Účel studie: Radiosynoviortéza (RSO), dříve též nazývána slovem radiosynovektomie (RS), je metoda zaměřená na léčbu bolesti a otoku kloubů způsobených synovitidou u artritid a dekompenzovaných artróz prostřednictvím lokální aplikace beta zářičů. Zářením vyvolaná povrchová nekróza části buněk v synoviální membráně ve svém výsledku může zmírnit bolest, snížit otoky a zlepšit funkci kloubů. Materiál a metoda: V období 2013–2024 bylo RSO léčeno celkem 436 pacientů, z toho 291 pro otok kolenního kloubu vzniklý v důsledku dekompenzované artrózy a 172 kvůli artritidě. Kolenní kloub byl RSO ošetřen 268krát a malé a střední klouby 50krát. Používalo se yttrium u kolenních kloubů, rhenium u středních nebo erbium u malých kloubů. Samotný zákrok spočíval v punkci kloubu a odsátí případného kloubního výpotku, následné aplikaci radiofarmaka a imobilizaci kloubu po dobu 2–3 dnů. Výsledky: K hodnocení klinického efektu RSO jsme vybrali aplikace v letech 2022 a 2023. V roce 2022 bylo provedeno 45 ošetření a v roce 2023 dalších 26. Po jednom roce bylo 61 % pacientů s léčbou kolenních kloubů zcela spokojeno, přičemž uváděli zmenšení otoku a zlepšení rozsahu pohybu. U pacientů léčených s malými a středně velkými klouby se celkové zlepšení objevilo u 57 % z nich. Někteří zaznamenali recidivující výpotek menšího objemu nebo jen částečné zlepšení. Závěr: Radiosynoviortéza je účinná léčba otoků a bolesti kloubů způsobených synovitidou s pozitivními výsledky jak u kolenních, tak i menších kloubů, což je doloženo jak objektivními, tak subjektivními zlepšeními.
Purpose of the study: Radiosynoviorthesis (RSO), previously also called radiosynovectomy (RS), is a method focused on the treatment of joint pain and swelling caused by synovitis in arthritis and decompensated osteoarthrosis using beta emitters. Radiation-induced surface necrosis of part of the cells in the synovial membrane can, as a result, relieve pain, reduce swelling, and improve joint function. Material and method: Between 2013-2024, 436 patients were treated with RSO, primarily for knee joint swelling due to decompensated osteoarthrosis (291 patients) and arthritis (172 patients). RSO was performed on the knee (268 cases) and on small/medium joints (50 cases), using yttrium for knee joints, rhenium for medium joins or erbium for small joints. The procedure involved puncture of the joint and suction of any joint effusion, injecting the radioactive isotope, and subsequently immobilizing the joint for 2–3 days. Results: We selected treatments in 2022 and 2023 to evaluate the clinical effect of RSO. In 2022, 45 treatments were performed, and in 2023 another 26. One year post-treatment, 61 % of patients with knee joint involvement were fully satisfied, reporting reduced swelling and improved range of motion. Among patients treated for small and medium-sized joints, 57 % experienced overall improvement. Some patients observed recurring effusions of smaller volume or only partial improvement. Conclusion: Radiosynoviorthesis is an effective treatment for joint swelling and pain caused by synovitis, with positive outcomes seen in knee as well as smaller joints. Both objective and subjective assessments confirmed significant benefits.
