90-yttrium
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Během 3 let (1993-1996) jsme v Nemocnici Na Homolce léčili stereotaktickou brachyterapií 16 pacientů s cystickým kraniofaryngeomem s užitím izotopu yttrium90. Soubor tvorilo 10 pacientů mužského a 6 Ženského pohlaví. Jejich průměrný věk byl 23,2 let (4-53). U 12 pacientů předcházela brachyterapii mikrochirurgická operace, u 3 pacientů punkce cysty a primární léčbou byla brachyterapie pouze u jedné pacientky. Po aplikaci yttria90 došlo u 87 % pacientů k regresi cysty (v 47 % k úphié regresi za 3-17 měsíců, průměrně 10 měsíců). Stereotaktická brachyterapie byla opakovaná u 3 pacientů, z toho u dvou 2krát. Perioperační morbiditu brachyterapeutické léčby jsme v našem souboru pacientů nezaznamenaU. Ke zlepšení endokrinopatie došlo po brachyterapií u 2 pacientů, ke zlepšení perimetru také u 2. Pro progresi solidní části nádoru byli 2 pacienti po brachyterapeutické léčbě mikrochirurgicky operováni. V pooperačním období zemřela 1 pacientka v souvislosti s nádorem 1 rok po brachyterapeutické léčbě.
During 3 years (1993-1996) we treated at Na Homolce Hospital 16 patients with cystic craniopharyngioma by stereotactic brachy therapy using isotope Yttrium90. The group comprised 10 males and 6 females, age 4-53, average 23.2 years. In one patient brachytherapy was primary treatment, in 12 patients it followed after microsurgery and in 3 patients after aspiration of the cyst. After instillation of Yttrium90 the cyst diminished in 87 % (in 47 % total regression was observed after 3-17 months, average 10 months). Stereotactic brachytherapy was repeated in 3 patients, in 2 of them twice. Perioperative morbidity of brachytherapy was not recorded. Endocrinopathy improved after brachytherapy in 2 patients and visual improvement occurred also in 2 patients. After progression of the solid part of the tumour 2 patients underwent subsequent resection. One patient died due to her tumour one year after brachytherapy.
- MeSH
- brachyterapie metody MeSH
- dítě MeSH
- dospělí MeSH
- kraniofaryngeom chirurgie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- radioizotopy ytria terapeutické užití MeSH
- stereotaktické techniky metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
Na základě údajů z odborné literatury a předpisů platných v České republice se pojednává o měření dávky v kůži rukou pracovníků Hp(0,07) a dávky Hp(lO) při práci s roztoky 90Y o vysoké aktivitě a o vhodných ochranných opatřeních. Účinné stínění lahviček a injekčních stříkaček před zářením beta zajišťují stínící kryty z polymetylmetakrylátu (PMMA) o tloušťce nejméně 6 mm, případně vrstva kombinovaná z PMMA a Pb. Údaj běžného komerčního termoluminiscenčního (TL) prstového dozimetru noseného rutinně na dolním článku prstu směrem od zdroje výrazně podceňuje dávku v kůži rukou ve srovnání s údajem tenkého TL dozimetru umístěného na špičce prstu. Dávka v kůži způsobená kontaminací roztokem 90Y může být značná - při stejné plošné aktivitě je vyšší než např. z radionuklidů 89Sr a 32p. Dávkový příkon brzdněho záření unikajícího z těla pacienta, kterému bylo aplikováno 90Y, je velmi nízký, avšak pacient propouštěný z nemocnice musí - v důsledku vylučování určité části aplikované aktivity do moči - obdržet písemné instrukce o jeho chování doma, zejména Z hlediska osobní hygieny, aby se co nejvíce snížilo riziko vnitřní kontaminace rodinných příslušníků a dalších osob, s nimiž pacient přichází do styku.
