Effects of photobiomodulation and an aerobic exercise on the level of pain and quality of life in women with fibromyalgia.

To evaluate the effectiveness of photobiomodulation (PBM) in conjunction with an aerobic exercise program (AEP) on the level of pain and quality of life of women with fibromyalgia (FM). METHODS: A double-blinded randomized controlled trial in which 51 participants with FM were allocated into 4 groups: control group (CG) (n = 12); active PBM group (APG) (n = 12); AEP and placebo PBM group (EPPG) (n = 13); AEP and active PBM group (EAPG) (n = 14). AEP was performed on an ergometric bicycle; and a PBM (with an increase dosage regime) [20 J, 32 J and 40 J] was applied using a cluster device. Both interventions were performed twice a week for 12 weeks. A mixed generalized model analysis was performed, evaluating the time (initial and final) and group (EAPG, EPPG, APG and CG) interaction. All analyses were based on intent-to-treat for a significance level of p ≤ 0.05. RESULTS: The intra-group analysis demonstrated that all treated groups presented a significant improvement in the level of pain and quality of life comparing the initial and final evaluation (p < 0.05). Values for SF-36 and 6-minute walk test increased significant in intragroup analysis for EPPG comparing the initial and final evaluation. No intergroup differences were observed. CONCLUSIONS: Both exercised and PBM irradiated volunteers present improvements in the variables analyzed. However, further studies should be performed, with other PBM parameters to determine the best regime of irradiation to optimize the positive effects of physical exercises in FM patients.

Use of photobiomodulation (880 nm) for anesthesia puncture pain reduction: A split-mouth case report.

The objective of this split-mouth case report is to evaluate the effect of photobiomodulation (PBM, 880 nm) on pain control during pterygomandibular puncture. A patient received anesthesia on both sides of the mouth in a randomized manner. On the right side, an 880-nm infrared laser was applied immediately before local anesthesia. On the left side, a sham laser was applied using the same technique. There was a 50% reduction in pain levels on the PBM-treated side compared to the PBM-sham side, as measured by the visual analog scale. Sensitivity tests revealed that anesthesia was more effective on the PBM side. There was no difference in blood pressure. This case report suggests that PBM (880 nm) before anesthesia may alleviate puncture pain associated with pterygomandibular anesthesia. Although these findings are based on a single case report, they can serve as the initial stepping stone for further randomized clinical trials.

Effectiveness of photobiomodulation therapy on pain intensity in postpartum women with nipple or perineal trauma: protocol for a multicentre, double-blinded, parallel-group, randomised controlled trial.

INTRODUCTION: Photobiomodulation (PBM) using low-level laser can affect tissue repair mechanisms and seems promising in reducing pain intensity. However, few studies support the effectiveness of PBM on postpartum period complications, such as nipple and/or perineal trauma and pain, probably due to the low doses used. The primary objective of this study is to analyse the effectiveness of PBM on pain intensity in the nipple and perineal trauma in women in the immediate postpartum period. Secondary objectives are to evaluate the effect on tissue healing and the women's satisfaction. METHODS AND ANALYSIS: A double-blind, multicentre, parallel-group, randomised controlled trial will be performed in two public referral maternity hospitals in Brazil with 120 participants, divided into two arms: 60 participants in the nipple trauma arm and 60 participants in the perineal trauma arm. Participants will be women in the immediate postpartum period, who present with nipple trauma or perineal trauma and report pain intensity greater than or equal to 4 points on the Numerical Rating Scale for Pain. Block randomisation will be performed, followed by blinding allocation. In the experimental group, one application of PBM will be performed between 6 hours and 36 hours after birth. For the sham group, the simulation will be carried out without triggering energy. Both participants and the research evaluator will be blinded to the allocation group. Intention-to-treat method and the between-group and within-group outcome measures analysis will be performed. ETHICS AND DISSEMINATION: This research protocol was approved by the Research Ethics Committees of the University of Campinas, Brazil, and of the School Maternity Assis Chateaubriand, Brazil (numbers CAAE: 59400922.1.1001.5404; 59400922.1.3001.5050). Participants will be required to sign the informed consent form to participate. Results will be disseminated to the health science community. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (RBR-2qm8jrp).

Simultaneous red and infrared light-emitting diodes reduced pain in individuals with temporomandibular disorder: a randomized, controlled, double-blind, clinical trial.

