Apport de la radiothérapie métabolique au samarium-153 dans le cancer de la prostate

Abstract

IntroductionProstate cancer is the third most common cancer of men in Tunisia, according to the three national cancer registers. Despite progress in the treatment of this osteophilic cancer, bone metastases remain found in 30–70% of patients. In this case, the pain is the most common symptom and the most difficult to support. Its treatment aims to improve the quality of life of patients. Metabolic radiotherapy with 153Sm-EDTMP is used in Tunisia since 2001 as an analgesic treatment of painful bone metastases, it is based on the action of targeted radioactive beta- particles emitted at the metastatic bone lesions. The aim of our study was to evaluate the value of this therapy in prostate cancer. MethodsA retrospective, descriptive, longitudinal study was carried about 13years on 67 patients with prostate adenocarcinoma with bone metastases, in the nuclear medicine department of Salah Azaiez Institute. All these patients were treated with at least one cure of 153Sm-EDTMP. For assessment of therapy effectiveness, three parameters were evaluated: motor activity, pain relief and reduction in analgesic requirements. Toxicity of 153Sm-EDTMP was also estimated. ResultsTreatment response was positive in 87.21% of cases. This positive response was complete in 32.56% and partial in 54.65% of the total of cures. The administration of successive cures of 153Sm-EDTMP, with 3 months interval between treatments, showed a similar response as in the first cure. Neither status of the patients before treatment nor treatment previously received had influence on this metabolic radiotherapy response. The therapeutic effectiveness was at least equivalent to those of other therapeutic modalities, with almost no side effects. The only observed toxicity was hematologic, usually mild and reversible in the months that were following cure. ConclusionDue to its efficiency and low toxicity, 153Sm-EDTMP should no longer be a solution of last resort. Its early introduction in the management of patients with prostate cancer and painful bone metastases could greatly improve their quality of life.