The authors deal with the dose measurement at the skin of workers Hp(0.07) and the dose Hp(lO) at work with solutions of »oY of high activity and deal with suitable protective measures based on the data from literature and regulations valid in the Czech Republic. An effective shield of the vials and injection syringes from beta radiation is secured by shield covers from polymethylmethacrylate (PMMA) of the minimal thickness of 6 mm, or by a layer combined from PMMA and lead. The data of common commercial thermoluminiscent (TL) finger dosimeter, carried routinely at the lower phalanx of the finger in direction from the source significantly understimates the dose on the hand skin as compared with the data of thin TL dosimeter located at the finger tip. The dose on the skin caused by contamination with the solution of 90Y may be significant - considering the same planar activity being higher than in the 89Sr and 32p radionuclides. The dose rate of bremsstrahlung released from the patient's body, who was administered 90Y is very low, but the patient dismissed from the hospital must - in view of the elimination of a certain part of the applied irradiation into urine - be given written instructions about his/her behavior at home, especially from the standpoint of personal hygiene. This measure is aimed at a maximum decrease in internal contamination of relatives and other persons, who the patient may encounter.
Repeated bleeding in the joint cavities is the most annoying symptom and often has disabling effects in patients with hemophilia (PWH). Our aim was to study the effect of radiosynovectomy (RSO) with beta particle-emitting radiocolloids in the treatment of hemorhagic arthropathy. We have treated 22 joints from 18 patients with hemophilia A, from April 2008 to February 2012, 5 knees, 11 elbows and 6 ankles. Joints were divided into two Groups, those treated with yttrium-90-citrate ((90)Y-C) (5 knees, 2 of them twice)-Group I and those with rhenium-186-sulfide ((186)Re-S) (11 elbows, 1 of them treated twice and 6 ankles)-Group II. A total of 25 treatments. Follow-up period was 3 months, 1 year and 3 years. Results showed a favourable subjective and a better objective result in all 5 joints of Group I and in 15/17 joints of Group II, respectively. Follow-up after 3 months showed significant improvement in Hemophilia Join Health Score (HJHS) after 20 treatments and steady score after 5 treatments. After 1 year, 19 treated joints had improved for the first time, 3 remained steady and 3 were not examined. After 3 years, 9 treated joints were HJHS steady, while 16 were not examined. One year after treatment, 13/14 joints of patients, aged 6-23 years showed better HJHS score, while 9/11 joints of patients aged 26-51 years, showed better HJHS. Synovial membrane thickness as measured by MRI in 8 joints, before and 3 months after treatment was not related to prognosis. In conclusion, in a small group of hemophilic patients with hemorrhagic arthropathy treated with (90)Y-C and with (186)Re-S, our study showed good results irrespective of age in 22/25 treatments after 3 months or 1 year. The thickness of synovial membrane in the 8 joints studied was not related to prognosis.
- MeSH
- citráty terapeutické užití MeSH
- dítě MeSH
- dospělí MeSH
- hemofilie A radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- organokovové sloučeniny terapeutické užití MeSH
- rhenium terapeutické užití MeSH
- synoviální membrána účinky záření MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
Seminars in oncology, ISSN 0093-7754 vol. 30, no. 6, suppl. 17, December 2003
34 s. : il., tab. ; 28 cm
- MeSH
- B-lymfocyty MeSH
- nehodgkinský lymfom terapie MeSH
- radioimunoterapie metody MeSH
- radioizotopy ytria MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- onkologie
- hematologie a transfuzní lékařství
Cíl: Zhodnotit první zkušenosti s prováděním transarteriální radioembolizace (TARE) jaterních nádorů mikročásticemi s obsahem 90-yttria Metodika: V průběhu 6 měsíců jsme provedli u šesti nemocných TARE s aplikací skleněných mikročástic TheraSphere®. U čtyř nemocných šlo o metastatické postižení jater kolorektálním karcinomem, u dvou nemocných hepatocelulárním karcinomem. U nemocných jsme sledovali peri- a postprocedurální průběh, výskyt komplikací, WHO performance status a časný efekt léčby. Výsledky: Ani u jednoho z nemocných jsme nezaznamenali závažné komplikace léčby, při sledování účinků léčby bylo po 6 týdnech zjištěno, že u jedné nemocné došlo k rapidnímu zlepšení WHO performance status o tři kategorie, u ostatních byl status zachován, ani u jednoho nemocného v časném horizontu nebyla zaregistrována jaterní progrese onemocnění. Závěr: První zkušenosti s TARE ukazují i u nemocných s neresekabilním jaterním postižením dobrou toleranci léčby a slibné výsledky terapie.
