in Patients with Disseminated Skeletal Metastases
Ajit S. Shinto, Deepu Shibu, Koramadai Karuppusamy Kamaleshwaran, Tapas Das, Sudipta Chakraborty, Sharmila Banerjee, Palanisamy Thirumalaisamy, Pravin Das, Ganesh Veersekar
Journal of Nuclear Medicine Technology Mar 2014, 42 (1) 55-61; DOI: 10.2967/jnmt.113.132266

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177Lu-EDTMP for Treatment of Bone Pain in Patients with Disseminated Skeletal Metastases
Ajit S. Shinto, Deepu Shibu, Koramadai Karuppusamy Kamaleshwaran, Tapas Das, Sudipta Chakraborty, Sharmila Banerjee, Palanisamy Thirumalaisamy, Pravin Das, Ganesh Veersekar
Journal of Nuclear Medicine Technology Mar 2014, 42 (1) 55-61; DOI: 10.2967/jnmt.113.132266
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Keywords

  • 177Lu-EDTMP
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