Radioisotope dosimetryRadioisotopes and vertebral augmentation: Dosimetric analysis of a novel approach for the treatment of malignant compression fractures☆
Section snippets
Materials and methods
The MCNP5 Monte Carlo computer code was used to characterize the dose delivered to tissue as a function of cortical bone thickness for a 1 mm radial bolus of isotope-infused PMMA. The isotope of interest is assumed to be uniformly distributed within the PMMA. The advantage of studying a bolus of this size is that it may be used as the basis for treatment plans containing complex fracture geometries. From these data, the authors derived the approximate source activity necessary to deliver a
Results
Results from this Monte Carlo analysis are presented in Fig. 3. Here, the absorbed dose deposited over the lifetime of the isotope, based on a 1 μCi (3.7 × 104 Bq) bolus, is presented as a function of cortical bone thickness; cortical bone thickness is defined as the distance from the edge of the PMMA bolus to the critical structure (tally voxel). Perhaps of greater clinical interest, the dosimetry for each isotope was normalized to the absorbed dose at a specific reference depth for that isotope.
Discussion
Targeted therapeutic radionuclide therapy has been used clinically for the treatment of bone metastases. Such therapy uses bone-seeking radiopharmaceuticals to target sites of bone metastases. The most commonly prescribed radiopharmaceuticals clinically are 89Strontium and 153Samarium. These systemic treatments are particularly useful in the setting of multifocal metastatic bony disease when repeated local treatments, particularly repeat external beam radiation therapy over critical normal
Conclusion
Vertebral augmentation is a relatively new and rapidly growing procedure that provides dramatic and often near immediate pain relief for patients with vertebral compression fractures. As the systemic oncology therapies continue to improve, patients with bone metastases are living longer than ever before [31], [32]. While external beam radiation therapy remains the standard of care for the treatment of bone metastases and is often effective in controlling pain, the external beam radiation dose
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2020, Nuclear Medicine and BiologyCitation Excerpt :However, further research and clinical trials are needed before this technique can be implemented in clinical setting. Furthermore, dosimetry, synthesis and characterization studies using acrylic cement of PMMA, calcium phosphate (sol-gel technique) or hydroxyapatite that is homogenously incorporated with 166Ho, 188Re or 153Sm have also been explored for similar application [161–163]. These radionuclides are selected due to their cost effectiveness, theranostic properties, relatively short physical half-life, easier way of production, wider availability and most importantly is the insignificant dose to the spinal cord [163].
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2009, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :We have described a novel technique to treat painful vertebral metastases using percutaneous intravertebral administration of cement and 153Sm. Hirsch et al.(34) investigated the feasibility of radionuclide therapy coupled with vertebral augmentation to treat both tumor metastases and VCFs. Six radioisotopes (although not 153Sm) were uniformly mixed in a polymethylmethacrylate bolus and investigated for dosimetric properties in a cortical bone phantom.
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2009, Journal of Vascular and Interventional RadiologyCitation Excerpt :RT can be given as local-field external or hemibody irradiation. Recent data have suggested a possible role for combination vertebral augmentation with radioisotopes (11). The response to radiation is directly dependent on the tumor's inherent radiation sensitivity.
Evaluation of a radiation transport modeling method for radioactive bone cement
2010, Physics in Medicine and Biology
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Presented in part at the 49th Annual ASTRO Meeting, October 28–November 1, 2007.