Aim: To evaluate an early experience with transarterial radioembolisation of liver tumors with microspheres with 90-yttrium. Method: During 6 monnths, we performed 6 months TARE with the application of glass-microspheres TheraSphere®. In 4 patients.colorectal carcinoma metastases were treated, in 2 hepatocellular carcinoma respectivelly In patients, the peri- and post-procedural disease development was surveyed according complications, WHO performance status an early effect of therapy. Results: No severe complication was noted, during 6 weeks was noted only one extreme improvement of WHO performance status with decrease by 3 grades, in rest of patients the performance status was unchanged. No progression in liver was noted within 6 weeks. Conclusion: Our early experience with TARE showed high safety, therapy is well tolerated and the therapy results are promising.
- Klíčová slova
- 90-yttrium, radioembolizace metastázy kolorektálního karcinomu,
- MeSH
- brachyterapie škodlivé účinky trendy MeSH
- hepatocelulární karcinom diagnóza radioterapie MeSH
- lidé MeSH
- metastázy nádorů diagnóza radioterapie MeSH
- nádory jater * radioterapie MeSH
- radioizotopy ytria aplikace a dávkování ekonomika terapeutické užití účinky záření MeSH
- terapeutická embolizace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Transarterial radio-embolization (TARE) using yttrium-90 microspheres is a promising method based on the brachytherapeutic effect of radionuclide with beta-minus decay dissolved in solid microparticles applied directly to tumor-supplying arteries. This treatment is complex, as well as logistically and technically extremely demanding and must be planned in detail. The visualization of the vascular supply of the liver and the possible parasitic supply of the tumor is essential not only for indication of the procedure and correct identification of the arteries to which the microspheres will be applied, but also for prevention of non-target deposition of radioactive material. This review addresses the use of computed tomographic angiography in the preparatory phase of TARE.
Léčba nemocných s lymfomy byla po desítky let minulého století založena jen na kombinaci chemoterapie a ozáření. Zavedení monoklonálních protilátek – zejména pak rituximabu – do léčby nemocných s nehodgkinskými lymfomy představovalo skutečný milník v léčbě lymfomů. Rituximab se poté na základě několika klinických studií stal standardní součástí léčby první i dalších linií u většiny B lymfomů, a to i v rámci udržovací léčby u nemocných s folikulárním lymfomem. Z dalších monoklonálních protilátek je v současné době v České republice k dispozici alemtuzumab (protilátka anti-CD52) pro nemocné s chronickou lymfatickou leukémií a T lymfomy a ibritumomab tiuxetan (protilátka anti-CD20 s navázaným radioizotopem yttria) pro nemocné s relabujícím a rituximab-refrakterním folikulárním lymfomem. Vývoj celé řady dalších protilátek (galiximab, bevacizumab, SGN 40, ofatumumab a mnoho dalších) ukazuje na to, že jedním z předpokládaných pilířů léčby lymfomů ve 21. století bude tedy použití cílené biologické léčby.
The treatment of lymphoma patients was only based on chemotherapy in combination with radiotherapy for decades in the last century. The introduction of monoclonal antibodies, rituximab in particular, in the treatment of non-Hodgkin's lymphoma patients was the real milestone in the management of lymphoma. Based on several clinical trials, rituximab has become a standard part of first-line and further--line therapy in most B lymphomas, and even of maintenance therapy in patients with follicular lymphoma. Other monoclonal antibodies currently available in the Czech Republic are alemtuzumab (anti-CD52 monoclonal antibody) for patients with chronic lymphocytic leukemia and T lymphomas and ibritumomab tiuxetan (yttrium-90-labeled anti-CD20 monoclonal antibody) for patients with relapsed and rituximab-refractory follicular lymphoma. The development of a wide range of other monoclonal antibodies (galiximab, bevacizumab, S GN 40, ofatumumab and many others) indicates that targeted biologic therapy should be one of the mainstays of treatment for lymphoma in the 21st century.
