Pain palliative therapy in women with breast cancer osseous metastatic disease and the role of specific serum cytokines as prognostic factors.

PURPOSE: To evaluate the efficacy of radionuclide palliative therapy (RPT) in women suffering from painful metastatic bone disease (MBD) due to breast cancer (BrCa), and to investigate the possible relationship between the RPT efficacy and cytokines levels. METHODS: Sixty-three BrCa women patients with MBD enrolled in a prospective, nonrandomized study. Thirty were treated with Rhenium-186-hydroxyethylidenediphosphonic acid ((186)Re-HEDP), 21 with Strontium-89-Chloride ((89)Sr-Cl2), and 12 with Samarium-153-thylenediaminetetramethylenephosphonic acid ((153)Sm-EDTMP). Blood samples were collected pre- and post-therapy to assess the interleukin (IL)-2, IL-6 and tumor necrosis factor (TNF)-a titers. The palliative effect of the treatment was evaluated using a modified Wisconsin test. RESULTS: All three radiopharmaceuticals were equally effective in pain relief. Pain palliation was complete in 52% of patients, partial in 31%, and absent in 16%. Responders to therapy had higher IL-2 and lower IL-6/TNF-a concentrations, compared with nonresponders, even though statistically significant difference in cytokines levels between responders and nonresponders before treatment was noted only for IL-6. CONCLUSION: All used radiopharmaceuticals had the same therapeutic effect. Pretherapy low titers of IL-6 levels seems to have a favorable prognostic value for the therapeutic outcome, while IL-2 and TNF-a alterations pre- and post-therapy can only serve as markers of a better RPT response.

SPECT imaging evaluation in movement disorders: far beyond visual assessment.

Single photon emission computed tomography (SPECT) imaging with (123)I-FP-CIT is of great value in differentiating patients suffering from Parkinson's disease (PD) from those suffering from essential tremor (ET). Moreover, SPECT with (123)I-IBZM can differentiate PD from Parkinson's "plus" syndromes. Diagnosis is still mainly based on experienced observers' visual assessment of the resulting images while many quantitative methods have been developed in order to assist diagnosis since the early days of neuroimaging. The aim of this work is to attempt to categorize, briefly present and comment on a number of semi-quantification methods used in nuclear medicine neuroimaging. Various arithmetic indices have been introduced with region of interest (ROI) manual drawing methods giving their place to automated procedures, while advancing computer technology has allowed automated image registration, fusion and segmentation to bring quantification closer to the final diagnosis based on the whole of the patient's examinations results, clinical condition and response to therapy. The search for absolute quantification has passed through neuroreceptor quantification models, which are invasive methods that involve tracer kinetic modelling and arterial blood sampling, a practice that is not commonly used in a clinical environment. On the other hand, semi-quantification methods relying on computers and dedicated software try to elicit numerical information out of SPECT images. The application of semi-quantification methods aims at separating the different patient categories solving the main problem of finding the uptake in the structures of interest. The semi-quantification methods which were studied fall roughly into three categories, which are described as classic methods, advanced automated methods and pixel-based statistical analysis methods. All these methods can be further divided into various subcategories. The plethora of the existing semi-quantitative methods reinforces the feeling that visual assessment is still the base of image interpretation and that the unambiguous numerical results that will allow the absolute differentiation between the known diseases have not been standardized yet. Switching to a commonly agreed-ideally PC-based-automated software that may take raw or mildly processed data (checked for consistency and maybe corrected for attenuation and/or scatter and septal penetration) as input, work with basic operator's inference and produce validated numerical results that will support the diagnosis is in our view the aim towards which efforts should be directed. After all, semi-quantification can improve sensitivity, strengthen diagnosis, aid patient's follow-up and assess the response to therapy. Objective diagnosis, altered diagnosis in marginal cases and a common approach to multicentre trials are other benefits and future applications of semi-quantification.

[Radiation doses from patients undergoing yttrium-90 silicate knee radiosynovectomy].

The present study was undertaken because we could not find references related to the minimal radiation doses emitted from patients treated with (90)Y-silicate colloid ((90)Y-SC) for radiosynectomy (RS). Radiation doses from 16 patients treated with about 181+/-13 MBq (90)Y-SC for RS of knee synovitis were estimated by dose rate measurements performed within 10 min after the (90)Y-SC injection with a calibrated survey dose ratemeter at 0.5 m, 1 m and 2 m distances from the treated joint. The mean dose rate values from the patients after bg subtraction were 0.6+/-0.4 microSv/h at 0.5 m, 0.1+/-0.1 microSv/h at 1 m and 0.1 +/- 0.0 microSv/h at 2 m distance. Dose rates at a distance of 0.5 m were significantly correlated (P<0.02) with the patient's weight but not with the height or the injected activity. The assumed estimated maximum whole body doses from a treated patient were 55 microSv for persons living with the patient, 2.9-3.4 microSv for the nursing staff, 0.2-1.8 microSv for the therapist physician and 0.3-0.6 microSv for the technologist, involved in the whole procedure. The above values were lower than those published with the same methodology for alternative RS radiopharmaceuticals for knee synovitis like dysprosium-165 ferric hydroxide macroaggregate ((165)Dy-FHMA) or holmium-166 ((166)Ho-FHMA), as estimated with their typical injected activities. In conclusion our results demonstrate that in (90)Y-SC knee synovectomy, the whole body radiation doses to medical and non medical personnel were as expected well below the maximum annual dose limits for the public and professionals exposed to radiation.