PALLIATION THERAPY :PALLIATION THERAPY Gipsy Morales


Objectives :Objectives Discuss Radiopharmacy Analyze indications and contraindications Detail patient preparation Specify procedures Analyze normal and abnormal results Discuss artifacts and patient history of palliation therapy


Radiopharmacy :Radiopharmacy Radionuclide Sr89 (β - ) Energy:1463kev(max), 583.3 kev (mean) Sm153 (β -, ﻻ ) Energy:632,702,805kev(max) 198,224,263 kev (mean) P32 (β- ) Energy:1710kev (max), 694.9kev (mean) Radiopharmaceutical Sr89 chloride Sm153 lexidronam (EDTMP) P32 sodium phosphate


Radiopharmacy :Radiopharmacy Localization Sr89 areas of active osteogenesis Sm153 phosphate compound concentrate in bone mineral. Lexidronam concentrate in osteoblastic lesions at 5:1 ratio P32 hematopoietic system Quality control Radiochemical purity >=90% P32 : 100% radiochemical purity Adult dose range Sr89 ____ 4mCi per kg Sm153 __ 1 mCi per kg P32 ____5-10mCi per kg


Radiopharmacy :Radiopharmacy Method of administration The syringe shielded Existing IV catheter or 21-gauge butterfly 10mCi of flush or more Performed by authorized user


Slide 6:Indications Palliation is intractable bone pain for patients with two or more osseous metastases documented by bone scan from primary cancer Candidates should have multiple bone metastases sites, bone pain, WBC counts >2400, platelet >60,000 Contraindications A solitary metastatic site Pregnancy Patient with evidence of seriously compromised bone marrow from previous therapy Patients with hypersensitivity to EDTMP No contraindications Anemia Conventional methods of pain palliation


Patient preparation :Patient preparation Identify the patient Ensure patient has and reads package insert information Signed informed consent from patient Result of latest laboratory test Results of latest bone scan Instruct patients with incontinence Instruct patients to ingest 500 ml of fluid


Equipment :Equipment Camera Large field of view Collimator Low energy or low energy high resolution Computer set-up Sm153 ; peak for 103 kev, 20% window Static 500,000-750,000 counts Whole body 10 cm/min, head to toe


Procedure :Procedure Time injection: 20 min; Images: 30-50 min Patient in supine position Injection preparation Place butterfly needle in the antecubital fossa attach a syringe containing 10ml of saline Injection performed by an authorized user Attach the syringe containing the radiopharmaceutical Time injection 30-60 seconds Observe injection for extravagation Count before proper disposal to ensure that there is not an abundance of residue Sm153 optional imaging: Obtain whole body scan at 3-48 hours after injection Compare results with most recent bone scan


Results :Results Normal Decrease bone pain Increase quality of life, decrease dependency on opiates (morphine) Patients can be treated again as early as 10 weeks Abnormal No change in deteriorating conditions Platelet counts decrease by 6 weeks


Artifacts :Artifacts Nonpatent IV site Myelosuppression (bone marrow toxicity); the patient should be monitored for any signs during this and other types of therapy


Role of NMT in therapy :Role of NMT in therapy Order and receive the radiopharmaceutical Prepare patient and paperwork for physician and therapy Provide a sterile area and proper equipment for the injection Assay the therapy dose and confirm the amount of activity Record any pertinent information about the therapy


Patient history :Patient history Specific question: Last chemotherapy Last radiotherapy Other type of therapy for pain Last bone scan Recent laboratory result (WBC->2500), platelets 9>60,000) Present bone pain Pain medication Read the information sheet


Summary :Summary Palliative therapy is intended to relieve symptoms but is not expected to be a cure Sr89 chloride __4 mCi per kg Sm153 lexidronam EDTMP__1mCi per kg P32 sodium phosphate__5-10mCi IV Method of administration: existing IV catheter or three way stopcock butterfly and 10 mCi saline to flush Indications: WBC >2400 and platelets >60,000 Contraindications: pregnancy, hypersensitivity to EDTMP Patient preparation: read package insert information Equipment: large field of view camera, low energy collimator Procedure: time injection 20 min, images 30-50 min Normal results: decreased bone pain Abnormal result: platelets decrease, no short term changes in pain Artifacts: Nonpatent IV, Myelosuppression


References :References Shackett, Pete. NMT: Procedures and Quick reference. 2nd Ed.. Baltimore: 2008. Grove MK, Hermann RE, Vogt DP, Broughan TA.  Role of radiation after operative palliation in cancer of the proximal bile ducts. Am J Surg 1991;161:454-458 Sodee DB, Early P. Principles and Practice of Nuclear Medicine. 2nd Ed. St. Louis: Mosby, 1995.


Questions :Questions List the Radionuclides use for palliation therapy Match the radionuclide with the correct radiopharmaceutical Sr89 a) sodium phosphate Sm153 b) lexidronam (EDTMP) P32 c) chloride True or false 3. Sr89 is localized in the areas active osteogenesis 4. P32 is located in the hematopoietic system Filling the blank The adult dose for Sr89 is_______ per ____ WBC counts >_______platelet count >________ List three patient preparation for palliation therapy What type of collimator is use in palliation therapy? List 2 roles of NMT in this therapy List 3 normal results of this therapy


Answers !!! :Answers !!! Sr89 , Sm153 , P32 . C B A T T The adult dose for Sr89 is__4_____ per __kg__ WBC counts >__2400__platelet count >__60,000__ Identify the patient, ensure patient has and reads package insert information, signed informed consent from patient, result of latest laboratory test, and results of latest bone scan Low energy 9. Order and receive the radiopharmaceutical and prepare patient and paperwork for physician and therapy 10. Decrease bone pain, increase quality of life, decrease dependency on opiates (morphine), and patients can be treated again as early as 10 weeks