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Figures
- FIGURE 1.
In these images of patient 3, CT transaxial slice through tumor site (top) shows massive tumor in left pelvis, and 186Re-HEDP posttherapy whole-body scan (bottom) shows heterogeneous but intense uptake at tumor site in both posterior (left) and anterior (right) views. In addition, metastases are noted in right lung field, L4 vertebra, and left ribs posteriorly.
Tables
Patient no. Age at diagnosis (y) Sex Weight (kg) Primary site Administered activity (MBq) Tumor absorbed dose (cGy) Metastases at presentation History before 186Re-HEDP 1 16 M 50 L tibia 2,820 2.3 No Ifosfamide; amputation; metastasectomy; lobectomy at 8 y; large bony secondary at 10 y 2 21 F 65 Sacrum 1,410 16 (hip) and 9 (knee) No Doxorubicin + cisplatin × 4; progression of primary tumor and lung, bone, and intraabdominal metastases 3 24 M 58.5 Pelvis 5,310 3.1 No Doxorubicin + cisplatin; progression; etoposide + cisplatin; excision; margin positive; ifosfamide; EBRT: 50 Gy per 11.3 kg (25 fractions) of body weight, paravertebral relapse; HDMTX 4 12 F 40 Ilium 1,350 1.60 and 3.1 No Cisplatin + ifosfamide (later omitted) + etoposide × 4; HDMTX × 2; good response by primary tumor but pulmonary progression; primary tumor inoperable 5 22 F 61 Distal femur 1,296 2.4 No Doxorubicin + cisplatin + etoposide; distal femoral replacement; local, nodal, and pulmonary progression at 14 mo 6 42 F 74 Sacrum 1,420 0.5–0.6 (4 sites) No Doxorubicin + cisplatin/carboplatin × 6 7 14 M 54 Tibia 1,430 2 No Doxorubicin + cisplatin × 6; amputation; bone metastasis; HDMTX; ifosfamide; further bone disease 8 12 M 45 Tibia 1,399 2, 2, and 5 (3 sites) No Doxorubicin + cisplatin × 6; amputation; pulmonary metastasis at 2 y; metastasectomies; further pulmonary relapse; HDMTX; ifosfamide 9 16 M 44 Distal femur 2,660 1.4 and 2.2 No Doxorubicin + cisplatin × 6; endoprosthetic replacement; pulmonary, mediastinal, and pleural relapse at 8 mo; ifosfamide + etoposide × 5; partial remission 10 16 M 55.2 Proximal humerus 1,182 14 No Doxorubicin + cisplatin × 6; disarticulation; adjuvant EBRT to supraclavicular fossa; pulmonary and pleural relapse at 72 mo; metastasectomy and pleurectomy; HDMTX; ifosfamide; etoposide; progressive disease 11 12 M 32 Femur 1,400 1.1 and 2.0 Yes Doxorubicin + cisplatin × 2; HDMTX; lung progression; endoprosthetic replacement; high-dose ifosfamide (12–14 g/m2) + etoposide × 3; progressive lung and bone disease 12 16 M 49 Femur 1,430 1.4 No Doxorubicin + cisplatin × 6, pleural recurrence; resection; ifosfamide + etoposide + MTX; bowel recurrence resected; internal mammary nodes eroding chest wall 13 27 M 55 Ilium + sacrum 1,500 16 No Doxorubicin + cisplatin + HDMTX; then ifosfamide + etoposide; EBRT to right pelvis; deposit L5 vertebra HDMTX = high-dose methotrexate.
Patient no. Response to treatment Survival after diagnosis of metastatic disease (mo) Survival after last 186Re HEDP therapy (mo) Site of metastases Subsequent therapy Follow-up 1 Stable disease: biopsy negative 216 60 Lung None Disease-free 2 Stable disease 48 10 Lung EBRT Died: perforated bowel 3 Stable disease 36 10 Lung Ifosfamide; palliative EBRT* Poor hematologic tolerance of oral etoposide given for palliation; died of gastrointestinal hemorrhage 3 mo after final 186Re-HEDP dose 4 Stable disease 48 1 Lung Supportive/EBRT Poor pain control; died at 6 mo 5 Stable disease 12 1 Lung Supportive†/EBRT Died at 5 mo: progressive lung disease 6 Stable disease 36 2 Scapula/sternum/thoracic spine Supportive†/EBRT Poor pain control: died 7 Lost to follow-up NA NA Lung EBRT Lost to follow-up at 3 mo 8 Progressive disease 45 36 Lung/femoral/iliac lymph nodes Palliative/EBRT Died at 1 mo of hepatic progression; platelets and white blood cells normal 9 Pain relief at 2 sites but not at third by 1 mo 12 4 Lung/bone Supportive/EBRT Died of progressive disease 12 mo after first 186Re-HEDP dose 10 Progressive disease 96 13 Lung Palliative EBRT 3 mo Died 11 Progressive disease 36 5 Lung Palliative EBRT 2 mo Died at 36 mo 12 No pain relief 20 6 Lung Supportive/EBRT Died at 24 mo 13 Progressive disease 30 2 Lung Palliative EBRT to 1 site at 1 mo Died Patient no. Chemotherapy/ 186Re-HEDP interval (mo) 186Re-HEDP/EBRT interval (wk) Platelet nadir grade White blood cell nadir grade WHO status* at 186Re-HEDP therapy Other toxicity 1 6 3 0 0 1 Preexisting chronic renal failure; no change after 186Re-HEDP therapy 2 6 3 0 0 3 None 3 2 2 2 4 1 Initial toxicity after first course only; white blood cell grade 4 toxicity after 4 cycles; patient recovered but was unable to tolerate palliative chemotherapy 4 2 1.6 3 1 2 Completely resolved at 4 mo 5 8 3 2 on second dose 2 1 None 6 1.5 1 4 during EBRT 3 2 Platelet toxicity persisted at grade 4 for 4 wk and required transfusion; gradually rose but never much beyond 50 × 109/L 7 1.75 2 0 0 1 None 8 36 1 0 0 1 None 9 4 0 0 2 None 10 14 3 0 1 2 None 11 3.5 5 0 1 2 Died within 4 wk because of pulmonary infection (unspecified) 12 5 2 0 0 1 None 13 7 6 0 3 1 None ↵* Criteria of the World Health Organization (11).
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