Response, complications and risk of leukemic transformation of phosphorus-32p treatment in philadelphia-negative chronic myeloproliferative syndromes.

OBJECTIVE: Describe our experience in treatment with Phosphorus-32P for refractory Philadelphia negative chronic myeloproliferative syndromes or with side effects to the usual treatment, its complications and risk of leukemic transformation. MATERIAL AND METHODS: Retrospective descriptive study including 17 patients with a diagnosis of Philadelphia-negative chronic myeloproliferative syndrome treated with Phosphorus-32P in our hospital from January 1985 to March 2017. Indications, response to treatment, as well as early and late complications have been analyzed. RESULTS: Of the 17 patients treated with 32P (11 men, 6 women; mean age 79,8 years), 6 patients had Polycythemia Vera and 11 Essential Thrombocytosis. A single dose was administered in 9 of the subjects, the rest required two or more doses due to inadequate hematological response and/or relapse. The total dose range of Phosphorus-32P administered was 116-951 MBq (median: 236 MBq). In 14 patients treated with Phosphorus-32P, complete or partial response was achieved in hematimetry. In 11 patients, the response was complete, established as a platelet count <400.000/mm3 in those diagnosed with Essential Thrombocythemia and a hematocrit <45% in cases of Polycythemia Vera. The median follow-up of patients from the date of the first treatment of Phosphorus-32P until study completion or death was 37 months (range: 5-230 months). Regarding early complications, 2 cases of anemia requiring blood transfusion were observed, and 1 case of mild thrombocytopenia. No leukemic transformation was identified. CONCLUSIONS: In our experience, treatment with Phosphorus-32P has been a useful therapeutic option in Philadelphia-negative chronic myeloproliferative syndromes in elderly patients who showed poor tolerance and/or resistance to first-line treatment. No leukemic transformation was identified.

The effect of radiation synovectomy with phosphorus-32 on the pain and swelling in 31 RA patients with resistant monoarthritis of the knee.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by symmetric polyarthritis. RA is routinely treated by various systemic drugs; on the other hand, administration of intra-articular corticosteroids or different types of synovectomies can be used in case of systemic medication's failure. Chemical, radio isotopic, and surgical synovectomies are being used as therapeutic options for chronic synovitis to improve joint function. Chemical synovectomy is not well tolerated, and the long-term response is relatively low. Surgical synovectomy has a better success rate, but it recommends higher expenses. In radiation synovectomy, radioactive labeled particles are applied directly in the articular cavity, followed by homogeneous distribution in joint. Next, the radioactive particles are transported in the depth of synovia and phagocytized by inflammatory cells. Finally, the radiation leads to fibrosis and sclerosis of formerly inflamed synovial membrane; thus, it stops the inflammation and reduces the symptoms. It has a success rate of 40-100% and its effect can be similar to surgical synovectomy. MATERIALS AND METHODS: Thirty-one patients with resistant monoarthritis of the knee were enrolled in this study. One millicurie of phosphorus-32 was injected into patients' knee via US guide. Saline was injected afterwards to prevent leakage. Direct pressure was performed after removing the needle and the knee was flexed slowly to ensure homogenous distribution and fixed with a splint for 1 to 2 weeks. Patients were followed up after 2 weeks, 1 month, 2 months, and 6 months. The following variables were assessed by the treating rheumatologist: patients' pain, joint tenderness, effusion, and ROM. At the time of injection and after the first week, patients were investigated for any complication including infection, necrosis, pain, and swelling. The effect of clinical characteristics and demographic data on existing complications and the changes of pain, joint tenderness, effusion, and ROM was assessed. RESULTS: Thirty-one patients with the mean age of 54.5 ± 12.2 years and the mean disease duration of 12 ± 6.5 years were enrolled in this study. Mean DAS-28 ESR score for our patients was 4 ± 0.7. The pain, effusion, and reduced ROM were decreased significantly after all follow-up intervals. Knee tenderness was not affected in the first 2 weeks, but it was reduced significantly after 1, 2, and 6 months. No serious complications like infection and necrosis were reported through our study. 51.6% and 54.8% of our patients reported pain and swelling in the administration site. Furthermore, 19.4% and 16.1% of patients reported deterioration of pain and effusion in the first week of injection. CONCLUSION: In our study, we demonstrated that pain, tenderness, effusion, and ROM are improved after radiation synovectomy with phosphorus-32. We also showed that there was no serious adverse effect like infection and necrosis. However, more than half of our patients experienced pain and swelling of injection site at the time of administration. Key points • We demonstrated the efficacy of radiation synovectomy as a medication for monoarthritis. • The results of our study can lead to a bigger clinical trial to assess the benefits and adverse effects of radiation synovectomy in comparison to treatment with local or systemic corticosteroids.

