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Radiation Synovectomy Using ¹⁶⁵Dy Ferric-Hydroxide and Oxidative DNA Damage in Patients with Different Types of Arthritis

Departments of Nuclear Medicine, Orthopedics, Occupational Medicine, and Pathology, University of Vienna, Vienna
University Hospital of Vienna, Research Center Seibersdorf, Vienna, Austria

Correspondence: For correspondence or reprints contact: Christian Pirich, MD, Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.

ABSTRACT

Radiation synovectomy is an effective treatment for chronic synovitis refractory to pharmacological treatment in patients with rheumatoid or seronegative arthritis. Concerns persist about possible radiation-induced cytogenetic damage after radiation synovectomy leading to recommendations to use this technique only in the elderly. Micronucleus (MN) frequency in lymphocytes and urinary excretion of 8-hydroxy-2'-deoxyguanosine (8OHdG) as an indicator of cellular oxidative DNA base damage are biomarkers of radiation-induced cytogenetic damage. The course of both biomarkers was studied in patients with different types of chronic synovitis undergoing radiation synovectomy with very short-lived ¹⁶⁵Dy-ferric-hydroxide (DFH). Methods: Radiation synovectomy of the knee was performed in 13 men and 12 women (mean age, 44 ± 15 y) using a mean activity of 9.48 ± 1.65 GBq ¹⁶⁵Dy-DFH in 27 consecutive treatments. MN frequency in lymphocytes and urinary excretion of 8OHdG, measured by high-performance liquid chromatography, were assessed before and 4 (MN only) and 20 h after radiation synovectomy. Results: Urinary excretion of 8OHdG in patients (in µmol/mol creatinine; pretreatment mean, 3.1 ± 3.4; median, 2.27) was not significantly different from that in healthy volunteers (mean, 2.0 ± 1.2; median, 1.87) and not altered by radiation synovectomy (post-treatment mean, 2.5 ± 1.5; median, 2.04, NS). An increase in 8OHdG levels after radiation synovectomy of more than 1 SD was found in only 1 patient, who experienced leakage to the lymph nodes but who already had elevated urinary 8OHdG levels before treatment. The frequency of MN/500 binucleated cells (BNCs) was slightly lower in patients (pretreatment mean, 4.3 ± 2.6; median, 4.25) than in healthy volunteers (mean, 5.4 ± 2.3; median, 5.3) and did not significantly change after therapy, either (4-h post-treatment mean, 3.9 ± 2.1, median, 3.8; 20-h post-treatment mean, 4.1 ± 2, median 3.8 MN/500 BNC). In 22 of 27 treatments, no leakage to nontarget organs could be monitored, whereas leakage to the local lymph nodes and the liver was detected after 5 treatments. Conclusion: Radiation synovectomy using ¹⁶⁵Dy-DFH causes no significant radiation burden to most patients as indicated by the absence of adverse changes in levels of biomarkers of cytogenetic damage and a low incidence of leakage. These data suggest that the risk of malignancy may not be elevated.

Key Words: radiation synovectomy • cytogenetic damage • cancer • biomarker

This article has been cited by other articles:

				S. Ofluoglu, E. Schwameis, H. Zehetgruber, E. Havlik, A. Wanivenhaus, I. Schweeger, K. Weiss, H. Sinzinger, and C. Pirich Radiation Synovectomy with 166Ho-Ferric Hydroxide: A First Experience J. Nucl. Med., November 1, 2002; 43(11): 1489 - 1494. [Abstract] [Full Text] [PDF]