Quantitative Bone Single-Photon Emission Computed Tomography for Prediction of Pain Relief in Metastatic Bone Disease Treated With Rhenium-186 Etidronate

Israel, Ora; Keidar, Zohar; Rubinov, R.; Iosilevski, Galina; Frenkel, Alex; Kuten, Abraham; Betman, Lise; Kolodny, Gerald M.; Yarnitsky, David; Front, Dov

doi:10.1200/jco.2000.18.14.2747

Cited by 18 publications

(8 citation statements)

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“…However, a wide range of lesion absorbed doses in patients treated with 186 Re-HEDP are available in the literature. Israel et al obtained a mean absorbed dose delivered to lesions of 2.1 Gy GBq −1 from 1.532 GBq (Israel et al 2000 ) in close agreement with our results. Higher absorbed doses were obtained by Maxon et al , with 33 Gy GBq −1 from 1.225 GBq calculated using whole-body planar imaging (Maxon et al 1990 ); and by Andreou et al with 52 Gy GBq −1 from 1.295 GBq (Andreou et al 2010 ).…”

Section: Discussionsupporting

confidence: 92%

A radiobiological model of metastatic burden reduction for molecular radiotherapy: application to patients with bone metastases

et al. 2017

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Skeletal tumour burden is a biomarker of prognosis and survival in cancer patients. This study proposes a novel method based on the linear quadratic model to predict the reduction in metastatic tumour burden as a function of the absorbed doses delivered from molecular radiotherapy treatments.The range of absorbed doses necessary to eradicate all the bone lesions and to reduce the metastatic burden was investigated in a cohort of 22 patients with bone metastases from castration-resistant prostate cancer. A metastatic burden reduction curve was generated for each patient, which predicts the reduction in metastatic burden as a function of the patient mean absorbed dose, defined as the mean of all the lesion absorbed doses in any given patient. In the patient cohort studied, the median of the patient mean absorbed dose predicted to reduce the metastatic burden by 50% was 89 Gy (interquartile range: 83–105 Gy), whilst a median of 183 Gy (interquartile range: 107–247 Gy) was found necessary to eradicate all metastases in a given patient. The absorbed dose required to eradicate all the lesions was strongly correlated with the variability of the absorbed doses delivered to multiple lesions in a given patient (r = 0.98, P < 0.0001). The metastatic burden reduction curves showed a potential large reduction in metastatic burden for a small increase in absorbed dose in 91% of patients.The results indicate the range of absorbed doses required to potentially obtain a significant survival benefit. The metastatic burden reduction method provides a simple tool that could be used in routine clinical practice for patient selection and to indicate the required administered activity to achieve a predicted patient mean absorbed dose and reduction in metastatic tumour burden.

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Section: Discussionsupporting

confidence: 92%

A radiobiological model of metastatic burden reduction for molecular radiotherapy: application to patients with bone metastases

et al. 2017

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“…A large heterogeneity in the absorbed dose delivered to individual lesions was observed, ranging from 4 to 78 Gy for administrations of 5 GBq. These are in close agreement with those calculated by Israel et al [ 46 ] using quantitative sequential SPECT imaging, with lesion absorbed doses ranging from 0.36 to 8.03 Gy from administered activities of 1380–1850 MBq. Maxon et al reported a significantly higher lesion mean absorbed dose of 40 Gy from 1.225 GBq, although these calculations were not based on SPECT imaging [ 22 ].…”

Section: Discussionsupporting

confidence: 91%

Phase I/II trials of 186Re-HEDP in metastatic castration-resistant prostate cancer: post-hoc analysis of the impact of administered activity and dosimetry on survival