Enhanced outcomes in residual or recurrent craniopharyngioma: evaluating combined gamma knife and phosphorus-32 brachytherapy.

BACKGROUND: Managing residual and recurrent craniopharyngioma effectively is crucial for improving patient outcomes. This study evaluates the combined use of gamma knife and phosphorus-32 brachytherapy, offering insights into alternative, less invasive treatment strategies. METHODS: We conducted a retrospective analysis of 97 patients treated from 2010 to 2016 for residual and recurrent craniopharyngioma using gamma knife and phosphorus-32 brachytherapy. We classified these patients into three groups: superficial solid (Group A), simple cystic (Group B), and mixed cystic-solid (Group C). We assessed the treatment's effectiveness by the tumor control rates and evaluated safety by monitoring vision, endocrine function improvements, and complication rates. RESULTS: The treatment achieved complete and adequate control rates of 49.5% and 87.6%, respectively. We observed improvements in vision or visual fields in 55.1% of the patients. The morbidity rate was 15.5%. The study found no significant differences in tumor control rates among the various lesion types. CONCLUSION: The combination of gamma knife and phosphorus-32 brachytherapy presents a viable, minimally invasive alternative for treating residual and recurrent craniopharyngioma. It offers high tumor control and functional improvement rates, suggesting its potential as a preferred strategy in some instances.

A multidisciplinary challenge: Therapy with phosphorus-32 for locally advanced pancreatic cancer.

Pancreatic cancer is a disease with a poor prognosis, and overall survival has improved the least in the last 40 years of all cancers. Locally advanced pancreatic adenocarcinoma, without distant metastasis but with limiting vascular involvement, constitutes almost one third of these patients. This group is the focus of most research efforts to introduce treatments to increase surgical salvage rates and/or survival, with two main objectives: local control and prevention of systemic progression. Intratumoural treatment with phosphorus-32 microparticles, guided by echoendoscopy and combined with standard chemotherapy may have significant and clinically relevant benefits in these patients, and therefore a valuable treatment option in a disease where there is an urgent need to develop new therapies to help improve outcomes.

Comparative study of Lutetium-177 and Phosphorus-32 in radioactive bone cement for the treatment of vertebral body metastasis.

