LONG-TERM EVALUATION OF RADIOISOTOPE SYNOVECTOMY WITH YTTRIUM-90 AND RHENIUM-186 FOR CHRONIC SYNOVITIS IN PEDIATRIC HEMOPHILIA: AKDENIZ UNIVERSITY EXPERIENCE

Year 2022, Volume: 23 Issue: 4, 385 - 391, 17.10.2022

Funda Tayfun Küpesiz Nurşah Eker Adil Boz Fikri Akyıldız Can Çevikol Deniz Güven Alphan Küpesiz

https://doi.org/10.18229/kocatepetip.930703

Abstract

OBJECTIVE: This study aimed to evaluate the effect of radioisotope synovectomy with Yttrium-90 and Rhenium-186 on the joints of patients with chronic hemophilic synovitis.
MATERIAL AND METHODS: Retrospective analysis of radioisotope synovectomy using Yttrium-90 and Rhenium-186 in pediatric hemophilia patients treated in the Akdeniz University School of Medicine between June 2005 and September 2014 was carried out.
RESULTS: Eighteen patients with severe hemophilia (mean age 12.55±4.93 years) underwent a total of 32 radioisotope synovectomy procedures: 13 elbow (40.6%), nine knee (28.2%), nine tibiotalar (28.2%), and 1 metatarsal (3.1%) joint. Ten patients (55.5%) had radioisotope synovectomy to a single joint; five patients (27.8%) had simultaneous radioisotope synovectomy to two joints. Three patients with inhibitors underwent a total of five radioisotope synovectomy procedures (15.6%). In 15 patients (83.3%), hemarthrosis was reduced after radioisotope synovectomy and no further treatment was required. The other three patients (four joints) underwent repeat radioisotope synovectomy after a mean of 20.75±14.77 months. The mean follow-up period of our patients was 8.81 ± 4.87 years [9.42 years (min-max; 1-22.58)]. Uncontrolled bleeding, need for additional dose factor treatment, radioisotope leakage, and local inflammatory reaction were not observed during and after radioisotope synovectomy.
CONCLUSIONS: Radioisotope synovectomy is an effective treatment method that can be used to prevent permanent joint damage in hemarthrosis and to reduce the frequency of bleeding and the use of coagulation factors. Treatment of radioisotope synovectomy should be considered before progressive joint damage has developed.

Keywords

Hemophilic arthropathy, Radioisotope synovectomy, Chronic synovitis

Supporting Institution

The authors did not apply for a specific grant for this research from any funding agency in the public commercial or non-profit sectors.

PEDİYATRİK HEMOFİLİKLERDE KRONİK SİNOVİT İÇİN YTTRIUM- 90 VE RHENIUM- 186 İLE RADYOİZOTOP SİNOVEKTOMİNİN UZUN SÜRELİ DEĞERLENDİRMESİ: AKDENİZ ÜNİVERSİTESİ DENEYİMİ

Abstract

AMAÇ: Bu çalışmanın amacı, kronik hemofilik sinoviti olan hastaların eklemlerinde Yttrium- 90 ve Rhenium- 186 ile radyoizotop sinovektominin etkisini değerlendirmektir.
GEREÇ VE YÖNTEM: Haziran 2005 - Eylül 2014 yılları arasında Akdeniz Üniversitesi Tıp Fakültesi`nde Yttrium- 90 ve Rhenium- 186 ile radyoizotop sinovektomi yapılan pediyatrik hemofili hastalarımızın verileri geriye dönük olarak analiz edildi.
BULGULAR: Çalışmamızdaki 18 ağır hemofili hastasına (12,55 ± 4,93 yıl) uygulanan 32 radyoizotop sinovektomi işleminin; 13’ü (% 40,6) dirsek, 9’u (% 28,2) diz, 9’u (%28,1) tibiotalar ve biri (%3,1) de metatars eklemine yapıldı. Hastaların 10’unda (% 55,5) bir ekleme radyoizotop sinovektomi uygulandı. Aynı seansta birden çok ekleme uygulama yapılan beş (%27,8) hasta vardı ve eş zamanlı olarak en fazla iki ekleme uygulama yapıldı. İnhibitör pozitifliği olan üç hastaya toplam beş (% 15,6) işlem gerçekleştirildi. İşlem sonrası hastaların 15` inde (% 83,3) radyoizotop sinovektomi uygulanan eklemlerde kanamaların azaldığı ve izlemde tekrar bir cerrahi ya da radyoizotop sinovektomi uygulanması gerekmediği görüldü. Diğer üç hastanın dört eklemine ortalama 20,75 ±14,77 ay sonra ikinci kez uygulama yapıldı. Hastalarımızın ortalama izlem süresi 8,81 ± 4,87 yıldı [9,42 yıl (min-max; 1-22,58)]. Radyoizotop sinovektomi sırasında ve sonrasında kontrol altına alınamayan kanama, ek doz koagülasyon faktör tedavi ihtiyacı, radyoizotop sızıntısı, lokal enflamatuar reaksiyon gözlenmedi.
SONUÇ: Radyoizotop sinovektomi, hemartrozda kalıcı eklem hasarını önlemek, kanama sıklığını ve pıhtılaşma faktörü kullanımını azaltmak için kullanılabilecek etkin bir tedavi yöntemidir. Radyoizotop sinovektomi, ilerleyici eklem hasarı gelişmeden önce düşünülmelidir.