- Keywords
- radiosynoviortéza,
- MeSH
- Arthritis diagnostic imaging radiotherapy MeSH
- Erbium administration & dosage therapeutic use MeSH
- Injections, Intra-Articular MeSH
- Clinical Trials as Topic MeSH
- Osteoarthritis diagnostic imaging radiotherapy MeSH
- Radiopharmaceuticals * administration & dosage therapeutic use MeSH
- Yttrium Radioisotopes administration & dosage therapeutic use MeSH
- Rhenium administration & dosage therapeutic use MeSH
- Synovitis * diagnostic imaging radiotherapy MeSH
- MeSH
- Carcinoid Tumor drug therapy MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Lutetium pharmacology therapeutic use MeSH
- Prostatic Neoplasms drug therapy MeSH
- Neoplasms * drug therapy MeSH
- Radiopharmaceuticals * pharmacology therapeutic use MeSH
- Radioisotopes pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
Úvod: Nehmatné léze prsu, u kterých je možný prs záchovný chirurgický výkon, vyžadují přesná předoperační označení patologického ložiska. Mamografický screening a moderní diagnostické metody vedou k stále časnější detekci těchto lézí. Metody: Představujeme naše 2leté praktické zkušenosti se značením nehmatných lézí radioaktivním zrnem Advantage™ I-125. Tuto metodu jsme aplikovali u 116 pacientek, z toho 34 pacientek bylo po úspěšné neoadjuvantní systémové terapii. Prvních 13 pacientek jsme značili duplicitně metodou Frankova vodiče spolu s aplikací zrna. Cílem naší práce bylo zhodnotit výhody a nevýhody metody jak pro pacientky, tak pro celý multidisciplinární tým. Výsledky: Úspěšně jsme odstranili všechna patologická ložiska během primárního výkonu. U 4 pacientek jsme zaznamenali dislokaci zrna, přičemž vždy došlo k identifikaci patologického ložiska i zrna v operačním poli. Z celkového počtu pacientek bylo 73 pacientek operováno pro duktální karcinom, 20 pacientek pro lobulární karcinom, 8 pacientek pro karcinom v terénu mikrokalcifikací, 2 pacientky pro invazivní papilární karcinom a 13 pacientek pro nejednoznačný bioptický nález. Metoda umožňuje přesné zaměření nehmatných lézí s minimální radiační zátěží pro pacientky i operační tým. Rovněž kosmetické výsledky této metody hodnotíme jednoznačně pozitivně. Závěr: Radioaktivní značení zrnem Advantage™ I-125 se nám potvrdilo jako spolehlivá metoda pro detekci nehmatných lézí prsu s minimálními komplikacemi. Její výhodu spatřujeme především v celkovém komfortu pro pacientky a z estetického hlediska nám umožňuje optimální umístění řezu. Naše výsledky potvrzují vysokou efektivitu této metody v rámci prs záchovného výkonu s dosažením R0 resekce.
Introduction: Non-palpable breast lesions that are eligible for breast-conserving surgery require precise preoperative localization of the pathological site. Mammographic screening and modern diagnostic methods contribute to the increasingly early detection of these lesions. Methods: We present our two-year practical experience with the marking of non-palpable breast lesions using the Advantage™ I-125 radioactive seed. This method was applied to 116 patients, 34 of whom had undergone successful neoadjuvant systemic therapy. The first 13 patients were marked using both the Frank wire method and radioactive seed application. The aim of our study was to evaluate the advantages and disadvantages of this method for both the patients and the entire multidisciplinary team. Results: All pathological lesions were successfully removed during the primary procedure. In four patients, we observed seed displacement; however, the pathological lesion and the seed were always identified within the surgical field. Among the total number of patients, 73 underwent surgery for ductal carcinoma, 20 for lobular carcinoma, 8 for carcinoma associated with microcalcifications, 2 for invasive papillary carcinoma, and 13 for ambiguous biopsy findings. The method enables precise targeting of non-palpable lesions with minimal radiation exposure for both the patients and the surgical team. Additionally, the cosmetic outcomes of this method were assessed as clearly positive. Conclusion: The Advantage™ I-125 radioactive seed localization proved to be a reliable method for detecting non-palpable breast lesions with minimal complications. Its main advantages lie in the overall comfort for patients and the ability to optimize incision placement from an aesthetic perspective. Our results confirm the high effectiveness of this method in breast-conserving surgery while achieving R0 resection.
- Keywords
- nehmatné léze prsu, radioaktivní zrno,
- MeSH
- Staining and Labeling methods instrumentation MeSH
- Surgical Procedures, Operative methods statistics & numerical data MeSH
- Isotope Labeling * methods instrumentation MeSH
- Organ Sparing Treatments methods instrumentation MeSH
- Humans MeSH
- Breast Neoplasms * surgery diagnostic imaging pathology MeSH
- Preoperative Care methods instrumentation MeSH
- Breast surgery diagnostic imaging pathology MeSH
- Radioactive Tracers MeSH
- Iodine Radioisotopes therapeutic use MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
An International Workshop on Standards and Measurements for Alpha-Emitting Radionuclides in Therapeutic Nuclear Medicine was held on 22-23 February 2024 at the Bureau International des Poids et Mesures (BIPM) and online. The workshop brought together members of the medical and metrology communities who play crucial roles in developing Targeted Alpha Therapy (TAT) radiopharmaceuticals. The workshop aimed to discuss ways to improve radioactivity measurements of alpha-emitting radionuclides for TAT. Through the presentations and discussions that took place over the two days of the workshop, information was exchanged, and recommendations for improvements that could lead to improved safety and effectiveness in TAT were proposed. This paper summarizes the topics and important ideas that were discussed at the workshop and presents recommendations for all the communities involved in the development of TAT radiopharmaceuticals to consider.