BACKGROUND: Vertebroplasty is a minimally invasive outpatient procedure to stabilize compression fractures in the spine. This procedure involves injecting bone cement into the vertebrae that have been cracked or broken, typically due to osteoporosis. The cement hardens inside the bones, providing stability to the fractures and supporting the spine. Additionally, radioactive bone cement and brachytherapy sources have been utilized to suppress tumor growth in the vertebral body. OBJECTIVE: We present a novel brachytherapy technique for treating vertebral body metastases using a liquid form of radioactive sources, Phosphorus-32 and Lutetium-177, separately mixed with bone cement and injected into vertebral body bone prostheses. We also investigated the dose distribution of the radioactive bone cement by theoretically calculating it using GEANT4 Monte Carlo and measuring it using TLD dosimeters for Phosphorus-32 and Lutetium-177 loaded in vertebral bodies. MATERIAL AND METHODS: CT-scanned images of each vertebral body (L2 and L3) were imported into GEANT4 for simulation purposes. Two simulations were performed to evaluate the possibility of using PLA prostheses in ex vivo measurements, using bone and PLA material as a bone substitute for brachytherapy of Lutetium-177 and Phosphorus-32. The simulations calculated the dose distribution, dose rates, and deposited dose to the spinal cord and aorta. Next, 3D-printed bone prostheses were drilled and separately filled with bone cement, including PMMA-P32 and PMMA-Lu177, in liquid form using the Vertebroplasty technique. The dose to regions of interest was measured using Thermoluminescence dosimeters. CONCLUSIONS: When comparing the simulated and measured results of dose rates, it was observed that P32 delivers higher doses to normal organs such as the spinal cord and aorta. At the same time, Lu177 has better sparing in these regions of interest. Therefore, while P32 and Lu177 are suitable for radioactive bone cement treatment, Lu177 delivers relatively lower doses to vital organs such as the spinal cord and aorta. Additionally, Lu177 has characteristics such as a shorter range and lower energies of beta particles in tissue and the presence of gamma rays that make it a better choice for the same treatments. It also provides the possibility of SPECT imaging.

ANALGESIC EFFECT OF VARIOUS RADIOPHARMACEUTICALS IN THE COMPLEX TREATMENT OF METASTATIC BONE DISEASE. / ZNEBOLIuVAL'NYI VPLYV RIZNYKh RADIOFARMPREPARATIV U KOMPLEKSNOMU LIKUVANNI METASTATYChNOGO URAZhENNIa KISTOK.

OBJECTIVE: The study objective was to investigate and compare the effectiveness of different radiopharmaceuticalsin the treatment of metastatic bone disease. MATERIALS AND METHODS: Cancer patients (n = 150, average age (55 ± 11.6) years, 95 females, 55 males) having gotvarious primary tumors and metastatic bone disease were given medical treatment at the Department of NuclearMedicine of the National Institute of Cancer. The 153Sm, 32Р, and 89Sr radiopharmaceutical agents produced by the«Radiopreparats¼ enterprise (Republic of Uzbekistan) and Radioisotope Centre Polatom (National Centre for NuclearResearch, Poland) were administered to the patients. There were cases of breast cancer (n = 75), prostate cancer(n = 45), lung cancer (n = 10), kidney cancer (n = 4), cervical cancer (n = 5), and rectosigmoid cancer (n = 11) amongthe treated subjects. In 135 patients (90 %) the bone metastases were detected by osteoscintigraphy with 99мTc- mo-nodiphosphonate. In 15 cases the diagnosis of metastatic bone disease was verified by other radiology methods. RESULTS: The pain intensity rating scale (LACOMED) was used to assay the analgesic effect of various radiopharma-ceuticals in metastatic bone disease. Results of treatment with 32P, 89Sr, and 153Sm were included in a comparativeanalysis procedure. It was established that the level of pain syndrome ranged from 7-8 points on the LACOMED scalebefore treatment. Upon administration of radionuclide therapy the level of pain was reduced down to 3-5 points,namely with 32P therapy it has decreased by 30.7 %, with 89Sr by 33.2 %, and with 153Sm by 41.5 % respectively. Timepattern of 153Sm analgesic effectiveness was studied depending on the number of treatment sessions. The best valueof analgesic effect of 153Sm was registered after the first treatment session with a tendency to decrease after the sec-ond and significantly lower analgesic effects after the third session. Tolerance of 153Sm was rated on the CTCNCA (v)4.3 scale. The best tolerance was peculiar to 153Sm corresponding to the «good¼ level according to a point assess-ment. When using 89Sr the drug tolerance was lower, not requiring however the drug discontinuation. The 32P radio-pharmaceutical featured the lowest tolerance approaching the «satisfactory¼ rating. In 11 patients upon that theside effects were found significantly impairing the patient's status, accordingly some extra measures were required.No decision to cancel the drug administration was made. CONCLUSIONS: Radionuclide therapy with 153Sm-oxabiphor agent can be used in the complex treatment of metastat-ic bone disease in cancer patients having got tumors of different localization. 153Sm-oxabiphor is the most effectiveand best tolerable radiopharmaceutical agent in the pain treatment in metastatic bone disease in comparison with32P and 89Sr preparations (р < 0.05).

