Skip to main content

Targeted High-LET Therapy of Bone Metastases

  • Chapter
Targeted Radionuclide Tumor Therapy

Summary

Bone metastases cause pain, and may result pathological fractures, spinal cord compression and bone marrow insufficiency. External beam radiation relieves pain, but this treatment modality is limited by lack of tumor cell selectivity. Short track length bone-seeking radioisotopes associated high Linear Energy Transfer offer an attractive alternative for the treatment of bone metastases. The advantages of this approach over external beam radiation are presented and recent preclinical and clinical experience are discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. British Association of Surgical Oncology Guidelines, The management of metastatic bone disease in the United Kingdom. The Breast Specialty Group of the British Association of Surgical Oncology. Eur. J. Surg. Oncol. 25 (1999) 3-23.

    Article  Google Scholar 

  2. R.E. Coleman, Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin. Cancer Res. 12 (2006) 6243s-6249s.

    Article  PubMed  Google Scholar 

  3. W.D. Hage, A.J. Aboulafia, and D.M. Aboulafia, Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop. Clin. North Am. 31 (2000) 515-528, vii.

    Article  PubMed  CAS  Google Scholar 

  4. O.S. Nielsen, A.J. Munro, and I.F. Tannock, Bone metastases: pathophysiology and management policy. J. Clin. Oncol. 9 (1991) 509-524.

    PubMed  CAS  Google Scholar 

  5. D. Hoegler, Radiotherapy for palliation of symptoms in incurable cancer. Curr. Probl. Cancer 21 (1997) 129-183.

    Article  PubMed  CAS  Google Scholar 

  6. S. Kaasa, E. Brenne, J.A. Lund, P. Fayers, U. Falkmer, M. Holmberg, M. Lagerlund, and O. Bruland, Prospective randomised multicenter trial on single fraction radiotherapy (8 Gy × 1) versus multiple fractions (3 Gy × 10) in the treatment of painful bone metastases. Radiother. Oncol. 79 (2006) 278-284.

    Article  PubMed  Google Scholar 

  7. D.E. Roos, S.L. Turner, P.C. O’Brien, J.G. Smith, N.A. Spry, B.H. Burmeister, P.J. Hoskin, and D.L. Ball, Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05). Radiother. Oncol. 75 (2005) 54-63.

    Article  PubMed  Google Scholar 

  8. E. Steenland, J.W. Leer, H. van Houwelingen, W.J. Post, W.B. van den Hout, J. Kievit, H. de Haes, H. Marijn, B. Oei, E. Vonk, E. van der Steen-Banasik, R.G. Wiggenraad, J. Hoogenhout, C. Wárlám-Rodenhuis, G. van Tienhoven, R. Wanders, J. Pomp, M. van Reijn, I. van Mierlo, and E. Rutten, The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother. Oncol. 52 (1999) 101-109.

    Article  PubMed  CAS  Google Scholar 

  9. W.B. van den Hout, Y.M. van der Linden, E. Steenland, R.G. Wiggenraad, J. Kievit, H.H. de, and J.W. Leer, Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial. J. Natl. Cancer Inst. 95 (2003) 222-229.

    Article  PubMed  Google Scholar 

  10. E. Chow, R. Wong, G. Hruby, R. Connolly, E. Franssen, K.W. Fung, L. Andersson, T. Schueller, K. Stefaniuk, E. Szumacher, C. Hayter, J. Pope, L. Holden, A. Loblaw, J. Finkelstein, and C. Danjoux, Prospective patient-based assessment of effectiveness of palliative radiotherapy for bone metastases. Radiother. Oncol. 61 (2001) 77-82.

    Article  PubMed  CAS  Google Scholar 

  11. E. Chow, K. Harris, G. Fan, M. Tsao, and W.M. Sze, Palliative radiotherapy trials for bone metastases: a systematic review. J. Clin. Oncol. 25 (2007) 1423-1436.

    Article  PubMed  Google Scholar 

  12. W.M. Sze, M.D. Shelley, I. Held, T.J. Wilt, and M.D. Mason, Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy-a systematic review of randomised trials. Clin. Oncol. (R. Coll. Radiol.) 15 (2003) 345-352.

