Introduction

Advance stage malignancy may leads to refractory skeletal metastases causing pain and affecting quality of life. Several radiopharmaceuticals with bone ­seeking properties are in use for bone pain palliation.  Lu-177 with 6.7days half-life, 497 keV maximum beta energy for therapy and available gamma emission 112 keV (6.4%), 208 keV (11%) for post-therapy imaging is emerging as a novel radionuclide. It can be labeled with PSMA (prostate specific membrane antigen), DOTMP (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid) or EDTMP (ethylene diamine tetramethylene phosphonic acid) for bone pain palliation. In this study we are presenting our experience with Lu-177 EDTMP in metastatic bone pain palliation.

Material & methods

We evaluated 07 male patients (mean age 67 years; range 46-80 years) with widespread refractory skeletal metastases due to prostate cancer and treated with Lu-177 EDTMP. Pre-treatment disease burden was evaluated with Tc-99m MDP bone scan. All the patients were evaluated for bone marrow status, renal function, pain scoring and quality of life both before and after the therapy. The mean dose of Lu-177 EDTMP was 58mCi (range 35-71). Post-therapy scans were done in all the patients and follow up was done to asses clinical and biochemical response of therapy.

Results

In all the patients’ post-therapy scans were consistent with pre-therapy diagnostic scan. Symptomatic relief in pain along with decrease in analgesic requirement and improvement in quality of life was noticed in all the patients at follow-up.

Conclusion

Our initial experience revealed that Lu-177 EDTMP is effective therapy for metastatic bone pain palliation. However, larger data and long follow up is required for better evaluation.