New model for an epoxy-based brachytherapy source to be used in spinal cancer treatment.

The present work described the cold fabrication of a P-32 radioactive source to be used in CNS cancer using epoxy resin. The epoxy plaque fabricated with Teflon mold presented better agreement. MCNP simulation evaluated the radiation dose. Special attention was given to factors that can impact dose distribution. Average dose was 16.44 ± 2.89% cGy/s. Differences of less than 0.01 cm in thickness within the plaque lead to differences of up to 12% in the dose rate.

An open-label, single-arm pilot study of EUS-guided brachytherapy with phosphorus-32 microparticles in combination with gemcitabine +/- nab-paclitaxel in unresectable locally advanced pancreatic cancer (OncoPaC-1): Technical details and study protocol.

Current treatment options for patients with unresectable locally advanced pancreatic cancer (LAPC) include chemotherapy alone or followed by chemoradiation or stereotactic body radiotherapy. However, the prognosis for these patients remains poor, with a median overall survival <12 months. Therefore, novel treatment options are needed. Currently, there is no brachytherapy device approved for pancreatic cancer treatment. Hereby, we present the protocol of a prospective, multicenter, interventional, open-label, single-arm pilot study (OncoPac-1, Clinicaltrial.gov-NCT03076216) aiming to determine the safety and efficacy of Phosphorus-32 when implanted directly into pancreatic tumors using EUS guidance, for patients with unresectable LAPC undergoing chemotherapy (gemcitabine ± nab-paclitaxel).

Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum.

OBJECTIVE: The current treatment of chordomas is associated with significant morbidity, high rates of local recurrence, and the potential for metastases. Stereotactic radiosurgery (SRS) as a primary treatment could reduce the need for en bloc resection to achieve wide or marginal margins. Spinal SRS outcomes support the exploration of SRS's role in the durable control of these conventionally radioresistant tumors. The goal of the study was to evaluate outcomes of patients with primary chordomas treated with spinal SRS alone or in combination with surgery. METHODS: Clinical records were reviewed for outcomes of patients with primary chordomas of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to the extent of surgery. RESULTS: In total, 35 patients with de novo chordomas of the mobile spine (n = 17) and sacrum (n = 18) received SRS and had a median post-SRS follow-up duration of 38.8 months (range 2.0-122.9 months). The median planning target volume dose was a 24-Gy single fraction (range 18-24 Gy). Overall, 12 patients (34%) underwent definitive SRS and 23 patients (66%) underwent surgery and either neoadjuvant or postoperative adjuvant SRS. Definitive SRS was selectively used to treat both sacral (n = 7) and mobile spine (n = 5) chordomas. Surgical strategies for the mobile spine were either intralesional, gross-total resection (n = 5) or separation surgery (n = 7) and for the sacrum en bloc sacrectomy (n = 11). The 3- and 5-year LRFS rates were 86.2% and 80.5%, respectively. Among 32 patients (91%) receiving 24-Gy radiation doses, the 3- and 5-year LRFS rates were 96.3% and 89.9%, respectively. The 3- and 5-year OS rates were 90.0% and 84.3%, respectively. The symptom response rate to treatment was 88% for pain and radiculopathy. The extent or type of surgery was not associated with LRFS, OS, or symptom response rates (p > 0.05), but en bloc resection was associated with higher surgical toxicity, as measured using the Common Terminology Criteria for Adverse Events (version 5.0) classification tool, than epidural decompression and curettage/intralesional resection (p = 0.03). The long-term rate of toxicity ≥ grade 2 was 31%, including 20% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, myelopathy, fracture, and secondary malignancy. CONCLUSIONS: High-dose spinal SRS offers the chance for durable radiological control and effective symptom relief with acceptable toxicity in patients with primary chordomas as either a definitive or adjuvant therapy.