    CAS  Google Scholar 

  13. J.S. Wu, R. Wong, M. Johnston, A. Bezjak, and T. Whelan, Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int. J. Radiat. Oncol. Biol. Phys. 55 (2003) 594-605.

    PubMed  Google Scholar 

  14. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. Radiother. Oncol. 52 (1999) 111-121.

    Google Scholar 

  15. P.H. Blitzer, Reanalysis of the RTOG study of the palliation of symptomatic osseous metastasis. Cancer 55 (1985) 1468-1472.

    Article  PubMed  CAS  Google Scholar 

  16. E. Chow, J.S. Wu, P. Hoskin, L.R. Coia, S.M. Bentzen, and P.H. Blitzer, International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Radiother. Oncol. 64 (2002) 275-280.

    Article  PubMed  Google Scholar 

  17. D. Tong, L. Gillick, and F.R. Hendrickson, The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group. Cancer 50 (1982) 893-899.

    Article  PubMed  CAS  Google Scholar 

  18. E. Maranzano, R. Bellavita, and R. Rossi, Radiotherapy alone or surgery in spinal cord compression? The choice depends on accurate patient selection. J. Clin. Oncol. 23 (2005) 8270-8272.

    Article  PubMed  Google Scholar 

  19. E.B. Silberstein, Systemic radiopharmaceutical therapy of painful osteoblastic metastases. Semin. Radiat. Oncol. 10 (2000) 240-249.

    Article  PubMed  CAS  Google Scholar 

  20. G. Bauman, M. Charette, R. Reid, and J. Sathya, Radiopharmaceuticals for the palliation of painful bone metastasis-a systemic review. Radiother. Oncol. 75 (2005) 258-270.

    PubMed  CAS  Google Scholar 

  21. I.G. Finlay, M.D. Mason, and M. Shelley, Radioisotopes for the palliation of metastatic bone cancer: a systematic review. Lancet Oncol. 6 (2005) 392-400.

    Article  PubMed  CAS  Google Scholar 

  22. V.J. Lewington, Bone-seeking radionuclides for therapy. J. Nucl. Med. 46 Suppl 1 (2005) 38S-47S.

    PubMed  CAS  Google Scholar 

  23. G.M. Reisfield, E.B. Silberstein, and G.R. Wilson, Radiopharmaceuticals for the palliation of painful bone metastases. Am. J. Hosp. Palliat. Care 22 (2005) 41-46.

    Article  PubMed  Google Scholar 

  24. I. Resche, J.F. Chatal, A. Pecking, P. Ell, G. Duchesne, R. Rubens, I. Fogelman, S. Houston, A. Fauser, M. Fischer, and D. Wilkins, A dose-controlled study of 153Sm-ethylenediamine- tetramethylenephosphonate (EDTMP) in the treatment of patients with painful bone metastases. Eur. J. Cancer 33 (1997) 1583-1591.

    Article  PubMed  CAS  Google Scholar 

  25. W. Akerley, J. Butera, T. Wehbe, R. Noto, B. Stein, H. Safran, F. Cummings, S. Sambandam, J. Maynard, R.G. Di, and L. Leone, A multiinstitutional, concurrent chemoradiation trial of strontium-89, estramustine, and vinblastine for hormone refractory prostate carcinoma involving bone. Cancer 94 (2002) 1654-1660.

    Article  PubMed  CAS  Google Scholar 

  26. L.C. Pagliaro, E.S. Delpassand, D. Williams, R.E. Millikan, S.M. Tu, and C.J. Logothetis, A Phase I/II study of strontium-89 combined with gemcitabine in the treatment of patients with androgen independent prostate carcinoma and bone metastases. Cancer 97 (2003) 2988-2994.

    Article  PubMed  CAS  Google Scholar 

  27. R. Sciuto, A. Festa, S. Rea, R. Pasqualoni, S. Bergomi, G. Petrilli, and C.L. Maini, Effects of low-dose cisplatin on 89Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J. Nucl. Med. 43 (2002) 79-86.