- MeSH
- biologická terapie metody trendy využití MeSH
- CD antigeny MeSH
- financování organizované MeSH
- imunoterapie metody trendy využití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- lymfom farmakoterapie radioterapie MeSH
- medicína založená na důkazech trendy MeSH
- monoklonální protilátky farmakokinetika farmakologie terapeutické užití MeSH
- radioimunoterapie metody trendy využití MeSH
- vaskulární endoteliální růstové faktory antagonisté a inhibitory terapeutické užití MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY: Chronic synovitis is a common finding in people with haemophilia. It regularly appears after recurrent episodes of intra-articular bleeding. The bleeding originates from the subsynovial venous plexus underlying the capsule where a lack of thromboplastic activity has been demonstrated. Therefore, the changed synovium appears to be a treatment target. There are several methods which can be used to remove the synovial layer from the joint. The aim of our study was to asses the efficacy of different treatment approaches used in a group of haemophiliacs between 1985 and 2005 in our hospital. MATERIAL AND METHODS: A group of 30 patients with bleeding disorders was evaluated in the study. There were 29 men with haemophilia and one woman with von Wilebrandt factor deficiency. Their age ranged from 6 to 18 (median 13) years. They underwent a total of 68 interventions including surgical synovectomy (n=28), radionuclide synovectomy (n=33) and corticosteroid instillation (n=7). The necessity of a repeat intervention was used as a criterion of successful treatment. RESULTS: In the group of surgical synovectomies, 22% of the patients required repeat operations, in the group of radiation synovectomy, this was 9% and, in the group treated with corticosteroids, this was 43%. The average hospitalisation time was 50 days for surgical procedures (19-133 days) and 7 days for radiation synovectomy procedures (4-13 days). DISCUSSION: In 1994 Merchan presented seven excellent or good results in a group of 10 knees evaluated 1 year after treatment with methylprednisolone. Six years later he reported that "five years after completion of treatment, all results of the observed patients were poor". Generally, corticosteroids will reduce synovitis in the majority of patients but the effect is temporary. A complete remission is a very rare situation under corticosteroid treatment. The experience with surgical synovectomies is not recent and this method is described as carrying a high risk of complications and requiring a high amount of coagulating factor consumption. There are several recent reports on the application of Yttrium-90: in Madrid they evaluated treated joints (knees, ankles and elbows, n = 66) in 44 patients aged from 9 to 39 years. The results were good in less than half of the knees and ankles. The treatment of elbows was more successful. It was recommended to perform synoviorthesis at the early stages of synovitis. In Israel, they reported that a decrease in the number of bleeding episodes was achieved in 80% of 115 patients treated with Yttrium-90; in 15% of them, bleeding in the treated joints stopped completely. In Izmir, Yttrium was used in the treatment of knees, elbows, ankles and also shoulders in children and young adults (3-25 years). The method was found to be safe and effective. Brazilian authors have experience with the treatment of knees, ankles, elbows and shoulders too; they have concluded that this method represents an important resource for the treatment of chronic haemophilic synovitis and markedly reduces joint bleeding frequency and pain, irrespective of the radiographic stage and inhibitor status. While the European Association of Nuclear Medicine (EANM) recommend using 186Re-sulfide for treatment in medium-sized joints, Chinese authors have published a study comparing the effect of using three different doses of 186Re-sulfide in the treatment of chronic synovitis in knees. Their patients have received an amount of radionuclide according to the thickness of their synovial layer measured on MRI, with the result that 22 patients exhibited significant reduction in synovial thickness. A reduction in the number of bleeding episodes was reached in 71% of the patients within an 18-month period. No significant differences were found among the groups receiving different radioactivity doses. In Turkey, 35 elbows, 26 ankles and two shoulders in 49 patients aged between 3 and 30 years were treated with 186Re. The patients were followed up from 6 months to 3 years. At 6 months after the procedure, 81% of the elbows and 86% of the ankles with grade II synovitis were free from bleeding, as well as 53% and 44% of the elbows and ankles with grade III synovitis, respectively. CONCLUSIONS: Radiation synovectomy appears to be the method of choice in the treatment of recurrent bleeding in the joint cavity in people with haemophilia. The efficacy of surgical synovectomy is lower in comparison with radiation synovectomy. Risks associated with surgery and anaesthesia, the need of hospitalisation and a prolonged period of rehabilitation are bothering. On the contrary, the application of corticosteroids cannot be recommended as a good method to treat recurrent haemarthroses.