The aim of the present study was to evaluate the effects of photobiomodulation (PBM) with the simultaneous use of red and infrared LEDs on pain and mandibular range of motion in individuals with temporomandibular disorder (TMD). Eighteen participants were randomly allocated to an LED group or control group. The device had 18 red LEDs (660 nm) and 18 infrared LEDs (850 nm), with a total power irradiated of 126 mW and 75.6 J per point. The device was placed in the regions of the temporomandibular joint (TMJ) and masticatory muscles once per day three times per week for 2 weeks. Pain intensity was measured using the visual analog scale (VAS). Mandibular range of motion was determined using digital calipers and considering different conditions (unassisted opening without pain, maximum opening with and without assistance, right and left lateral movements, and protrusion). Evaluations were performed before treatment, immediately after the first LED irradiation session and at the end of six sessions. A significant reduction in pain intensity was found in the LED group at the end of treatment compared to the control group (p < 0.001) as well as in the comparison between the pretreatment and end of treatment evaluations (p < 0.001). Regarding mandibular movements, no statistically significant differences between the LED group and control group were found at the end of treatment for any of the conditions analyzed or in the comparison between the beginning and end of treatment with LED. Photobiomodulation using a cluster with red and infrared LEDs induced a reduction in pain in individuals with temporomandibular disorder but did not alter mandibular range of motion in these individuals. Trial registration number: NCT03696706; retrospectively registered (ClinicalTrials.gov).

Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms.

PURPOSE: This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. METHODS: We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). RESULTS: At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. CONCLUSION: Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.

Utilidad de la radiación electromagnética en el síndrome doloroso subcalcáneo / Value of Electromagnetic Radiation in Subcalcaneal Pain Syndrome

RESUMEN Introducción: La causa común de dolor en la región subcalcánea es la fascitis plantar. Por su efecto analgésico y antiinflamatorio, el empleo de la radiación electromagnética en su tratamiento constituye una opción terapéutica. Objetivos: Evaluar la utilidad de la radiación electromagnética en pacientes que presentaban síndrome doloroso en la región subcalcánea y relacionar la mejoría clínica con los grupos de edades y sexos. Métodos: Se realizó un estudio descriptivo de corte transversal a dos grupos de pacientes con dolor en la región subcalcánea. Para el análisis estadístico, al final del tratamiento se utilizó la prueba de homogeneidad λ2 con un nivel de significación de ά 0,05. Resultados: A las 20 sesiones de tratamiento, el 93,33 por ciento de los pacientes tratados con la radiación electromagnética no presentaron dolor, el 94,44 por ciento de ellos pertenecían al grupo de edades de 25-59 años y el 90,90 por ciento eran del sexo femenino. Conclusiones: Se evalúa de positiva la utilidad de la radiación electromagnética en el tratamiento del dolor en la región subcalcánea, con una diferencia significativa en relación con el tratamiento médico convencional. El mayor número de pacientes correspondió al grupo de edades entre 25 y 59 años, con predominio del sexo femenino(AU)

ABSTRACT Introduction: The common cause of pain in the subcalcaneal region is plantar fasciitis. The electromagnetic radiation in its treatment constitutes a therapeutic option due to its analgesic and anti-inflammatory effect. Objectives: To assess the value electromagnetic radiation in patients who suffered pain syndrome in the subcalcaneal region and to relate the clinical improvement with age and gender groups. Methods: A descriptive cross-sectional study was conducted in two groups of patients with pain in the subcalcaneal region. For the statistical analysis, the λ2 homogeneity test was used at the end of the treatment with a significance level of ά 0.05. Results: After a treatment of 20 electromagnetic radiation sessions, 93.33 percent did not had pain, 94.44 percent were in the 25-to-59-year-olds group and 90.90 percent were women. Conclusions: The value of electromagnetic radiation in the treatment of pain in the subcalcaneal region is positively assessed, showing significant difference in relation to conventional medical treatment. The largest number of patients corresponded to the 25-to-59-year-olds group, with a predominance of women(AU)

The effectiveness of photobiomodulation in the management of temporomandibular pain sensitivity in rats: behavioral and neurochemical effects.