    PubMed  CAS  Google Scholar 

  28. S.M. Tu, J. Kim, L.C. Pagliaro, F. Vakar-Lopez, F.C. Wong, S. Wen, R. General, D.A. Podoloff, S.H. Lin, and C.J. Logothetis, Therapy tolerance in selected patients with androgenindependent prostate cancer following strontium-89 combined with chemotherapy. J. Clin. Oncol. 23 (2005) 7904-7910.

    Article  PubMed  CAS  Google Scholar 

  29. A. Widmark, New principles in the treatment of prostate cancer-the oncologist’s view. Scand. J. Urol. Nephrol. Suppl (2003) 23-27.

    Google Scholar 

  30. S. Nilsson, P. Strang, C. Ginman, R. Zimmermann, M. Edgren, B. Nordstrom, M. Ryberg, K.M. Kalkner, and J.E. Westlin, Palliation of bone pain in prostate cancer using chemotherapy and strontium-89. A randomized phase II study. J. Pain Symptom. Manage. 29 (2005) 352-357.

    Article  PubMed  CAS  Google Scholar 

  31. B.J. Allen, C. Raja, S. Rizvi, Y. Li, W. Tsui, D. Zhang, E. Song, C.F. Qu, J. Kearsley, P. Graham, and J. Thompson, Targeted alpha therapy for cancer. Phys. Med. Biol. 49 (2004) 3703-3712.

    Article  PubMed  CAS  Google Scholar 

  32. G. Henriksen, K. Breistol, O.S. Bruland, O. Fodstad, and R.H. Larsen, Significant antitumor effect from bone-seeking, alpha-particle-emitting (223)Ra demonstrated in an experimental skeletal metastases model. Cancer Res. 62 (2002) 3120-3125.

    PubMed  CAS  Google Scholar 

  33. R.H. Larsen, K.M. Murud, G. Akabani, P. Hoff, O.S. Bruland, and M.R. Zalutsky, 211At- and 131I-labeled bisphosphonates with high in vivo stability and bone accumulation. J. Nucl. Med. 40 (1999) 1197-1203.

    PubMed  CAS  Google Scholar 

  34. D.A. Mulford, D.A. Scheinberg, and J.G. Jurcic, The promise of targeted {alpha}-particle therapy. J. Nucl. Med. 46 Suppl 1 (2005) 199S-204S.

    PubMed  Google Scholar 

  35. M.W. Brechbiel, Targeted alpha-therapy: past, present, future? Dalton Trans. (2007) 4918-4928.

    Google Scholar 

  36. T.E. Wheldon and J.A. O’Donoghue, The radiobiology of targeted radiotherapy. Int. J. Radiat. Biol. 58 (1990) 1-21.

    Article  PubMed  CAS  Google Scholar 

  37. E.J. Hall, Radiobiology for the radiologist, Lippincott, Williams & Wilkins, Philadelphia, PA (2000).

    Google Scholar 

  38. M.A. Ritter, J.E. Cleaver, and C.A. Tobias, High-LET radiations induce a large proportion of non-rejoining DNA breaks. Nature 266 (1977) 653-655.

    Article  PubMed  CAS  Google Scholar 

  39. O.S. Bruland, S. Nilsson, D.R. Fisher, and R.H. Larsen, High-linear energy transfer irradiation targeted to skeletal metastases by the alpha-emitter 223Ra: adjuvant or alternative to conventional modalities? Clin. Cancer Res. 12 (2006) 6250s-6257s.

    Article  CAS  Google Scholar 

  40. G. Henriksen, D.R. Fisher, J.C. Roeske, O.S. Bruland, and R.H. Larsen, Targeting of osseous sites with alpha-emitting 223Ra: comparison with the beta-emitter 89Sr in mice. J. Nucl. Med. 44 (2003) 252-259.

    PubMed  CAS  Google Scholar 

  41. V. Tolmachev, J. Carlsson, and H. Lundqvist, A limiting factor for the progress of radionuclide-based cancer diagnostics and therapy-availability of suitable radionuclides. Acta Oncol. 43 (2004) 264-275.

