RESUMEN
PURPOSE: Radium-223 is an alpha-emitting radiopharmaceutical that significantly prolongs overall survival in patients with castration-resistant prostate cancer and symptomatic bone metastases. We report a retrospective analysis of our clinical experience with Radium-223 in the first 68 patients treated. METHODS: The incidence of hematologic, gastrointestinal, and other adverse events was identified, including events that led to treatment discontinuation or delay. Alterations in bone pain and prostate-specific antigen and serum alkaline phosphatase levels were evaluated. Bone scan changes were identified and correlated with the clinical course. RESULTS: Sixty-eight patients were included in the study. The median number of radium-223 injections was 5 (range 1-6), with 69% of patients receiving 5 to 6 injections. The most common side effects were digestive alterations in 24 patients, anemia in 7 patients, and thrombocytopenia in 5 patients. Clear downward trends in serum alkaline phosphatase were seen, that were less clear in prostate-specific antigen. Mean serum alkaline phosphatase decreased from baseline in 77% of the patients, and prostate-specific antigen in less than 40%. The majority of patients (62) experienced an improvement in bone pain intensity or no increase in bone pain intensity. No prostate-specific antigen flare phenomenon was noted. CONCLUSIONS: Radium-223 was generally well tolerated and there were no safety concerns. The adverse events were mild and manageable. A decline in serum alkaline phosphatase was more common than a decline in prostate-specific antigen. Monitoring changes in serum alkaline phosphatase dynamics may be useful.
Asunto(s)
Neoplasias de la Próstata Resistentes a la Castración/radioterapia , Radiofármacos/uso terapéutico , Radio (Elemento)/uso terapéutico , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Humanos , Calicreínas/sangre , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata Resistentes a la Castración/sangre , Estudios Retrospectivos , Factores de TiempoAsunto(s)
Adenoma/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Adenoma/complicaciones , Adenoma/patología , Adenoma/cirugía , Femenino , Cámaras gamma , Humanos , Hipercalcemia/etiología , Hiperparatiroidismo Primario/etiología , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Radiografía Intervencional/instrumentación , Radiografía Intervencional/métodos , Radiofármacos , Tecnecio , Tecnecio Tc 99m SestamibiRESUMEN
The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.
Asunto(s)
Eritrocitos/diagnóstico por imagen , Hígado , Esplenosis/diagnóstico por imagen , Tecnecio , Humanos , Masculino , CintigrafíaRESUMEN
OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.