Nuklearmedizin 1999; 38(08): 337-340
DOI: 10.1055/s-0038-1632233
Original Article
Schattauer GmbH

High-Activity Samarium-153-EDTMP Therapy in Unresectable Osteosarcoma

Samarium-153-EDTMP-Therapie mit hoher Aktivität bei nichtresezierbarem Osteosarkom
Christiane Franzius
1   Department of Nuclear Medicine (Head: Prof. Dr. med. Dr. rer. nat. Otmar Schober FESC)
,
S. Bielack
2   Department of Pediatric Hematology and Oncology (Head: Prof. Dr. med. Heribert Jürgens), University Hospital, Münster, Germany
,
J. Sciuk
1   Department of Nuclear Medicine (Head: Prof. Dr. med. Dr. rer. nat. Otmar Schober FESC)
,
B. Yollet
1   Department of Nuclear Medicine (Head: Prof. Dr. med. Dr. rer. nat. Otmar Schober FESC)
,
H. Jürgens
2   Department of Pediatric Hematology and Oncology (Head: Prof. Dr. med. Heribert Jürgens), University Hospital, Münster, Germany
,
O. Schober
1   Department of Nuclear Medicine (Head: Prof. Dr. med. Dr. rer. nat. Otmar Schober FESC)
› Author Affiliations
Further Information

Publication History

Received: 11 August 1999

in revised form: 17 August 1999

Publication Date:
02 February 2018 (online)

Summary

Despite highly efficacious chemotherapy, patients with osteosarcomas still have a poor prognosis if adequate surgical control cannot be obtained. We applied high-activity Sm-153-EDTMP therapy within a multimodal therapy concept to improve local control of an unresectable osteosarcoma with poor response to initial polychemotherapy. A 21-yearold woman with an extended, unresectable pelvic osteosarcoma and multiple pulmonary metastases was treated with high-activity of Sm-153- EDTMP (150 MBq/kg BW, total 8.1 GBq). Afterwards external radiotherapy of the primary tumor site was performed and polychemotherapy was continued, followed by autologous peripheral blood stem cell reinfusion. Within 48 h after Sm-153-EDTMP application the patient had complete pain relief. After three weeks the response was documented by 3-phase Tc-99m-MDP bone scintigraphy (primary tumor and metastases: decreased tracer uptake), whole-body F-18-FDG-PET (primary tumor and metastases: diminution of glucose metabolism) and thoracic CT (metastases: reduction of size). The present case warrants further evaluation of feasibility and efficacy of this multimodal therapy combination of high-activity Sm-153-EDTMP therapy, external radiation, polychemotherapy and stem cell support for unresectable osteosarcomas.

Zusammenfassung

Trotz effektiver Chemotherapie haben Osteosarkom-Patienten noch immer eine schlechte Prognose, wenn eine adäquate chirurgische Lokaltherapie nicht erreichbar ist. Innerhalb eines multimodalen Therapiekonzepts führten wir eine Sm-153-EDTMP-Therapie mit hoher Aktivität durch, um die Lokalkontrolle eines nichtresezierbaren Osteosarkoms, welches schlecht auf die initiale Chemotherapie angesprochen hatte, zu verbessern. Eine 21jährige Patientin mit einem ausgedehnten, nichtresezierbaren Becken-Osteosarkom und multiplen pulmonalen Metastasen wurde mit hoher Aktivität von Sm-153-EDTMP (150 MBq/kg KG, insgesamt 8,1 GBq) therapiert. Anschließend wurde eine externe Radiatio des Primärtumors durchgeführt, die Polychemotherapie fortgesetzt, gefolgt von einer autologen peripheren Blutstammzell-Reinfusion. Innerhalb von 48 h nach Sm-153-EDTMP-Applikation war die Patientin vollständig beschwerdefrei. Nach drei Wochen wurde das Ansprechen mittels 3-Phasen-Tc-99m-MDP-Skelettszintigraphie (Primärtumor und Metastasen: rückläufige Knochenstoffwechselsteigerung), Ganzkörper-F-18-FDG-PET (Primärtumor und Metastasen: verringerte Stoffwechselaktivität) und Thorax-CT (Metastasen: Größenreduktion) dokumentiert. Die vorgestellte Kasuistik rechtfertigt eine weitere Evaluation der Durchführbarkeit und Wirksamkeit dieser multimodalen Therapiekombination aus Sm-153-EDTMP-Therapie mit hoher Aktivität, externer Radiatio, Polychemotherapie und Blutstammzell-Reinfusion für nichtresezierbare Osteosarkome.