    Article  PubMed  CAS  Google Scholar 

  42. G. Henriksen, P. Hoff, J. Alstad, and R.H. Larsen. 223Ra for endoradiotherapeutic applica- tions prepared from an immobilized 227Ac/227Th source. Radiochim. Acta. 89 (2001) 661-666.

    Article  CAS  Google Scholar 

  43. G. Henriksen, O.S. Bruland, and R.H. Larsen, Thorium and actinium polyphosphonate compounds as bone-seeking alpha particle-emitting agents. Anticancer Res. 24 (2004) 101-105.

    PubMed  CAS  Google Scholar 

  44. G. Henriksen, P. Hoff, and R.H. Larsen, Evaluation of potential chelating agents for radium. Appl. Radiat. Isot. 56 (2002) 667-671.

    Article  PubMed  CAS  Google Scholar 

  45. T.J. Jonasdottir, D.R. Fisher, J. Borrebaek, O.S. Bruland, and R.H. Larsen, First in vivo evaluation of liposome-encapsulated 223Ra as a potential alpha-particle-emitting cancer therapeutic agent. Anticancer Res. 26 (2006) 2841-2848.

    PubMed  CAS  Google Scholar 

  46. G. Henriksen, B.W. Schoultz, T.E. Michaelsen, O.S. Bruland, and R.H. Larsen, Sterically stabilized liposomes as a carrier for alpha-emitting radium and actinium radionuclides. Nucl. Med. Biol. 31 (2004) 441-449.

    Article  PubMed  CAS  Google Scholar 

  47. S. Sofou, J.L. Thomas, H.Y. Lin, M.R. McDevitt, D.A. Scheinberg, and G. Sgouros, Engineered liposomes for potential alpha-particle therapy of metastatic cancer. J. Nucl. Med. 45 (2004) 253-260.

    PubMed  CAS  Google Scholar 

  48. S. Nilsson, L. Balteskard, S.D. Fosså, and Ø.S. Bruland. Phase I study of Alpharadin™ (223Ra), and alpha-emitting bone-seeking agent in cancer patients with skeletal metastases. Eur. J. Nucl. Med. Mol. Imaging 370 Suppl (2004) 290.

    Google Scholar 

  49. S. Nilsson, R.H. Larsen, S.D. Fossa, L. Balteskard, K.W. Borch, J.E. Westlin, G. Salberg, and O.S. Bruland, First clinical experience with alpha-emitting radium-223 in the treatment of skeletal metastases. Clin. Cancer Res. 11 (2005) 4451-4459.

    Article  PubMed  CAS  Google Scholar 

  50. S. Nilsson, L. Franzen, C. Parker, C. Tyrrell, R. Blom, J. Tennvall, B. Lennernas, U. Petersson, D.C. Johannessen, M. Sokal, K. Pigott, J. Yachnin, M. Garkavij, P. Strang, J. Harmenberg, B. Bolstad, and O.S. Bruland, Bone-targeted radium-223 in symptomatic, hormone-refractory prostate cancer: a randomised, multicentre, placebo-controlled phase II study. Lancet Oncol. 8 (2007) 587-594.

    Article  PubMed  CAS  Google Scholar 

  51. M. Lassmann, D. Nosske, and C. Reiners, Therapy of ankylosing spondylitis with 224Ra-radium chloride: dosimetry and risk considerations. Radiat. Environ. Biophys. 41 (2002) 173-178.

    PubMed  Google Scholar 

  52. Y. Kvinnsland, A. Skretting, and O.S. Bruland, Radionuclide therapy with bone-seeking compounds: Monte Carlo calculations of dose-volume histograms for bone marrow in trabecular bone. Phys. Med. Biol. 46 (2001) 1149-1161.