Evaluación de fugas extrarticulares del Fosfato crómico marcado con Fósforo-32 de producción nacional en pacientes hemofílicos / Evaluation of joint leakage of national Chromic Phosphate labeled with Phosphorus-32 in hemophilic patients

La radiosinoviortesis como tratamiento de la artropatía hemofílica, frecuentemente, ofrece excelentes resultados, al reducir grandemente el número de episodios de sangramiento y evitar daños ulteriores a las articulaciones. El Centro de Isótopos desarrolló el fosfato crómico coloidal marcado con Fósforo-32, producto listo para su empleo en pacientes hemofílicos. El objetivo de este trabajo fue evaluar la fuga extrarticular de este radiofármaco utilizado en la radiosinoviortesis en pacientes hemofílicos. Se determinó el porcentaje de fuga extrarticular del radiofármaco en 9 pacientes hemofílicos con sinovitis crónica, a los que se les realizó la radiosinoviortesis en la articulación de la rodilla. La radiactividad se midió, con un contador Geiger-Muller, sobre la rodilla tratada, en sus aspectos lateral, encima y medial; la rodilla contralateral; las cadenas linfáticas inguinales, de ambos lados, y el hígado. Los valores de fuga encontrados posteriormente a la inyección fueron 0,0046 por ciento a los 10 min; 0,0023 por ciento a las 24 horas; 0,1332 por ciento el día 7 y 4,0213 por ciento el día 30. Estos resultados coinciden con los valores comunicados por otros autores y con lo esperado de acuerdo a las características del producto, indican que se ejecutó el proceder adecuadamente y que los pacientes fueron seleccionados correctamente(AU)

Radiosynoviorthesis as a treatment for hemophilic arthropathy often offers excellent results, greatly reducing the number of bleeding episodes and avoiding further damage to the joints. The Isotope Center developed a product, Colloidal Chromic Phosphate labeled with Phosphorus-32, ready for use in hemophiliac patients. Our objective was to evaluate the joint leakage of this radiopharmaceutical use in radiosynoviorthesis in hemophilic patients. The percentage of radiopharmaceutical joint leakage was evaluated in 9 hemophilic patients with chronic synovitis, who underwent radiosynoviorthesis in the knee joint. The radioactivity was measured on the treated knee, in its lateral, above and medial aspects, the contralateral knee, the inguinal lymphatic chains of both sides and the liver, with a Geiger-Muller detector. The leakage values 8203;​found after the injection were 0.0046 percent at 10 minutes, 0.0023 percent at 24 hours, 0.1332 percent on day 7 and 4.0213 percent on day 30. These results are agreed with the values reported by other authors and with was expected according to the characteristics of the product, indicatate that the procedure was executed properly and that the patients were correctly selected(AU)

Evaluation of Bremsstrahlung radiation dose in stereotactically radiocolloid therapy of cystic craniopharyngioma tumors with 32P radio-colloid.

Over 90% of craniopharyngeal brain tumors are cystic, which enables the injection of beta emitters such as phosphorus-32 (32P) radio-colloid into cysts for their treatment. The aim of this study was to evaluate the clinical and theoretical modelling of Bremsstrahlung radiation dose resulting from stereotactic radio-colloid therapy of cystic craniopharyngioma tumors with 32P. 32P radio-colloid with appropriate activity concentration was injected to a head phantom, and then the Bremsstrahlung radiation spectrum and planar images were obtained using a gamma camera. Both phantom and gamma camera were simulated using MCNPX code, and the results were compared with practical results. Bremsstrahlung radiation spectrum was measured using a handheld gamma spectrometer for two patients treated with stereotactic radio-colloid therapy with 32P in different positions and compared to Monte Carlo simulation. Results of counting and determining sensitivity coefficients in the air and the attenuating environment were obtained. Also, comparing the counting sensitivity from practical and simulation methods indicated the agreement of the data between the two methods. Comparison of the spectra from different positions around patient's head indicated the ability to use this detector to quantify the activity in the operating room. Selection of the spectrum is important in Bremsstrahlung radiation imaging. We can take advantage of spectrometry measurement using gamma camera, handheld gamma spectrometer for patient, and theoretical modeling with Monte Carlo code to evaluate radiopharmaceutical distribution, leakage, as well as estimate activity and predict therapeutic effects in other adjacent structures and ultimately optimize radio-colloid therapy in cystic craniopharyngeal patients.

