The Role of Radiopharmaceuticals in the Bone Metastases Therapy

Year 2023, , 319 - 336, 01.08.2023

Hümeyra Battal , Suna Erdoğan

https://doi.org/10.55262/fabadeczacilik.1191048

Abstract

Cancer, having quite high morbidity and mortality rates, has become a significant public health problem in recent years, and it is the second leading cause of death after heart disease in the world. Metastases are one of the most serious complications of cancer, and bone metastases are detected in 2/3 of metastatic cancer cases. General therapy approaches in bone metastases can be classified as surgery, bisphosphonates therapy, radiotherapy, and radionuclide therapy. Radionuclide therapy using alpha and beta emitting radionuclides is more selective and effective than other local and systemic treatment methods, and this feature provide several advantages over existing therapeutic methods. Radionuclide therapy used in bone metastasis for reducing the pain, killing tumor cells, prolonging life span, and improving quality of life.

In recent years, alpha-emitting radiopharmaceuticals [such as Radium-223 (Ra-223) chloride] and beta-emitting radiopharmaceuticals [such as Strontium-89 (Sr-89) chloride, Lutetium-177 (Lu-177) labeled Ethylenediamine Tetra Methylene Phosphonic Acid (EDTMP), Samarium-153 (Sm-153) labeled EDTMP] are introduced in the clinic for especially the treatment of painful bone metastases and on the other hand new radiopharmaceutical development studies also continue intensively, like Actinium-225 labeled prostate-specific membrane antigen-617 (Ac-225-PSMA). Many studies have proven that using radiopharmaceuticals in the therapy of bone metastases improves the patient's general health, reduces pain and the risk of pathological fractures, and increases survival.

This review presents an overview of radionuclide therapy used in bone metastases. In this context, general information about the radiopharmaceuticals is given, and the importance of the use of radiopharmaceuticals in bone metastases therapy is explained with experimental and clinical studies examples.

Keywords

Cancer, Bone Metastases, Radionuclide Therapy, Radiopharmaceutical

Kemik Metastazlarının Tedavisinde Radyofarmasötiklerin Rolü

Abstract

Kanser, morbidite ve mortalite oranları yüksek olan ve son yıllarda büyük bir halk sağlığı sorunu haline gelen bir hastalıktır ve dünyada kalp hastalıklarından sonra ölüm nedenleri arasında 2. sırada yer almaktadır. Metastazlar kanserin en ciddi komplikasyonlarından biri olup kemik metastazları, metastatik kanser olgularının 2/3' sinde saptanmaktadır. Kemik metastazlarında genel tedavi yaklaşımları, cerrahi, bifosfanatlarla tedavi, radyoterapi ve radyonüklid tedavi olarak sınıflandırılabilir. Radyonüklid tedavinin diğer lokal ve sistemik tedavi yöntemleriyle karşılaştırıldığında daha seçici ve etkili olması yöntemi avantajlı hale getirmektedir. Alfa ve beta partikülü yayan radyonüklidlerin kullanıldığı bu tedavi yöntemi, kemik metastazı olan hastalarda sıklıkla görülen ağrının azaltılmasında, tümör hücrelerinin öldürülmesinde, yaşam süresinin uzatılmasında ve yaşam kalitesinin artırılmasında etkili bir yöntemdir.

Son yıllarda alfa partikülü yayan; Radyum-223 (Ra-223) klorür, beta partikülü yayan; Stronsiyum-89 (Sr-89) klorür, Lutesyum-177 (Lu-177) işaretli Etilendiamin Tetra Metilen Fosfonik Asit (EDTMP) ve Samaryum-153 (Sm-153) işaretli EDTMP başta olmak üzere çok sayıda radyofarmasötik kemik metastazlarının tedavisinde klinik kullanıma girmişken Aktinyum-225 işaretli prostat spesifik membran antijeni-617 (PSMA-617) gibi yeni radyofarmasötiklerin geliştirilmesi üzerinede çalışmalar yoğun şekilde devam etmektedir. Yapılan birçok çalışma kemik metastazı tedavisinde radyofarmasötiklerin kullanımının hastanın genel sağlık durumunu iyileştirdiğini, ağrıları ve patolojik kırık riskini azaltığını ve sağkalımı artırdığını kantılamıştır.

Bu derlemede kemik metastazı tedavisinde kullanılan radyonüklid tedaviye genel bir bakış açısı sunulmuştur. Bu kapsamda klinikte kullanılan ve araştırmaları devam eden radyofarmasötiklerle ilgili genel bilgiler verilmiş, deneysel ve klinik çalışma örnekleriyle kemik metastazı tedavisinde radyofarmasötiklerin kullanımının önemi açıklanmıştır.

Keywords

Kanser, Kemik metastazı, Radyonüklid Tedavi, Radyofarmasötik

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