Keywords

Hemofilik artropati, Radyoizotop sinovektomi, Kronik sinovit

References

• 1. Querol-Giner M, Perez-Alenda S, Aguilar-Rodriguez M, et al. Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients. Haemophilia. 2017;23(6):e497-e503.
• 2. Rodriguez-Merchan EC. Articular Bleeding in Hemophilia. Cardiovasc Hematol Disord Drug Targets. 2016;16(1):21-4.
• 3. Rodriguez-Merchan EC. Radiosynovectomy in haemophilia. Blood Rev. 2019;35:1-6.
• 4. Kavakli K, Aydogdu S, Omay SB, et al. Long-term evaluation of radioisotope synovectomy with Yttrium 90 for chronic synovitis in Turkish haemophiliacs: Izmir experience. Haemophilia. 2006;12(1):28-35.
• 5. Hanley J, McKernan A, Creagh MD, et al. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia: A United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO) guideline. Haemophilia. 2017;23(4):511-20.
• 6. Ali T, Abou Fakher FH, Schved JF. Chemical vs. radioactive synoviorthesis for treatment of chronic haemophilic synovitis: Syrian experience. Haemophilia. 2016;22(6):e573-e5.
• 7. Thomas S, Gabriel MB, Assi PE, et al. Radioactive synovectomy with Yttrium(9)(0) citrate in haemophilic synovitis: Brazilian experience. Haemophilia. 2011;17(1):e211-6.
• 8. Kachooei AR, Heidari A, Divband G, et al. Rhenium-188 radiosynovectomy for chronic haemophilic synovitis: Evaluation of its safety and efficacy in haemophilic patients. Haemophilia. 2020;26(1):142-50.
• 9. Turkmen C, Kilicoglu O, Dikici F, et al. Survival analysis of Y-90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10- year retrospective review. Haemophilia. 2014;20(1):e45-50.
• 10. De la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. What patient, joint and isotope characteristics influence the response to radiosynovectomy in patients with haemophilia? Haemophilia. 2011;17(5):e990-8.
• 11. Kavakli K, Aydogdu S, Taner M, et al. Radioisotope synovectomy with rhenium186 in haemophilic synovitis for elbows, ankles and shoulders. Haemophilia. 2008;14(3):518-23.
• 12. De La Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Consecutive radiosynovectomy procedures at 6-monthly intervals behave independently in haemophilic synovitis. Blood Transfus. 2013;11(2):254-9.
• 13. Rampersad AG, Shapiro AD, Rodriguez-Merchan EC, et al. Radiosynovectomy: review of the literature and report from two haemophilia treatment centers. Blood Coagul Fibrinolysis. 2013;24(5):465-70.
• 14. Nuss R, Kilcoyne RF, Geraghty S, et al. MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage. Haemophilia. 2000;6(3):162-9.
• 15. Rodriguez-Merchan EC. Musculo-skeletal manifestations of haemophilia. Blood Rev. 2016;30(5):401-9.
• 16. Teitel JM, Sholzberg M. Current status and future prospects for the prophylactic management of hemophilia patients with inhibitor antibodies. Blood Rev. 2013;27(2):103-9.
• 17. Ozulker T, Ozulker F, Derin E, et al. The efficacy of magnetic resonance imaging and x-ray in the evaluation of response to radiosynovectomy in patients with hemophilic arthropathy. Mol Imaging Radionucl Ther. 2011;20(2):38-44.
• 18. Erken EH. Radiocolloids in the management of hemophilic arthropathy in children and adolescents. Clinical orthopaedics and related research. 1991(264):129-35.
• 19. Alioglu B, Ozsoy H, Koca G, et al. The effectiveness of radioisotope synovectomy for chronic synovitis in Turkish paediatric haemophiliacs: Ankara experience. Haemophilia. 2010;16(6):932-6.
• 20. Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. Thromb Res. 2014;134(5):985-90.
• 21. Koc B, Kilicoglu O, Turkmen C, Zulfikar B. Prognostic factors of radiosynovectomy in haemophilia patients with inhibitors: Survival analysis in a 19-year period. Haemophilia. 2020;26(5):855-60.
• 22. Ozcan Z. Radiosynovectomy in hemophilic synovitis. Mol Imaging Radionucl Ther. 2014;23(1):1-4.