Quantitative Bone Single-Photon Emission Computed Tomography for Prediction of Pain Relief in Metastatic Bone Disease Treated With Rhenium-186 Etidronate

• Published in: Journal of clinical oncology Vol. 18; no. 14; pp. 2747 - 2754
• Main Authors: Israel, Ora, Keidar, Zohar, Rubinov, Rafael, Iosilevski, Galina, Frenkel, Alex, Kuten, Abraham, Betman, Lise, Kolodny, Gerald M., Yarnitsky, David, Front, Dov
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.07.2000; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Biological and medical sciences; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - radiotherapy; Bone Neoplasms - secondary; Breast Neoplasms - pathology; Diseases of the osteoarticular system; Dose-Response Relationship, Radiation; Etidronic Acid - therapeutic use; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Organometallic Compounds - therapeutic use; Osteoarticular system. Muscles; Pain - etiology; Pain - radiotherapy; Pain Measurement; Palliative Care; Prostatic Neoplasms - pathology; Radionuclide investigations; Radiopharmaceuticals - therapeutic use; Radiotherapy Dosage; ROC Curve; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tumors of striated muscle and skeleton; Radionuclide study; Human; Prognosis; Treatment efficiency; Diphosphonic acid derivatives; Metastasis; Radiotherapy; Photon; Radiation dose; Measurement technique; Bone; Rhenium; Intractable pain; Quantitative analysis; Emission tomography
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2000.18.14.2747

PURPOSE: To calculate radiation doses of rhenium-186 ( 186 Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ( 99m Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of 186 Re etidronate in painful lesions. MATERIALS AND METHODS: Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of 186 Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)–measured concentration of 186 Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of 186 Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of 99m Tc MDP was compared with radiation doses to painful metastases. RESULTS: The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between 99m Tc MDP concentration and radiation doses of 186 Re etidronate was 0.92. CONCLUSION: QBS-measured radiation doses of 186 Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using 99m Tc MDP predicts radiation doses delivered by 186 Re etidronate.