Novel Application of 32P Brachytherapy: Treatment of Angiolymphoid Hyperplasia with Eosinophilia in the Right Auricle with 8-Year Follow-Up.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a distinctive benign vascular disease that can be challenging to treat due to inconsistent results for various treatment modalities such as surgical excision, corticosteroids, radiotherapy, laser therapy, and other therapies, so novel approaches are needed to improve treatment outcomes. MATERIALS AND METHODS: ALHE on the right auricle of a 54-year-old Chinese woman underwent brachytherapy using 32P simple drug membranes for five times. The 32P brachytherapy involving simple drug membranes of brachytherapy began by diluting a 32P solution with 0.9% NaCl solution to produce a radioactivity of 69.2-74.7 MBq/mL(1.87-2.02 mCi/mL). The drug membranes were removed between 48 and 72h after application. There were intervals ranging from 65 to 72d between the membrane application periods, and the last treatment was in June 2010. RESULTS: After the 32P brachytherapy, follow-up results over the course of 8 years were promising. The regional symptoms disappeared, the right preauricular swelling decreased, the subcutaneous nodules decreased in size, the exudate disappeared, and the skin appearance improved. CONCLUSIONS: This case indicated that 32P brachytherapy may represent a novel ALHE treatment method that produces a favorable long-term outcome.

Drug distribution and clinical safety in treating cystic craniopharyngiomas using intracavitary radiotherapy with phosphorus-32 colloid.

The present study evaluated drug distribution and clinical safety in treating patients with cystic craniopharyngioma (CP) with intracavitary radiotherapy using phosphorus-32 (32P) colloid. In total, 40 patients who were recently diagnosed with primary or recurrent cystic CP were enrolled into the study. Patients underwent stereotactic intracavitary therapy and were administered 32P colloid and iopamidol-300 (1:1 dilution). Head computed tomography (CT) scans were performed 2 h after surgery in order to assess drug distribution and leakage. Results obtained from the ophthalmic examination (visual acuity, visual field and fundus), enhanced head magnetic resonance imaging and/or CT scans, blood analysis, coagulation tests, electrolyte tests, pituitary hormone level analysis, and hepatic and renal function tests were compared between the 0.5, 1, 1.5 and 2 mCi groups. The 32P colloid per minute radioactive count was quantitatively measured in urine and blood samples using a CAPRAC well-type NaI γ counter at 1, 3 and 7 days post-surgery. In total, 6, 2 and 1 case(s) from the 2, 1.5 and 1 mCi groups, respectively, demonstrated heterogeneous drug distribution and intracavitary cerebrospinal fluid leakage. Furthermore, out of 24 patients, no significant differences were identified in blood analysis, blood biochemical measurements and pituitary hormone levels prior to and 7 days after surgery. Blood 32P deposition returned to normal levels within 3 days after surgery, whereas urine deposition returned to normal within 7 days after surgery. Methods utilized in the present study were advantageous in terms of convenience, speed and low cost, therefore, these techniques are suitable for continuous monitoring of patient 32P colloid deposition.

EANM guidelines for radionuclide therapy of bone metastases with beta-emitting radionuclides.