This study analyzed the effects of photobiomodulation (PBM) with low-level laser therapy on nociceptive behavior and neuronal activity in the trigeminal nucleus after experimental unilateral temporomandibular joint (TMJ) disc injury. The animals were divided into 4 groups (n = 10 each): group 1, surgical injury of the articular disc and PBM; group 2, sham-operated subjected to PBM; group 3, surgical injury of the articular disc; and group 4, control (Naïve). Ten sessions of PBM were performed using GaAs laser with a wavelength of 904 nm, power of 75 W pico, average power of 0.043 W, area of the beam of 0.13 cm2, duration of the pulses of 60 nseg (in the frequency of 9500 Hz), energy density of 5.95 J/cm2, energy per point of 0.7 J, and power density of 333.8 mW/cm2, and the irradiation was done for 18 s per point. Neuropathic symptoms were evaluated using the von Frey test. Trigeminal ganglion samples underwent immunoblotting to examine the expression of substance P, vanilloid transient potential receptor of subtype-1 (TRPV-1), and peptide related to the calcitonin gene (CGRP). There was a total decrease in pain sensitivity after the second session of PBM in operated animals, and this decrease remains until the last session. There was a significant decrease in the expression of SP, TRPV-1, and CGRP after PBM. Photobiomodulation therapy was effective in reducing nociceptive behavior and trigeminal nucleus neuronal activity after TMJ disc injury.

The effect of a single irradiation of low-level laser on nipple pain in breastfeeding women: a randomized controlled trial.

Photobiomodulation with low-level laser therapy (PBM-LLLT) has been introduced as a new tool to relieve nipple pain and repair nipple damage in breastfeeding women; however, evidence is needed to assess its effectiveness. The aim was to evaluate the effect of a single application of PBM-LLLT for breastfeeding women with nipple pain and damage; side effects were also collected. We conducted a randomized double-blinded controlled trial with women with nipple damage who were exclusively breastfeeding and rooming-in at Amparo Maternal maternity service, São Paulo, Brazil (May 2016 to May 2017). Women were randomly assigned into laser (n = 40) or control group (n = 40). Intervention was a single irradiation (660 nm, 100 mW, 2 J, 66.66 J/cm2, 3.3 W/cm2, 20 s of irradiation, punctual, and continuous mode) applied directly. Women reported pain levels at recruitment (before and immediately after irradiation), 6 and 24 h after the treatment. Pain level during a breastfeed was assessed using the Visual Analogue Scale (0 to 10). The primary outcome was the level of nipple pain immediately after the laser irradiation. Data were analyzed using hierarchical model and Wald test. At baseline, pain levels were similar (mean of 7.4 in laser group and 7.1 in control group). Women's perception of pain reduced approximately one point in both groups. Thirty-one percent of participants in the laser group (11/36) reported secondary effects, such as tingling (10/36) and pricking (2/36). The laser protocol of a single application was not effective in reducing pain in women with damaged nipples. Tingling sensation may be experienced by women receiving laser treatment for nipple damage.

Photobiomodulation and salivary glands: a systematic review.

To date, there is no compilation of evidence-based information associating photobiomodulation effect and salivary glands. This systematic review aims to assess photobiomodulation effect of low intensity laser on salivary glands in the presence of systemic diseases. MEDLINE databases were searched in duplicate through December 2018. In vivo studies and clinical trials were included if photobiomodulation was performed in salivary glands of animal (rat or mice) or human in the presence of systemic disease. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS). Search strategy identified 483 potentially eligible articles, and 449 were included. The Boolean search naturally leads to a high amount of works the majority of which were excluded because the analysis of the title and abstract demonstrated it was not focusing on PBM. Only 34 studies were selected for the full-text analysis, of which 5 were excluded due to non-use of photobiomodulation, 4 due to lack of control group, 2 because they were studies of cell cultures and 1 because they did not have the total of animals used. Thus, 21 papers were included for the critical evaluation of the impact of photobiomodulation on the major salivary glands; the studies used rats (n = 10) and humans (n = 11). Although studies reported an increase in the salivary rate, decrease in pain, and increase in quality of life after the PBM, the lack of standards for the application of light and reporting of the parameters, make it hard to reproduce the results. This topic is still in need for further research.

Intraoral photobiomodulation diminishes pain and improves functioning in women with temporomandibular disorder: a randomized, sham-controlled, double-blind clinical trial : Intraoral photobiomodulation diminishes pain in women with temporomandibular disorder.

