Documente Academic
Documente Profesional
Documente Cultură
Manual de prezentare
CANTER-Redifos
Radioterapia cancerului osos
si a metastazelor osoase generalizate
Manual de prezentare
CANTER-Redifos
Finantat prin
Programul National de Cercetare-Dezvoltare si Inovare
“Viata si Sanatatea”
PNCDI VIASAN
(Contract 284 / 2003)
ISBN 973-0-03802-3
Tiparit: Martie 2005
IFIN-HH
Nr exemplare: 100
ISBN 973-0-03802-3
Responsabil produs
Dr. Dana Niculae
Institutul de Fizica si Inginerie Nucleara “Horia Hulubei”
Departamentul Compusi Marcati si Radiofarmaceutice (CPR)
Str. Atomistilor nr. 407 Magurele, jud Ilfov
Tel. +4 021 4042300 int 4518
Fax +4 021 4574440
E-mail radphy@ifin.nipne.ro
Cuprins / Content
Introducere / Introduction 5
Metastaze osoase / Bone metastases 6
Imagistica si terapia cancerului si metastazelor
osoase / Bone imaging and therapy 8
Re-188 / Re-188 11
188Re(Sn)HEDP / 188Re(Sn)HEDP 12
CANTER-Redifos
Caracteristicile procesului de marcare / Labelling
process parameters 13
Schema de preparare / Preparation procedure 14
Stabilitatea in vitro / In vitro stability 15
Controlul de calitate / Quality control 16
Biodistributia / Biodistribution 17
Recomandari / Recommendations 18
Bibliografie / References 19
Introducere
Metastazele osoase apar frecvent, la peste 70% din
pacientii suferind de cancer de san sau prostata in faze
avansate [1], si la aproximativ 15 – 30 % din cazurile
diagnosticate cu carcinom pulmonar, al colonului, stomacului,
vezicii urinare, uterului, rectului, tiroidei sau renal.
Consecintele metastazelor osoase sunt adesea
devastatoare. Astfel, metastazele osteolitice pot cauza dureri severe,
fracturi patologice, hipercalcemie cronica, compresie spinala sau alt
sindrom de compresie a sistemului nervos. Metastazele osteoblastice
induc, de asemenea, dureri osoase si fracturi patologice cauzate de
calitatea slaba a tesutului osos produs de osteoblaste [2]. Mai mult,
cancerul este in general incurabil atunci cand tumora primara
metastazeaza in os: numai 20 de procente din pacientele cu cancer
de san supravietuiesc 5 ani de la descoperirea metastazelor osoase
[3].
Introduction
Bone metastases are frequent complication of cancer
occurring up to 70 percent of patients with advanced breast or
prostate cancer [1] and in approximatively 15 to 30 percent of
patients with carcinoma of the lung, colon, stomach, bladder, uterus,
rectum, thyroid or kidney.
The consequences of bone metastasis are often devastating.
Osteolytic metastases can cause severe pain, pathologic fracture,
life-threatening hypercalcemia, spinal cord compression and other
nerve-compression syndromes. Patients with osteoblastic
metastases have bone pain and pathologic fractures because of
poor quality of bone produced by the osteoblasts [2]. Furthermore
once tumors metastasize to bone they are usually incurable: only 20
percent of patients with breast cancer are still alive five years after
the discovery of bone metastases [3].
Metastaze Bone
osoase Metastases
Fig 2
Procesele de resorbtie (A)
si formare (B) a tesutului osos
Bone resorption (A)
and bone formation (B) processes
Bone metastases
imaging and therapy
Inorganic ions were the first materials to be used in bone
imaging because of the known mineral exchange processes in bone.
Fluorine use is limited by high energy, strontium by slow uptake and
rapid decay.