The skeleton is the most common metastatic site in patients with advanced cancer. Pain is a major healthcare problem in patients with bone metastases. Bone-seeking radionuclides that selectively accumulate in the bone are used to treat cancer-induced bone pain and to prolong survival in selected groups of cancer patients. The goals of these guidelines are to assist nuclear medicine practitioners in: (a) evaluating patients who might be candidates for radionuclide treatment of bone metastases using beta-emitting radionuclides such as strontium-89 (89Sr), samarium-153 (153Sm) lexidronam (153Sm-EDTMP), and phosphorus-32 (32P) sodium phosphate; (b) performing the treatments; and

Criterios de calidad de dispersiones radiactivas en radiosinovectomía / Quality criteria of the radiopharmaceutical suspensions used in radiosynoviorthesis

En el trabajo se examinan los criterios de calidad de dispersiones radiactivas utilizadas en radiosinovectomía a partir de los requisitos recogidos en la farmacopea para el Fosfato Crómico- de la firma Mallinkrodt, las recomendaciones de uso de radiofármacos registrados de la Asociación Europea de Medicina Nuclear y datos aportados por las firmas comercializadoras. Tomando como base el estudio de dos formulaciones propias de Fosfato Crómico, una marcada con y la otra, con , en las que se estudia la consistencia (reproducibilidad) tanto de la pureza radioquímica como de la distribución de tamaños de partículas, se prueba que el tenor de 5 % de fosfato libre admitido en la formulación de la firma Mallinkrodt y que se extendiera a formas iónicas de otros radiofármacos de matrices diferentes, se debe probablemente al efecto inevitable de la esterilización a vapor sobre la suspensión y de que tanto al momento de decidir sobre el empleo de un lote, como en los requisitos de las farmacopeas, debiera prestarse más atención a la distribución de tamaños por estar más vinculada a la eficacia y seguridad de los radiofármacos

The quality criteria of radioactive dispersions used in radiosynovectomy are examined, taking into account the requirements of the Pharmacopoeia for the Chromic Phosphate P-32 of Mallinckrodt, recommendations for the use of approved radiopharmaceuticals of the European Association of Nuclear Medicine and data provided by others marketing firms. The behavior of two formulations of chromic phosphate, one -labeled and the second -labeled, from the point of view of the consistency (reproducibility) of both the radiochemical purity and the particle size distribution was assayed. It is proven that the presence of 5% of free phosphate admitted in the Mallinckrodt formulation, and extended to the presence of ionic forms of other radiopharmaceuticals of different matrices, is probably due to the inevitable effect of steam sterilization on the suspension. Based on these results and the accumulated clinical experience, it is considered that to establish the quality requirements of the radioactive suspensions for radiosynovectomy, more attention should be paid to the particle size distribution than to the percentage of free ionic forms. The first one is more related to the efficacy and safety of this kind of radiopharmaceuticals

Treatment of Graves' ophthalmopathy with an in-house Phosphorus-32 source: Initial clinical observations.

The objective of the present study was to observe the therapeutic effect of radiation delivered via a 32P source on Graves' ophthalmopathy. A32P solution was injected into a 10-ml vacuum flask held inside a lead container. A window was cut in the lead, generating a treatment beam. Radiation was given to four areas: The upper and lower orbit (covering ~1/3 of the eyelid) and the inner and outer canthus. Each site received 10 daily doses of 20 cGy. Proptosis was measured by an exophthalmometer and the palpebral aperture was determined with a ruler. Measurements were taken before and after the treatment. After 5 days of treatment, the patient displayed a significant improvement, and by 10 days, the average reduction of proptosis in Graves' ophthalmopathy was 3.36±1.73 mm for the left and 3.05±2.04 mm for the right eyes. The treatment was effective in all patients, who uniformly reported rapid pain relief. Conjunctival congestion and eyelid edema also improved significantly. However, only 50% of patients showed improved diplopia after treatment, which was poor compared with other symptoms. No obvious side effects were found in the subsequent follow-up. In conclusion, 32P brachytherapy for Graves' ophthalmopathy was simple and effective, with few side effects, and should be considered as a promising therapy.

Treatment of Cystic Craniopharyngioma with Intracystic Stereotactic Instillation of Phosphorus 32.