The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.

O significado da dor para mulheres em braquiterapia ginecológica: abordagem fenomenológica na consulta de enfermagem / El significado del dolor para las mujeres en la braquiterapia ginecológica: enfoque fenomenológico en la consulta de enfermería / The meaning of pain for women in gynecological brachytherapy: phenomenological approach in nursing consultation

Objetivo: Identificar a percepção da dor para mulheres em braquiterapia ginecológica na consulta de enfermagem. Método: Estudo qualitativo, realizado entre fevereiro a novembro de 2012, apoiado na abordagem da Fenomenologia Sociológica Compreensiva de Alfred Schutz. Treze mulheres participaram, maiores de dezoito anos, submetidas à braquiterapia ginecológica de dois serviços de radioterapia localizados no Rio de Janeiro e outro em São Paulo. Resultados: Uma característica que sobressaiu a partir dos depoimentos se referiu à dor na braquiterapia ginecológica, em que as mulheres revelaram o anseio por superá-la. Conclusão: Tal anseio independe da idade e do grau de instrução, é comum a todas e oriundo do vivido com o câncer. O que modifica é a maneira como se apresenta e a sua intensidade, que variam conforme a singularidade de cada sujeito

Objetivo: Identificar la percepción del dolor para las mujeres en braquiterapia ginecológica en la consulta de enfermería. Método: Estudio cualitativo, realizado de febrero a noviembre de 2012, a favor del enfoque de la fenomenología sociológica Integral de Alfred Schutz. Los participantes fueron trece las mujeres mayores de dieciocho años sometidos a la braquiterapia ginecológica dos servicios de radioterapia ubicadas en Río de Janeiro y otro en Sao Paulo. Resultados: Una característica que se destacó de los estados mencionados dolor en la braquiterapia ginecológica, en el que las mujeres revelan el deseo de superación. Conclusión: Este deseo es independiente de la edad y nivel de educación, es común a todos y procedentes de los vivos con el cáncer. Lo que cambia es la forma en que se presenta y su intensidad, que varían de acuerdo a la singularidad de cada sujeto

Objective: The study's goal has been to identify the perception of pain for women in gynecological brachytherapy in nursing consultation. Methods: It a qualitative study, carried out from February to November 2012, supported in the approach of the Sociological Phenomenology Comprehensive Alfred Schutz. Participants were thirteen women over eighteen years submitted to gynecological brachytherapy two radiotherapy services located in Rio de Janeiro and another in Sao Paulo. Results: One characteristic that emerged from the statements referred to pain in gynecological brachytherapy, in which women revealed the desire to overcoming it. Conclusion: This desire is independent of age and level of education; it is common to all and coming from the living with cancer. What changes is the way it is presented and its intensity, which vary according to the uniqueness of each subject

Low-level laser therapy combined to functional exercise on treatment of fibromyalgia: a double-blind randomized clinical trial.

This study aims to investigate the effects of low-level laser therapy (LLLT) combined to a functional exercise program on treatment of FM. A double-blind and placebo-controlled randomized clinical trial composed of 22 women divided into two groups: placebo group (functional exercise program associated with placebo phototherapy n = 11) and laser group (same exercise program associated with active phototherapy; n = 11). Each session lasted from 40 to 60 min and was performed three times a week for 8 weeks. Phototherapy (808 nm, 100 mW, 4 J, and 142.85 J/cm2 per point) was bilaterally applied to different points of the quadriceps (8), hamstrings (6), and triceps sural muscles (3) immediately after each exercise session. Pre- and post-intervention evaluations regarding pain (sites, intensity, and threshold), functional performance (balance, functional tests), muscle performance (flexibility and isokinetic variables), depression, and quality of life were conducted. A reduction in pain and improvement in functional and muscular performance, depression, and quality of life were observed in both groups (p < 0.05); however, with no significant differences between them (p > 0.05). In conclusion, the benefic effects of functional exercise were not improved by combination with LLLT.

Treatment of mucositis with combined 660- and 808-nm-wavelength low-level laser therapy reduced mucositis grade, pain, and use of analgesics: a parallel, single-blind, two-arm controlled study.