 
  • REFERENCES

  • 1 Albrecht MR, Henze G, Rühl U, Habermalz HJ. Osteosarcoma – A Radioresistent Tumor? Long-Term Evaluation After Multidrug Chemotherapy and Definitive Irradiation. Med Pediatr Oncol 1996; 27: 314.
  • 2 Anderson PM. Sm-153-EDTMP therapy with stem cell support in patients. In: Towards the Eradication of Osteosarcoma Metastases. Bruland OS. (ed.). The Norwegian Radium Hospital; Oslo, Norway: 1998: 87-8.
  • 3 Bruland OS, Pihl A. On the Current Management of Osteosarcoma. A Critical Evaluation and a Proposal for a Modified Treatment Strategy. Eur J Cancer 1997; 33: 1725-31.
  • 4 Bruland OS, Skretting A, Solheim OP, Aas M. Targeted Radiotherapy of Osteosarcoma using Sm-153-EDTMP. A new promising approach. Acta Oncologica 1996; 35: 381-4.
  • 5 Farhanghi M, Holmes RA, Volkert WA, Logan KW, Singh A. Samarium-153-EDTMP: Pharmacokinetic, Toxicity and Pain Response Using an Escalating Dose Schedule in Treatment of Metastatic Bone Cancer. J Nucl Med 1992; 33: 1451-8.
  • 6 Franzius C, Sciuk J, Schober O. Radionuclide Therapy of Bone Tumors: From Palliative to Curative Approach. Nuklearmedizin. 1999 (8); Editorial
  • 7 Fuchs K, Bielack SS, Epier D, Bieling P, Delling G, Körholz D, Graf N, Heise U, Jürgens H, Kotz R, Salzer-Kuntschik M, Weinel P, Werner M, Winkler K. Long-term results of the co-operative German-Austrian-Swiss osteosarcoma study group’s protocol COSS-86 of intensive multidrug chemotherapy and surgery for osteosarcoma of the limbs. Ann Oncol 1998; 9: 893-9.
  • 8 Gaitan-Yanguas M. A study of the response of osteogenic sarcoma and adjacent normal tissue to radiation. Int J Radiat Oncol Biol Phys 1981; 7: 593-5.
  • 9 Lattimer JC, Corwin Jr. LA, Stapleton J, Volkert WA, Ehrhardt GJ, Ketring AR, Anderson SK, Simon J, Goeckeler WF. Clinical and Clinicopathologic Response of Canine Bone Tumor Patients to Treatment with Samarium-153-EDTMP. J Nucl Med 1990; 31: 1316-25.
  • 10 Logan KW, Volkert WA, Holmes RA. Radiation Dose Calculations in Persons Receiving Injection of Samarium-153 EDTMP. J Nucl Med 1987; 28: 505-9.
  • 11 Moe L, Boysen M, Aas M, Lonaas L, Gamlem H, Bruland O. Maxillectomy and targeted radionuclide therapy with 153Sm-EDTMP in a recurrent canine osteosarcoma. J Small Anim Pract 1996; 37: 241-6.
  • 12 van Rendsburg AJ, Alberts AS, Louw WKA. Quantifying the Radiation Dosage to Individual Skeletal Lesions Treated with Samarium-153-EDTMP. J Nucl Med 1998; 39: 2110-5.
  • 13 Winderen M, Kjoenniksen I, Fodstad O. Pronounced Therapeutic Effect of Samarium-153-Ethylene-diamine-tetramethylene Phosphonate in an Orthotopic Human Osteosarcoma Tibial Tumor Model. J Nat Cancer Inst 1995; 87: 221-2.