RESUMEN
For almost five decades, 131I treatment of thyroid cancer has been based empirically on administered activity rather than on actual radiation doses delivered. In 1983, we defined radiation dose thresholds for successful treatment. This report is concerned with the subsequent validation of those thresholds in 85 patients. The successful ablation of thyroid remnants occurred after a single initial 131I administration in 84% of inpatients and in 79% of outpatients when treatment was standardized to a radiation dose of at least 30,000 cGy (rad). Administered activities low enough to permit outpatient therapy could be used in 47% of the patients. Lymph node metastases were treated successfully in 74% of patients with a single administration of 131I calculated to deliver at least 8,500 cGy (rad). For athyrotic patients with nodal metastases only, success was achieved in 86% of patients at tumor doses of at least 14,000 cGy (rad). These success rates are equal to or better than those reported with empiric methods of 131I administration. The individualized treatment planning selectively allocates hospitalization and higher exposures to 131I to those patients who require them.
Asunto(s)
Adenocarcinoma/radioterapia , Carcinoma Papilar/radioterapia , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Adenocarcinoma/epidemiología , Adenocarcinoma/cirugía , Carcinoma Papilar/epidemiología , Carcinoma Papilar/cirugía , Terapia Combinada , Estudios de Evaluación como Asunto , Humanos , Estudios Prospectivos , Dosificación Radioterapéutica , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
Small children often cannot describe the location of bone pain for parents or physicians. Bone scans were performed in 56 children under five years of age with lower extremity pain and/or gait abnormalities of unknown etiology. Patients with fever, and those known to have infection, child abuse, malignancy, and/or radiographic abnormalities were excluded. Thirty patients had abnormal bone scans. Abnormalities included evidence of hip synovitis (4), femoral head avascularity (2), various proximal femoral abnormalities (3), knee synovitis (3), toddler's fracture (1), various tibial or fibular abnormalities (4), and various abnormalities of the tarsal bones (16). Tarsal bone abnormalities included four with abnormal calcaneal uptake and nine with abnormal uptake in or adjacent to the cuboid bone. Correlative imaging studies were available for 26 sites, and focal bone findings were noted at only five locations. Tarsal bone abnormalities accounted for over half of the scintigraphic abnormalities in these preschool children with gait abnormalities. Abnormal uptake in/or adjacent to the cuboid bone was common and probably represented stress injury.
Asunto(s)
Enfermedades Óseas/diagnóstico por imagen , Pierna , Dolor/diagnóstico por imagen , Medronato de Tecnecio Tc 99m , Preescolar , Femenino , Articulación de la Cadera/diagnóstico por imagen , Humanos , Lactante , Rodilla/diagnóstico por imagen , Masculino , CintigrafíaRESUMEN
Thirty-one children with stage III and IV neuroblastoma were studied with iodine-131 metaiodobenzyl-guanidine (MIBG) scintigraphy, technetium-99m medronate scintigraphy, skeletal plain radiography, and computed tomography (CT) before and after bone marrow transplantation (BMT). Twenty-six pre-BMT and 90 post-BMT studies were reviewed. Fourteen patients were alive without tumor, and one patient died at 4 months while free of tumor. I-131 MIBG scans obtained before and after BMT were negative in eight of the 15 patients. Seven had positive I-131 MIBG scans obtained before BMT that became negative after BMT. Six of 15 patients had small, questionable lesions on CT scans of the chest or abdomen that never increased in size, and the I-131 MIBG scans remained negative. Sixteen children had progressive disease or relapse, including four in whom I-131 MIBG scans showed new abnormalities, four with persistently positive I-131 MIBG scans, and three who had negative I-131 MIBG scans at relapse. Two of the 16 patients initially had small lesions seen on abdominal CT scans that were not seen on I-131 MIBG scans; mass lesions were later seen at CT in these locations. Detectable I-131 MIBG uptake in abdominal and thoracic lesions was related to the diameter of the lesion. Both I-131 MIBG scintigraphy and CT should be used to evaluate patients with neuroblastoma who have undergone BMT.
Asunto(s)
Trasplante de Médula Ósea , Medios de Contraste , Yodobencenos , Neuroblastoma/diagnóstico por imagen , 3-Yodobencilguanidina , Huesos/diagnóstico por imagen , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Neuroblastoma/mortalidad , Neuroblastoma/secundario , Neuroblastoma/cirugía , Cintigrafía , Tasa de SupervivenciaRESUMEN
Single intravenous injections of 30 to 35 mCi (1,110 to 1,295 MBq) of Re-186(Sn)HEDP previously have been shown to result in palliation of painful skeletal metastases from prostate cancer. There are no reports of patients receiving repetitive Re-186(Sn)HEDP therapy. We have followed two such patients who received multiple (five to seven) injections of Re-186(Sn)HEDP at 2-month intervals. Each experienced a sustained decrease in both pain and analgesic intake. The only evident clinical or biochemical toxicity was a mild progressive decline in their total platelet counts.
Asunto(s)
Neoplasias Óseas/fisiopatología , Ácido Etidrónico/uso terapéutico , Compuestos Organometálicos/uso terapéutico , Dolor Intratable/terapia , Cuidados Paliativos/métodos , Adenocarcinoma/fisiopatología , Adenocarcinoma/secundario , Anciano , Neoplasias Óseas/secundario , Humanos , Masculino , Recuento de Plaquetas , Neoplasias de la Próstata/patologíaRESUMEN
Rhenium-186 (tin)hydroxyethylidene diphosphonate (HEDP) is a new radiopharmaceutical that localizes in skeletal metastases in patients with advanced cancer. A single intravenous administration of approximately 34 mCi (1,258 MBq) resulted in significant improvement in pain in 33 of 43 evaluable patients (77%) following the initial injection, and in 7 of 14 evaluable patients (50%) following a second treatment. Patients responding to treatment experienced an average decrease in pain of about 60%, with one in five treatments resulting in a complete resolution of pain. The only adverse clinical reaction was the occurrence after about 10% of the administered doses of a mild, transient increase in pain within a few days following injection. Statistically significant but clinically unimportant decreases in total white blood cell counts and total platelet counts were observed within the first 8 weeks following the injection; no other toxicity was apparent. Rhenium-186(Sn)HEDP is a useful new compound for the palliation of painful skeletal metastases.
Asunto(s)
Neoplasias Óseas/secundario , Ácido Etidrónico/uso terapéutico , Compuestos Organometálicos/uso terapéutico , Dolor/radioterapia , Cuidados Paliativos , Neoplasias Óseas/fisiopatología , Humanos , Dolor/etiologíaRESUMEN
Rhenium-186 (tin) hydroxyethylidene diphosphonate (HEDP) is a new radiopharmaceutical that simultaneously localizes in multiple skeletal metastases in patients with advanced cancer. A single intravenous administration of 30-35 mCi (1110-1295 MBq) is associated with a prompt, significant relief of osseous pain in about 80% of such patients. The efficacy of this new compound was evaluated further by utilizing a double-blind crossover comparison with 99mTc-methylene diphosphonate (MDP) as a radioactive placebo. The new rhenium compound resulted in a significantly (p less than 0.05) greater decrease in pain than did treatment with the radioactive placebo. Rhenium-186(Sn)HEDP appears to be a useful new compound for the palliation of painful skeletal metastases.