    Article  PubMed  CAS  Google Scholar 

  53. R.H. Larsen, J. Borrebaek, J. Dahle, K.B. Melhus, C. Krogh, M.H. Valan, and O.S. Bruland, Preparation of TH227-labeled radioimmunoconjugates, assessment of serum stability and antigen binding ability. Cancer Biother. Radiopharm. 22 (2007) 431-437.

    Article  CAS  Google Scholar 

  54. M.R. McDevitt, D. Ma, J. Simon, R.K. Frank, and D.A. Scheinberg, Design and synthesis of 225Ac radioimmunopharmaceuticals. Appl. Radiat. Isot. 57 (2002) 841-847.

    Article  PubMed  CAS  Google Scholar 

  55. J. Dahle, J. Borrebaek, K.B. Melhus, O.S. Bruland, G. Salberg, D.R. Olsen, and R.H. Larsen, Initial evaluation of 227Th-p-benzyl-DOTA-rituximab for low-dose rate alpha-particle radioimmunotherapy. Nucl. Med. Biol. 33 (2006) 271-279.

    Article  PubMed  CAS  Google Scholar 

  56. K.B. Melhus, R.H. Larsen, T. Stokke, O. Kaalhus, P.K. Selbo, and J. Dahle, Evaluation of the binding of radiolabeled rituximab to CD20-positive lymphoma cells: an in vitro feasibility study concerning low-dose-rate radioimmunotherapy with the alpha-emitter 227 Th. Cancer Biother. Radiopharm. 22 (2007) 469-479.

    Article  CAS  Google Scholar 

  57. J. Dahle, J. Borrebaek, T.J. Jonasdottir, A.K. Hjelmerud, K.B. Melhus, O.S. Bruland, O.W. Press, and R.H. Larsen, Targeted cancer therapy with a novel low-dose rate alpha-emitting radioimmunoconjugate. Blood 110 (2007) 2049-2056.

    Article  PubMed  CAS  Google Scholar 

  58. S. Braun, F.D. Vogl, B. Naume, W. Janni, M.P. Osborne, R.C. Coombes, G. Schlimok, I.J. Diel, B. Gerber, G. Gebauer, J.Y. Pierga, C. Marth, D. Oruzio, G. Wiedswang, E.F. Solomayer, G. Kundt, B. Strobl, T. Fehm, G.Y. Wong, J. Bliss, A. Vincent-Salomon, and K. Pantel, A pooled analysis of bone marrow micrometastasis in breast cancer. N. Engl. J. Med. 353 (2005) 793-802.

    Article  PubMed  CAS  Google Scholar 

  59. A. Berg, A. Berner, W. Lilleby, O.S. Bruland, S.D. Fossa, J.M. Nesland, and G. Kvalheim, Impact of disseminated tumor cells in bone marrow at diagnosis in patients with nonmetastatic prostate cancer treated by definitive radiotherapy. Int. J. Cancer 120 (2007) 1603-1609.

    Article  PubMed  CAS  Google Scholar 

  60. I.J. Diel, E.F. Solomayer, S.D. Costa, C. Gollan, R. Goerner, D. Wallwiener, M. Kaufmann, and G. Bastert, Reduction in new metastases in breast cancer with adjuvant clodronate treatment. N. Engl. J. Med. 339 (1998) 357-363.

    Article  PubMed  CAS  Google Scholar 

  61. R.K. Jain, Barriers to drug delivery in solid tumors. Sci. Am. 271 (1994) 58-65.

    Article  PubMed  CAS  Google Scholar 

  62. L. Eikenes, O.S. Bruland, C. Brekken, and C.L. Davies, Collagenase increases the transcapillary pressure gradient and improves the uptake and distribution of monoclonal antibodies in human osteosarcoma xenografts. Cancer Res. 64 (2004) 4768-4773.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science + Business Media B.V

About this chapter

Cite this chapter

Bruland, Ø.S., Jostein, D., Olsen, D.R., Larsen, R.H. (2008). Targeted High-LET Therapy of Bone Metastases. In: Stigbrand, T., Carlsson, J., Adams, G.P. (eds) Targeted Radionuclide Tumor Therapy. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-8696-0_10

Download citation

Publish with us

Policies and ethics