Oral squamous cell carcinoma (OSCC) is the most frequent oral malignant neoplasia. As consequence of OSCC treatment, oral mucositis (OM) is one of the most common adverse effects of OSCC treatment. Currently, there is no consensus for OM treatment. The purpose of the current study was to test the combination of red and infrared low-level laser therapy (LLLT) for OM treatment. Primary culture of human fibroblast was performed to identify LLLT dose. After laboratory tests, a two-arm parallel, single-blind, controlled study was conducted. The two arms were group 1, both 660- and 808-nm wavelengths (300 J/cm2, 9 J of total energy, 100 mW, spot size 3 mm2), and group 2, only 660-nm wavelength (300 J/cm2, 9 J of total energy, 100 mW, spot size 3 mm2). Both treatments were performed twice a week. Group 1 presented a reduction of mucositis grade in comparison to group 2. Group 1 also presented reduction of analgesics prescription. But no significant differences between groups 1 and 2 were observed according to the pain scale. In conclusion, the current study demonstrated that a combination of red and infrared at a higher dose (300 J/cm2) reduced both oral mucositis grade and analgesics prescription. The effects of the combination of RT and LLLT are unclear and need more studies.

Evaluation of the therapeutic effects of led (λ627 ± 10 nm) on the initial phase of ankle sprain treatment: a randomised placebo-controlled clinical trial.

Various therapies for the treatment of sprains have emerged as advances occur in biomedical engineering and photobiology. Therapy with coherent and non-coherent light is a treatment modality for various musculoskeletal injuries. The main certified phototherapy benefits are the reduction of nociceptive processes and the modulation of the inflammatory process, among others. The objective of this study was to analyse the changes caused by the use of light-emitting diodes (LED) (λ627 ± 10 nm) with an energy density of 10 J/cm2 in 40 subjects divided into two groups (20 placebo and 20 LED). All of the volunteers had acute ankle sprains by inversion of grade II treated with the PRICE (protection, rest, ice, compression and elevation) technique and were treated for 6 days with LED therapy and LED therapy turned off (placebo). Pain assessment was performed on the 1st, 3rd and 6th days using the visual analogue scale (VAS) of pain, the McGill Pain Questionnaire and volumetry. The group treated with LED showed statistically decreased pain compared to the placebo group in both the VAS (85.79 vs 55.73%) and McGill questionnaire (83.33 vs 52.52%). The reduction of oedema in the LED group on the 3rd and 6th days after therapy was statistically superior to that in the placebo (p < 0.0001). Based on the results of this study, treatment with LED, using the tested dose, is effective for pain and oedema in the initial phase of ankle sprains.

Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis.

OBJECTIVES: To assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontic pain after the application of orthodontic force (OF). METHODS: A systematic search was conducted in the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, and EBSCOhost databases. The study included randomized clinical trials (RCT) which analysed the effectiveness of LLLT in reducing orthodontic pain assessed at 24 and 72 hrs after the application of OF. The risk of bias of the eligible trials was assessed using the Cochrane Collaboration's risk of bias tool. Standard mean difference was calculated and pooled by meta-analysis using random effect models. RESULTS: Of 467 identified articles, 20 RCT were finally included. In the risk of bias assessments, 13 studies presented a high risk, 5 an unclear risk, and 2 a low risk. The meta-analysis showed that in patients treated with laser versus placebo there was a difference in favour of LLLT in spontaneous pain 24 and 72 hrs after the installation of light archwires and spontaneous pain and chewing pain 24 and 72 hrs after the installation of elastomeric separators. CONCLUSIONS: LLLT proved to be effective in promoting a reduction in spontaneous and chewing pain after the application of OF; however, the poor quality of the evidence requires these results to be treated with caution.

A randomized placebo-blind study of the effect of low power laser on pain caused by irreversible pulpitis.