Bacelar

Chittenden

Dearnaley

et al. 2016

Eur J Nucl Med Mol Imaging

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PurposeTo investigate the role of patient-specific dosimetry as a predictive marker of survival and as a potential tool for individualised molecular radiotherapy treatment planning of bone metastases from castration-resistant prostate cancer, and to assess whether higher administered levels of activity are associated with a survival benefit.MethodsClinical data from 57 patients who received 2.5–5.1 GBq of 186Re-HEDP as part of NIH-funded phase I/II clinical trials were analysed. Whole-body and SPECT-based absorbed doses to the whole body and bone lesions were calculated for 22 patients receiving 5 GBq. The patient mean absorbed dose was defined as the mean of all bone lesion-absorbed doses in any given patient. Kaplan–Meier curves, log-rank tests, Cox’s proportional hazards model and Pearson’s correlation coefficients were used for overall survival (OS) and correlation analyses.ResultsA statistically significantly longer OS was associated with administered activities above 3.5 GBq in the 57 patients (20.1 vs 7.1 months, hazard ratio: 0.39, 95 % CI: 0.10–0.58, P = 0.002). A total of 379 bone lesions were identified in 22 patients. The mean of the patient mean absorbed dose was 19 (±6) Gy and the mean of the whole-body absorbed dose was 0.33 (±0.11) Gy for the 22 patients. The patient mean absorbed dose (r = 0.65, P = 0.001) and the whole-body absorbed dose (r = 0.63, P = 0.002) showed a positive correlation with disease volume. Significant differences in OS were observed for the univariate group analyses according to disease volume as measured from SPECT imaging of 186Re-HEDP (P = 0.03) and patient mean absorbed dose (P = 0.01), whilst only the disease volume remained significant in a multivariable analysis (P = 0.004).ConclusionThis study demonstrated that higher administered activities led to prolonged survival and that for a fixed administered activity, the whole-body and patient mean absorbed doses correlated with the extent of disease, which, in turn, correlated with survival. This study shows the importance of patient stratification to establish absorbed dose–response correlations and indicates the potential to individualise treatment of bone metastases with radiopharmaceuticals according to patient-specific imaging and dosimetry.

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“…These include 111 In-labeled antibodies and tumor-seeking radiopharmaceuticals (37)(38)(39), 131 I uptake in tumors (40,41), 177 Lu for dosimetry calculations in therapeutic applications (42,43), 186 Re in palliative bone cancer therapy (44), and even quantitative bremsstrahlung imaging of 90 Y (45).…”

Section: Results Demonstrating Quantitative Accuracy In Spectmentioning

confidence: 99%

An Evidence-Based Review of Quantitative SPECT Imaging and Potential Clinical Applications

2013

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Learning Objectives: On successful completion of this activity, participants should be able to (1) review the current status of SPECT imaging, with an emphasis on clinical applications for quantitative interpretations; (2) consider the requirements for quantitative SPECT imaging-instrumentation, software, and image calibration; and (3) acquire knowledge of the capabilities of quantitative SPECT with a view to developing new clinical applications.Financial Disclosure: Dr. Bailey is an employee of NSW Health, University of Sydney, and an investigator for NHMRC, ARC, Cure Cancer Australia. Dr.Willowson is an employee of the University of Sydney and is supported by the Australian Research Council and the NSW Cancer Council in conjunction with the Cure Cancer Australia Foundation. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through January 2016.SPECT has traditionally been regarded as nonquantitative. Advances in multimodality g-cameras (SPECT/CT), algorithms for image reconstruction, and sophisticated compensation techniques to correct for photon attenuation and scattering have, however, now made quantitative SPECT viable in a manner similar to quantitative PET (i.e., kBqÁcm 23 , standardized uptake value). This review examines the evidence for quantitative SPECT and demonstrates clinical studies in which the accuracy of the reconstructed SPECT data has been assessed in vivo. SPECT reconstructions using CT-based compensation corrections readily achieve accuracy for 99m Tc to within 610% of the known concentration of the radiotracer in vivo. Quantification with other radionuclides is also being introduced. SPECT continues to suffer from poorer photon detection efficiency (sensitivity) and spatial resolution than PET; however, it has the benefit in some situations of longer radionuclide half-lives, which may better suit the biologic process under examination, as well as the ability to perform multitracer studies using pulse height spectroscopy to separate different radiolabels.Key Words: SPECT (single-photon emission computed tomography); quantification; scatter correction; attenuation correction; validation Nucl Med 2013; 54:83-89 DOI: 10.2967/jnumed.112.111476 Quant itative emission tomography is a powerful investigative tool in clinical practice and biomedical research. The two principal forms of emission tomography using radionuclide-labeled compounds are SPECT and PET. Although PET has a tremendous sensitivity advantage and higher spatial resolutio...

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Quantitative Bone Single-Photon Emission Computed Tomography for Prediction of Pain Relief in Metastatic Bone Disease Treated With Rhenium-186 Etidronate

Abstract: QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Cited by 18 publications

References 15 publications

A radiobiological model of metastatic burden reduction for molecular radiotherapy: application to patients with bone metastases

A radiobiological model of metastatic burden reduction for molecular radiotherapy: application to patients with bone metastases

Phase I/II trials of 186Re-HEDP in metastatic castration-resistant prostate cancer: post-hoc analysis of the impact of administered activity and dosimetry on survival

An Evidence-Based Review of Quantitative SPECT Imaging and Potential Clinical Applications

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