The first technetium agents used were the polyphosphates,
but these proved less than ideal because of the susceptibility of the P-
O-P link to attack by phosphatase enzymes. Development of the
phosphonates containing a P-C-P link resolved this problem. The most
important compound of this class is MDP (methylenediphosphonic
acid). Mechanism of uptake of diphosphonates, especially MDP with a
possible structure [Tc(MDP)(OH)]n-, is based on spacing of O- donor
Imagistica si terapia cancerului si metastazelor
osoase / Bone metastases imaging and therapy
atoms in MDP matches the spacing of the Ca ions on
hydroxyapatite crystals (3.44 A) with following structure:
[3Ca3(PO4)2Ca(OH)2]
Early autoradiographic studies showed that the
binding of phosphates to the bone crystal surface appeared to be
irreversible, with the compounds becoming incorporated into the
crystal structure.
Phosphonates can form monomeric and polymeric species
around the Me(IV) core, up to 11 molecular species with different
molecular weights have been identified by HPLC. Complexes formed
around Me(V)core (MW 820 – 880 d) shows best ratio between bone
uptake and urine clearance.
The prelevance of metastatic bone disease in all countries,
both developed and developing, creates a large demand for new
therapeutic and palliative agents. A great interest for radiotherapy of
skeletal metastases is represented by phosphonic acid chelates labeled
with β-emitting therapeutic radionuclides such as 186,188Re, 153Sm, 177Lu,
166Ho [6,7]. Radiolabeling of a wide range of phosphonates ligands,
CANTER-Redifos
Reniu-188-hidroxietiliden Rhenium-188-hydroxy-
difosfonatul (188Re-HEDP) este ethylidene diphosphonate (188Re-
un nou radiofarmaceutic, cu HEDP) is a novel and attractive
localizare preferentiala la nivelul radiopharmaceutical that localizes
metastazelor osoase, depozitand in areas of osseous metastases
local o radiatie beta eficienta and emits beta particles with
terapeutic. energy sufficient to be
Pentru obtinerea acestui therapeutically useful.
produs, HEDP (99,9%), un To get the product, HEDP
derivat fosfonic cu activitate (99,9%), a phosphonate with
biologica, a fost radiomarcat cu biological activity and therapeutic
radionuclidul 188Re, beta- potential, was radiolabelled with the
emitator. Pentru marcare se radionuclide 188Re, a beta-emitter.
utilizeaza solutie de perrenat de Sodium perrhenate solution, eluted
sodiu, eluata de la un generator from a 188W/188Re generator was
188W/188Re si perrenat de potasiu
used and potassium perrhenate
(solutie) ca purtator. solution was added as carrier.
Reducerea Re(VII) in 90
randament
reducere /
trepte de valenta inferioare, 80
reducing yield
necesare procesului de 70 (%)
(Sn++). 40
Procesul de marcare al 30
The reduction of
100
Randament reducere / reduction yield (%)
30 min
state, asked by chelating
80
24 h
Compozitie / Formulation
15 mg HEDP;
4,5 mg SnCl2x2H20; GENERATOR
4 mg ascorbic acid; 188W/188Re
8,4 mg NaHCO3;
2,7 mg NaCl; 10 µL HCl 37%
apa pana la / water up to 1 mL 2 mL Na188ReO4
(658.6 MBq)
Sterilizare Liofilizare 150 µg KReO4
Sterilization Freeze drying
pastrare la /
Storage at
2-8°C 188Re-HEDP
pH=5,5-6
pH=1,5-1,7 NaOH 2N
100
99
98
97
RCP (%)
96
95
94
93
92
91
90
0h 4h 24h 48h
Timp (h)
.
188Re(Sn)HEDP
phosphonate
MEC / MEK 0.00 1.00 -
80 4
24
70
48
60
50
40
30
20
10
0
48
Liver
Thyroid Blood 24 timp /
Bone time (h)
Organ Muscle
Lung
Kidney
4
GIT
Ficat Tiroida Sange Os Muschi Pulmon Rinichi GIT
SCINTIFIN-PIROFOSFAT
SCINTIFIN-DTPA
SCINTIFIN-MEDRONAT
SCINTIFIN-GLUCOHEPTONAT
SCINTIFIN-FITAT
Generatorul de 99Mo/99mTc
fabricat cu 99Mo de fisiune
(import MDS Nordion)
Disponibil cu activitati de
4 GBq; 8 GBq; 15 GBq; 18 GBq
Se livreaza impreuna cu trusa de
elutie (10 flacoane vidate si 5
flacoane continand NaCl 0,9%)