- MeSH
- Alpha Particles * therapeutic use MeSH
- Humans MeSH
- Nuclear Medicine MeSH
- Radiopharmaceuticals * therapeutic use MeSH
- Radioisotopes * therapeutic use standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Acinetobacter baumannii (AB) is an opportunistic pathogen with growing clinical relevance due to its increasing level of antimicrobial resistance in the last few decades. In the event of an AB hospital outbreak, fast detection and localization of the pathogen is crucial, to prevent its further spread. However, contemporary diagnostic tools do not always meet the requirements for rapid and accurate diagnosis. For this reason, we report here the possibility of using gallium-68 labeled siderophores, bacterial iron chelators, for positron emission tomography imaging of AB infections. In our study, we radiolabeled several siderophores and tested their in vitro uptake in AB cultures. Based on the results and the in vitro properties of studied siderophores, we selected two of them for further in vivo testing in infectious models. Both selected siderophores, ferrioxamine E and ferrirubin, showed promising in vitro characteristics. In vivo, we observed rapid pharmacokinetics and no excessive accumulation in organs other than the excretory organs in normal mice. We demonstrated that the radiolabeled siderophores accumulate in AB-infected tissue in three animal models: a murine model of myositis, a murine model of dorsal wound infection and a rat model of pneumonia. These results suggest that both siderophores radiolabeled with Ga-68 could be used for PET imaging of AB infection.
- MeSH
- Acinetobacter baumannii * MeSH
- Acinetobacter Infections * diagnostic imaging microbiology MeSH
- Rats MeSH
- Disease Models, Animal MeSH
- Mice MeSH
- Positron-Emission Tomography * methods MeSH
- Gallium Radioisotopes * chemistry MeSH
- Siderophores * chemistry pharmacokinetics MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Mice MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
BACKGROUND: To validate the clinical utility of a previously identified circulating tumor DNA methylation marker (meth-ctDNA) panel for disease detection and survival outcomes, meth-ctDNA markers were compared to PSA levels and PSMA PET/CT findings in men with different stages of prostate cancer (PCa). METHODS: 122 PCa patients who underwent [68Ga]Ga-PSMA-11 PET/CT and plasma sampling (03/2019-08/2021) were analyzed. cfDNA was extracted, and a panel of 8 individual meth-ctDNA markers was queried. PET scans were qualitatively and quantitatively assessed. PSA and meth-ctDNA markers were compared to PET findings, and their relative prognostic value was evaluated. RESULTS: PSA discriminated best between negative and tumor-indicative PET scans in all (AUC 0.77) and hormone-sensitive (hsPC) patients (0.737). In castration-resistant PCa (CRPC), the meth-ctDNA marker KLF8 performed best (AUC 0.824). CHST11 differentiated best between non- and metastatic scans (AUC 0.705) overall, KLF8 best in hsPC and CRPC (AUC 0.662, 0.85). Several meth-ctDNA markers correlated low to moderate with the tumor volume in all (5/8) and CRPC patients (6/8), while PSA levels correlated moderately to strongly with the tumor volume in all groups (all p < 0.001). CRPC overall survival was independently associated with LDAH and PSA (p = 0.0168, p < 0.001). CONCLUSION: The studied meth-ctDNA markers are promising for the minimally-invasive detection and prognostication of CRPC but do not allow for clinical characterization of hsPC. Prospective studies are warranted for their use in therapy response and outcome prediction in CRPC and potential incremental value for PCa monitoring in PSA-low settings.
- MeSH
- Circulating Tumor DNA genetics blood MeSH
- Edetic Acid analogs & derivatives MeSH
- Gallium Isotopes * MeSH
- Middle Aged MeSH
- Humans MeSH
- DNA Methylation * genetics MeSH
- Biomarkers, Tumor * genetics blood MeSH
- Prostatic Neoplasms, Castration-Resistant genetics blood diagnostic imaging MeSH
- Prostatic Neoplasms * genetics blood diagnostic imaging MeSH
- Positron Emission Tomography Computed Tomography * methods MeSH
- Prognosis MeSH
- Prostate-Specific Antigen * blood genetics MeSH
- Cross-Sectional Studies MeSH
- Gallium Radioisotopes * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
In previous RENEB interlaboratory comparisons based on the manual scoring of dicentric chromosomes, a tendency for systematic overestimation for doses > 2.5 Gy was found. However, these exercises included only very few doses in the high dose range, and they were heterogeneous in terms of radiation quality and evaluation mode, and comparable only to a limited extent. Here, this presumed deviation was explored by investigating three doses > 2.5 Gy. Blood samples were irradiated (2.56, 3.41 and 4.54 Gy) using a 60Co source and sent to 14 member laboratories of the RENEB network, which performed the dicentric chromosome assay (manual and/or semi-automatic scoring) and reported dose estimates. Most participants provided estimates that agreed very well with the physical reference doses and all provided dose estimates were in the correct clinical category (> 2 Gy). The previously observed tendency for a systematic bias across all laboratories was not confirmed. However, tendencies for systematic underestimation were detected for dose estimations for reference doses given in terms of absorbed dose to blood and for some participants, a laboratory-specific trend of systematic under- or overestimation was observed. The importance of regularly performed quality checks for a broad dose range became obvious to avoid misinterpretation of results.