This randomized placebo-blind study aimed to evaluate the effect of laser phototherapy (LPT) on pain caused by symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP were randomly assigned to treatment groups (n = 15): G1 (control), G2 (laser placebo-sham irradiation), G3 (laser irradiation at 780 nm, 40 mW, 4 J/cm2), and G4 (laser irradiation at 780 nm, 40 mW, 40 J/cm2). Spontaneous pain was recorded using a VAS score before (T0), immediately after (T1), and 15 min after treatment (T2). Local anesthetics failure during emergency endodontic treatment was also assessed. There was no pain difference in T1 and T2 between the experimental laser groups (G3 and G4) and the placebo group (G2). The 4-J/cm2 (G3) irradiation resulted in significant increase in the local anesthetics failure in lower jar teeth. This effect could be suggested as consequence of the LPT improvement in local circulation and vasodilatation that would result in the increase of local anesthetic agent absorption. The application of 780-nm diode laser irradiation, at 4 and 40 J/cm2, showed no effect in reducing the pain in SIP in comparison to the placebo group. The fluence of 4 J/cm2 showed a negative effect in local anesthetics, resulting in significant increase of complimentary local anesthesia during emergency endodontic treatment. This work provides evidence of the consequence of LPT application on teeth with symptomatic irreversible pulpitis. LPT should be avoided in teeth with pain due to irreversible pulpitis.

Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions.

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.

Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.

¹77Lu-Labeled Agents for Neuroendocrine Tumor Therapy and Bone Pain Palliation in Uruguay.

Lutetium-177 is an emerging radionuclide due its convenient chemical and nuclear properties. In this paper we describe the development and evaluation in Uruguay of the targeted 177Lu labelled radiopharmaceuticals EDTMP (for bone pain palliation) and DOTA-TATE (neuroendocrine tumors). We optimized the preparation of these 177Lu radiopharmaceuticals including radiolabelling, quality control methods, in vitro and in vivo stability and their therapeutic application in patients. Radiation dosimetry aspects of 177Lu are also included. Nine male patients with prostate cancer and four female patients with breast carcinoma with multiple bone metastatic lesions were treated with 177Lu-EDTMP. Four patients with gastroentheropancreatic neuroendocrine tumors (GEP-NET) and one patient with bronchial NET were treated with 1- 3 cycles with a cumulative dose of 4.44-22.2 GBq of 177Lu-DOTA-TATE. Scintigraphic images of the patients treated with 177Lu-EDTMP evidenced high and rapid uptake in bone metastasis, remaining after 7 days post administration. Images allow skeletal visualization with high definition and demonstrate increased uptake in bone metastases. For 177Lu-DOTA-TATE, partial remissions were obtained in 4 patients and the remaining patient did not show significant progression 3 months after the second cycle. No serious adverse effects were registered, even in two patients with confirmed renal disease and high risk for renal disease Dosimetry assessments confirm the predictive value of the personalized therapy with radiolabelled peptides. We found it is possible to accumulate high therapeutic doses in tumours in sequential administrations of 177Lu-DOTA-TATE, increasing the probability of biological response without significant impairment of the renal function in patients with risk factors. These results demonstrate the attractive therapeutic properties of these two 177Lu labelled agents and the feasibility of this metabolic therapy in regions far away from 177Lu producing countries.

(153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies.

BACKGROUND AND AIMS: Approximately 85% of patients with cancer suffer severe metastatic bone pain for which radionuclide therapy has been employed for pain palliation. We undertook this study to evaluate the pain relief effect of (153)Sm-EDTMP in Mexican patients with severe and painful bone metastases from mainly prostate, breast, and renal cancer and other malignancies. METHODS: Patients (277) with intense sustained pain caused by bone metastases were referred to the Nuclear Medicine Department of the Oncology Hospital of the Mexican Social Security Institute. The patients had to have acceptable physical conditions, a previous positive (99m)Tc-MDP scan and blood values within normal range. (153)Sm-EDTMP was prepared at the Instituto Nacional de Investigaciones Nucleares (ININ) and 37 MBq/kg of body weight was injected intravenously. Pain palliation was evaluated with a visual analogue scale (VAS) and a verbal rating scale (VRS) before treatment and 3 and 12 weeks after treatment was started. RESULTS: The age interval of the patients was 24-92 years with a mean age of 64 ± 12 years. Mean values for hemoglobin, leukocyte and platelet counts did not statistically differ at zero time, 3 and 12 weeks after treatment. Pain intensity and relief assessment were statistically different: 9.1 ± 0.61 units initially; 4.2 ± 1.3 units 3 weeks later (54%) and after 12 weeks the pain diminished to 2.4 ± 1.4 units (74%) in the pain relief score scales. CONCLUSIONS: (153)Sm-EDTMP was readily available, safe and well tolerated. We conclude that (153)Sm-EDTMP was an adequate palliative agent and was the best option for our Mexican patients to relieve their severe metastatic bone pain.