Lani
06-05-2007, 10:47 AM
Ethanol Injections Manage Bone Metastases From Thyroid Cancer
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June 5, 2007 (Washington) — Percutaneous ethanol injections (PEI) effectively reduce tumor size and relieve symptoms of bone metastases from differentiated thyroid cancer, according to new research.
Lead investigator Kunihiro Nakada, MD, PhD, of the Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, in Sapporo, Japan, presented the study in a poster paper at the 54th annual meeting of the Society of Nuclear Medicine. The study evaluated PEI in patients whose bone metastases did not take up radioiodine (I-131) or did not decrease in size despite I-131 uptake.
Approximately 2% to 12% of patients with differentiated thyroid cancer develop bone metastases, which is frequently accompanied by pain, fracture, and neurologic damage. Of the 12 patients in this study, 9 had papillary and 3 had follicular cancers. The tumors treated with PEI were located in the sternum (n = 5), ribs (n = 2), scapula (n = 2), and pelvic bones (n = 3).
Absolute ethanol was injected under local anesthesia using a fractionated session technique: a series of injections with a fine needle delivered 3 to 15 milliliters per session into the deep core of the tumor. This procedure was repeated until the total volume injected exceeded the tumor volume, calculated from magnetic resonance imaging (MRI) or computed tomography scans.
Dr. Nakada described the details of the procedure in an interview with Medscape: "Actually, we need more ethanol volume than the calculated tumor volume because once ethanol is injected into the tumor, it will be diluted and its anti-cancer effect may be reduced. So 120% to 130% of the tumor volume would be essential. If I wanted to inject a volume of 30 milliliters, I would inject 10 milliliters 3 times. A small amount of leakage usually occurs; however, the leakage may work to prevent the invasion of the tumor."
Localization of the injections is also important, said Dr. Nakada. "Guidance with imaging modality is essential. We need to scan with ultrasound to confirm that the needle is in the tumor mass. Inject [the ethanol] into the deep center of the tumor, and it diffuses from there."
After PEI treatment, tumor viability was evaluated with MRI, fluorodeoxyglucose (FDG)-positron emission tomography, or a thallium (Tl)-201 scan. In all 12 cases, tumor volume decreased more than 50% after PEI, and the reduction lasted 9 to 54 months. In 7 patients, pain and neurologic problems were relieved; in 2 patients, gait improved significantly. Six patients no longer showed Tl-201 or FDG uptake or postcontrast enhancement with MRI.
Dr. Nakada listed several therapies used for metastatic bone tumors resistant to I-131 and external beam: "radio frequency ablation (RFA), trans-arterial embolization (TAE), cement infusion, biphosphonates, and chemotherapy. But PEI is simpler and more cost effective. In addition, PEI doesn't cause any systemic side effects and it can be repeated [an unlimited number of times]."
Rosalie J. Hagge, MD, MS, associate professor of nuclear medicine, Department of Radiology, University of California - Davis, and a vice chair for the oncology track on the Scientific Program Committee of the Society of Nuclear Medicine, commented to Medscape about Dr. Nakada's study: "It looks like a very effective therapy for the type of condition that they're treating."
Dr. Hagge observed that this therapy is done on a lesion-by-lesion basis for palliation of symptoms caused by a particular lesion. "Treating 1 lesion, of course, will not cure the systemic problem. But for a very painful bony lesion, or a lesion that is compressing the spinal cord or another critical structure, this therapy would be very useful for shrinking the tumor and improving the symptoms."
SNM 54th Annual Meeting: Abstract 1212. Presented June 4, 2007.
.
June 5, 2007 (Washington) — Percutaneous ethanol injections (PEI) effectively reduce tumor size and relieve symptoms of bone metastases from differentiated thyroid cancer, according to new research.
Lead investigator Kunihiro Nakada, MD, PhD, of the Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, in Sapporo, Japan, presented the study in a poster paper at the 54th annual meeting of the Society of Nuclear Medicine. The study evaluated PEI in patients whose bone metastases did not take up radioiodine (I-131) or did not decrease in size despite I-131 uptake.
Approximately 2% to 12% of patients with differentiated thyroid cancer develop bone metastases, which is frequently accompanied by pain, fracture, and neurologic damage. Of the 12 patients in this study, 9 had papillary and 3 had follicular cancers. The tumors treated with PEI were located in the sternum (n = 5), ribs (n = 2), scapula (n = 2), and pelvic bones (n = 3).
Absolute ethanol was injected under local anesthesia using a fractionated session technique: a series of injections with a fine needle delivered 3 to 15 milliliters per session into the deep core of the tumor. This procedure was repeated until the total volume injected exceeded the tumor volume, calculated from magnetic resonance imaging (MRI) or computed tomography scans.
Dr. Nakada described the details of the procedure in an interview with Medscape: "Actually, we need more ethanol volume than the calculated tumor volume because once ethanol is injected into the tumor, it will be diluted and its anti-cancer effect may be reduced. So 120% to 130% of the tumor volume would be essential. If I wanted to inject a volume of 30 milliliters, I would inject 10 milliliters 3 times. A small amount of leakage usually occurs; however, the leakage may work to prevent the invasion of the tumor."
Localization of the injections is also important, said Dr. Nakada. "Guidance with imaging modality is essential. We need to scan with ultrasound to confirm that the needle is in the tumor mass. Inject [the ethanol] into the deep center of the tumor, and it diffuses from there."
After PEI treatment, tumor viability was evaluated with MRI, fluorodeoxyglucose (FDG)-positron emission tomography, or a thallium (Tl)-201 scan. In all 12 cases, tumor volume decreased more than 50% after PEI, and the reduction lasted 9 to 54 months. In 7 patients, pain and neurologic problems were relieved; in 2 patients, gait improved significantly. Six patients no longer showed Tl-201 or FDG uptake or postcontrast enhancement with MRI.
Dr. Nakada listed several therapies used for metastatic bone tumors resistant to I-131 and external beam: "radio frequency ablation (RFA), trans-arterial embolization (TAE), cement infusion, biphosphonates, and chemotherapy. But PEI is simpler and more cost effective. In addition, PEI doesn't cause any systemic side effects and it can be repeated [an unlimited number of times]."
Rosalie J. Hagge, MD, MS, associate professor of nuclear medicine, Department of Radiology, University of California - Davis, and a vice chair for the oncology track on the Scientific Program Committee of the Society of Nuclear Medicine, commented to Medscape about Dr. Nakada's study: "It looks like a very effective therapy for the type of condition that they're treating."
Dr. Hagge observed that this therapy is done on a lesion-by-lesion basis for palliation of symptoms caused by a particular lesion. "Treating 1 lesion, of course, will not cure the systemic problem. But for a very painful bony lesion, or a lesion that is compressing the spinal cord or another critical structure, this therapy would be very useful for shrinking the tumor and improving the symptoms."
SNM 54th Annual Meeting: Abstract 1212. Presented June 4, 2007.