Ralph G. Robinson

Treatment of metastatic bone pain with strontium-89

We have utilized 89Sr as palliative treatment for bone pain secondary to metastatic cancer in the skeleton of over 200 patients. The best results have been in patients with carcinoma of the prostate (80% response rate) and breast (89%). Results in a small number of patients with a variety of other cell types were not nearly as encouraging. Strontium-89 provides excellent palliation in the management of bone pain secondary to prostate and breast carcinoma.

Comparison of computed tomography and other imaging modalities in the evaluation of musculoskeletal tumors.

An algorithmic approach for the evaluation of musculoskeletal tumors is proposed on the basis of a prospective comparison of different imaging techniques in 50 unselected patients. Conventional radiography was superior to other techniques in predicting the nature of primary bone tumors. Computed tomography proved the most effective method for assessing the extent of musculoskeletal tumors and therefore had a significant influence on management in 66% of patients studied. CT was more informative than angiography and also provided more anatomical detail than ultrasound. Radionuclide scanning was mainly of value in detecting unsuspected skeletal metastases in patients with apparently solitary skeletal lesions.

Radionuclide Therapy of Intractable Bone Pain: Emphasis on Strontium-89

Management of bone pain in patients with multiple osseous metastases is a significant clinical problem. Phosphorus-32 has been used as systemic radioisotope therapy for the management of bone pain for over 40 years. However, significant hematological depression usually results and its use is limited. More recently, the bone-seeking radiopharmaceuticals strontium-89, samarium-153-ethylenediaminetetramethylene phosphonic acid, and rhenium-186-hydroxyethylidene diphosphonate have all been used as palliative treatment for patients with clinically significant bone pain. Excellent clinical responses with acceptable hematological toxicity have been observed. The clinical results rival those of external beam radiation therapy, with fewer systemic and hematological side effects. Systemic radionuclide therapy is indicated in the management of patients with painful metastatic prostate cancer in bone as soon as they escape primary hormonal management. This therapy also should play a role in the management of many patients with advanced breast cancer metastatic to bone. The role of radionuclidic therapy in osseous metastases from other malignancies is still being investigated. These compounds also hold promise as primary therapy for tumors of osseous origin. Systemic radionuclide therapy of painful bony metastases will become common in nuclear medicine practice in the next decade.

Measurement of fetoplacental blood volume in the human previable fetus

Abstract Circulating fetoplacental blood volume (Vm) was measured in 19 previable human fetuses with 125 I-RISA. Fetal weight ranged from 130 to 464 grams and spanned a gestational age interval of six weeks. Mean Vm (±1 S.D.) was 16.2 ± 2.06 ml. per 100 grams of fetal weight. The increase in Vm appeared to be linear with increases in fetal weight.

Strontium-89--precursor targeted therapy for pain relief of blastic metastatic disease.

Strontium‐89 is a radioactive calcium analog that provides an energetic beta particle for radiation therapy of osteoblastic disease. Strontium‐89 is used as palliative therapy with the primary goal being pain relief. More than 500 patients with painful blastic metastatic disease were treated at University of Kansas Medical Center since the initiation of the first clinical trial there 15 years ago. Most patients have had metastatic prostate cancer to bone or breast cancer, as these tumors are commonly associated with bone pain as their primary clinical management problem. Improvement (decrease in pain, increase in physical activity level) was noted in 80% of patients with prostate carcinoma and 81% of patients with metastatic breast cancer to bone. Marrow toxicity levels were acceptable. The therapy can be repeated at 3‐month intervals. Strontium‐89 is a safe and effective systemic therapy for painful blastic metastatic disease. There is no longer any reason why the vast majority of persons with painful blastic metastatic disease should continue to hurt.

Prolongation of gastric emptying by oral propantheline

The present study shows that a single oral recommended dose of propantheline bromide normally doubles the mean gastric half‐emptying time in man. In a prospective, double‐blind, randomized crossover design 13 normal subjects were given 30 mg propantheline or placebo 90 min before taking a l l Sm‐indium‐labeled liquid test meal, the volume of which was adjusted to body weight . The disappearance of radioisotope from the area of the stomach was determined by external gamma counting . After placebo the mean half‐emptying time was 68 min and after propantheline it was 135 min (p < 0.005). Although salivary fiow decreased and pulse rate increased there were no visual disturbances . In studies already reported maximally tolerated oral doses of quaternary ammonium anticholinergic drugs have not consistently retarded gastric emptying in man.

A case for 77-bromine labelled radiopharmaceuticals.

Abstract The use of radiobromine as a label for radiopharmaceuticals was demonstrated by the synthesis of 82 Br-2,4-dibromoesterone, using the procedure of Slaunwhite and Neely . Structure determination of the brominated steroid was accomplished by the use of melting point data, paper chromatoraphy and mass spectra analysis. Tissue distribution studies in animals demonstrated rapid blood clearance and excretion in the bile. Calculated radiation exposure dose for 77 Br-2,4-dibromoestrone is less than 131 I-Rose Bengal. A significant difference in tissue distribution was found when the data for 82 Br-2,4-dibromoesterone was compared to literature values for 82 Br-7,8-dibromoesterone. Comparison with 131 I-Rose Bengal and 99 m Tc-pyrodoxylideneglutamate suggest 77 Br-2,4-dibromoestrone would be a tracer of potential value for liver and gallbladder function studies.

Oral anticholinergics and gastric emptying

The quaternary ammonium antimuscarinic drugs propantheline bromide and clidinium bromide, given orally at the usual therapeutic doses, delayed gastric emptying of a swallowed radiolabeled liquid meal as measured by a gamma camera. Delay of emptying was dose dependent. If an identical meal was given by gastric tube, there was no slowing of emptying by propantheline in the group as a whole. Six subjects who emptied the intubated meal more quickly with placebo had slowed emptying after 30 mg propantheline. In five others, intubation alone slowed gastric emptying while the addition of 30 mg propantheline caused a paradoxical acceleration of gastric emptying. Clidinium bromide, 5 mg, delayed gastric emptying to the same extent as 15 mg propantheline bromide without the marked suppression of salivary secretion induced by the latter.

Radioiodine therapy for differentiated thyroid carcinoma

Radioiodine (iodine 131) is an effective form of adjuvant therapy that is frequently underutilized. A review of our recent experience was undertaken to assess the role of this treatment modality in the routine management of thyroid carcinoma. Over a 2-year period, 29 patients received adjuvant iodine 131 therapy. Ten of these patients (35 percent) were found to have local or distant metastasis by iodine-131 scan, and 7 (24 percent) had a metastatic lesion not suspected by operative findings or chest radiography. A complete response was obtained in 70 percent of the patients with metastatic disease. This study supports more frequent use of adjuvant radioiodine therapy in the management of differentiated thyroid carcinoma.

A Kit for the Preparation of Basic 99mTc Penicillamine for Renal Scanning

Abstract A kit for preparing basic (pH 8.4) 99mTc-penicillamine complex for renal studies is described. The radiopharmaceutical prepared from the kit localizes in the kidneys, primarily in the renal cortex. Data is presented which demonstrates that the kit method for 99mTc-penicillamine results in biological distribution of the 99mTc-penicillamine complex equivalent to that observed for the older extemporaneous method of preparation. The per cent of injected dose localized in the kidneys of rabbits at one hour is 18.3 ± 3.1%, which compares favorably with other 99mTc-complexes used for renal imaging.