- MeSH
- Chromosome Aberrations * radiation effects MeSH
- Radiation Dosage MeSH
- Laboratories standards MeSH
- Humans MeSH
- Cobalt Radioisotopes * MeSH
- Radiometry * methods MeSH
- Dose-Response Relationship, Radiation MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
The use of new radiopharmaceuticals labeled with lutetium-177 represents a successful translation of experimental results into clinical practice. Recent experimental data suggests that terbium-161 might well follow the example of lutetium-177 regarding applicability in nuclear medicine. Similarly to lutetium-177, the terbium-161 emits beta particles and gamma-radiation, although terbium-161 emits short-ranged conversion and Auger electrons, creating an effect that may eliminate smaller tumor metastases more effectively than lutetium-177. Terbium-161 may exert a higher radiobiological effect in the target tissues in comparison with lutetium-177, a difference which makes possible a reduction in the doses of radioactivity administered. Further, due to the similar chemical properties of lutetium-177 and terbium-161, similar radiolabeling techniques can be used. The differences found in preclinical experiments on radiotoxicity of the counterparts seem to be minor. Despite intensive progress, the number of preclinical studies on 161Tb-labeled agents is still not comparable to studies on lutetium-177. Clinical trials with 161Tb-labeled radiopharmaceuticals focused on the treatment of prostate cancer and selected neuroendocrine tumors have already begun, although none of them have been completed yet.
- MeSH
- Clinical Trials as Topic MeSH
- Humans MeSH
- Lutetium * therapeutic use adverse effects chemistry MeSH
- Nuclear Medicine * methods MeSH
- Radiopharmaceuticals therapeutic use MeSH
- Radioisotopes * therapeutic use adverse effects MeSH
- Terbium * therapeutic use chemistry adverse effects MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Comparative Study MeSH
Limited availability constrains the implementation of 225Ac, the most promising α emitter for targeted therapy, in clinical practice. Proton activation of 226Ra is one of few realistic solutions to this problem. We have therefore measured cross sections of relevant 226Ra(p,xn) nuclear reactions in the energy range of 12.0 to 17.2 MeV. The obtained results allowed us to deduce the yield of 224Ac, 225Ac, and 226Ac. The consequences of our data to predictions of production capacity and radionuclidic purity of 225Ac are thoroughly discussed, and their comparison with previous measurements and with the prediction of the TALYS 1.96 nuclear reaction model code run with default parameters are provided.
- MeSH
- Actinium * chemistry MeSH
- Phosphorus * chemistry MeSH
- Radiochemistry MeSH
- Radium * chemistry MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. OBJECTIVE: To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg). DESIGN: Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success. RESULTS: Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT-containing bismuth, metronidazole and tetracycline-plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness. CONCLUSION: The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness. TRIAL REGISTRATION NUMBER: NCT02328131.
- MeSH
- Amoxicillin therapeutic use administration & dosage MeSH
- Anti-Bacterial Agents * therapeutic use adverse effects administration & dosage MeSH
- Bismuth * therapeutic use administration & dosage MeSH
- Adult MeSH
- Helicobacter pylori * drug effects MeSH
- Helicobacter Infections * drug therapy MeSH
- Proton Pump Inhibitors * therapeutic use administration & dosage adverse effects MeSH
- Clarithromycin therapeutic use administration & dosage MeSH
- Drug Therapy, Combination * MeSH
- Middle Aged MeSH
- Humans MeSH
- Metronidazole therapeutic use administration & dosage MeSH
- Registries * MeSH
- Aged MeSH
- Tetracycline therapeutic use administration & dosage MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Geographicals
- Europe MeSH