OBJECTIVE: Cystic craniopharyngiomas are considered the most common intracranial nonglial tumor in children with the tendency for cyst formations. The aim of this study was to evaluate the effect of intracystic phosphorus 32 (P32) therapies on controlling the growth of the cystic component of craniopharyngioma. MATERIALS & METHODS: This clinical study was conducted on 47 patients with cystic craniopharyngioma from March 1998 to June 2012 at Shohada Tajrish Hospital, Tehran, Iran. Patients were treated with stereotactic intracystic P32. The mean cyst volume was 23.5 ml, and the dose of radiation to the inner cyst wall was 250 Gy. RESULTS: The overall response rate was 78.1% and the mean survival was 113.1±11months. The survival rate at 1, 3, 5, and 10 years after p32 therapy was 91%, 77%, 73%, and 52%, respectively. There was no mortality related to the procedure and no visual or endocrinal deterioration. Visual improvement occurred in 88% of patients presented with recent deterioration due to the cyst enlargement. CONCLUSION: Intracystic p32 therapy was an effective and almost safe procedure for the treatment of cystic component of craniopharyngioma.

Evaluación isotópica del fósforo de un suelo ferralítico rojo bajo varios sistemas de fertilización / Phosphorus isotopic evaluation of a Red Ferralitic soil under various fertilization systems

Se analizaron muestras de un suelo ferralítico rojo de la Estación Experimental “Juan Tomás Roig” de la Universidad de Ciego de Ávila, sometido a dos rotaciones de cultivo y cuatro sistemas de fertilización fosfórica. El objetivo fue evaluar, mediante la dilución isotópica del 32P, los parámetros estáticos del fósforo (P) en un suelo que recibió fertilizante fosfórico por dos métodos de aplicación (en bandas y a voleo) durante varios años. Se utilizó un método radioquímico de laboratorio usando una disolución marcada con 32P libre de portador, basado en el intercambio isotópico entre los fosfatos de los sólidos y la solución del suelo. Las muestras de suelo se analizaron en los laboratorios del Departamento del Comisariado de Energía Atómica, Francia. Se determinaron los factores cantidad (E1) como el P isotópicamente intercambiable en un minuto, intensidad (Cp) como la concentración de P en la solución del suelo y capacidad como la relación E1/Cp. La evaluación isotópica mediante 32P indicó que el suelo necesita de aplicaciones de P altas y en bandas para alcanzar valores de E1 y Cp adecuados para la nutrición de los cultivos agrícolas. Con la fertilización en bandas se logró un efecto acumulativo del P en el suelo después de tres ciclos de rotación de cultivos, que permitió incrementar su disponibilidad para las plantas. El factor capacidad resultó muy alto en todas las muestras de suelo, lo cual indica que el suelo mantiene una reserva de P que es difícilmente intercambiable con el P de la solución del suelo

Soil samples from a red ferralitic soil from the "Juan Tomás Roig" Experimental Station, belonging to Ciego de Avila University were analyzed under two crop rotations and four phosphoric fertilization systems. The objective was to evaluate, through the 32P isotopic dilution, phosphor (P) static parameters in a soil that has received P fertilizer through two placement methods (banding and broadcasting) for several years. A radiochemical laboratory method using a 32P free-carrier solution as a tracer based on isotopic exchange between solid phase and soil solution phosphate ions was used. Soil samples were analyzed at the CEA Department laboratories, in Francia. Quantity (E1), as isotopic exchangeable P at one minute, intensity (Cp), as P concentration in soil solution, and capacity, as (E1/Cp), factors were determined. 32P isotopic evaluation indicated that the soil needs high banding P application to reach adequate E1 and Cp values for crop nutrition. A cumulative P effect in the soil through banding fertilization after three crop rotation cycles was obtained, which allows to increase plant P availability. The capacity factor was very high in all soil samples, indicating that soil maintains a P reserve that is difficult to exchange with the phosphor present in the soil solution