- MeSH
- chronická nemoc MeSH
- disekce * MeSH
- dítě MeSH
- glukokortikoidy aplikace a dávkování MeSH
- hemartróza * diagnóza etiologie patofyziologie terapie MeSH
- hemofilie A komplikace MeSH
- injekce intraartikulární MeSH
- lidé MeSH
- mladiství MeSH
- ortopedie metody MeSH
- radioterapie metody MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- synovektomie MeSH
- synoviální membrána * účinky léků patologie účinky záření MeSH
- synovitida diagnóza etiologie patofyziologie terapie MeSH
- von Willebrandova nemoc komplikace MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
A conceptually new bimodal immunoradiotherapy treatment was demonstrated using thermoresponsive polymer β-glucan-graft-poly(2-isopropyl-2-oxazoline-co-2-butyl-2-oxazoline) bearing complexes of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid with yttrium-90(III) at the graft ends. The behavior of this thermoresponsive polymer in aqueous solutions was studied, and it showed the appropriate cloud point temperature for brachytherapy applications. The polymer was tested in vitro, and it exhibited nontoxicity and active uptake into cancer cells and macrophages with colocalization in the lysosomes and macrophagosomes. Moreover, the observed oxidative burst response of the leukocytes established the immunostimulatory properties of the polymer, which were also studied in vivo after injection into the thigh muscles of healthy mice. The subsequent histological evaluation revealed the extensive immune activation reactions at the site of injection. Furthermore, the production of tumor necrosis factor α induced by the prepared polymer was observed in vitro, denoting the optimistic prognosis of the treatment. The biodistribution study in vivo indicated the formation of the polymer depot, which was gradually degraded and excluded from the body. The radiolabeled polymer was used during in vivo antitumor efficiency experiments on mice with EL4 lymphoma. The immunoradiotherapy group (treated with the radiolabeled polymer) demonstrated the complete inhibition of tumor growth during the beginning of the treatment. Moreover, 7 of the 15 mice were completely cured in this group, while the others exhibited significantly prolonged survival time compared to the control group. The in vivo experiments indicated the considerable synergistic effect of using immunoradiotherapy compared to separately using immunotherapy or radiotherapy.
- MeSH
- antibakteriální látky chemická syntéza farmakologie MeSH
- aza sloučeniny chemie MeSH
- beta-glukany chemie MeSH
- brachyterapie metody MeSH
- heterocyklické sloučeniny monocyklické chemie MeSH
- imunitní systém účinky léků MeSH
- komplexní sloučeniny chemie MeSH
- leukocyty účinky léků metabolismus MeSH
- lidé MeSH
- myši inbrední C57BL MeSH
- nádorové buněčné linie MeSH
- oxazoly chemie MeSH
- oxidace-redukce MeSH
- polymery chemie MeSH
- protinádorové látky chemická syntéza farmakologie terapeutické užití MeSH
- radioimunoterapie metody MeSH
- radioizotopy ytria chemie MeSH
- Staphylococcus aureus účinky léků MeSH
- teplota MeSH
- viabilita buněk účinky léků MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH