Radionuclides for Patients With Painful Skeletal Metastases
In the United States, bone-seeking radionuclides are generally administered in the outpatient setting, as the lack of significant gamma emission makes radiation precaution isolation procedures unnecessary. In other countries, regulatory authorities may require patients to remain in the hospital for hydration and observation for several hours or overnight after the administration. Following informed consent, the patient is identified through two or more identifiers. Intravenous access is obtained and flushed prior to the procedure. Patients often are hydrated prior to the injection, either orally or with up to 500 mL of normal saline, to allow for an efficient elimination of radionuclide not incorporated into bone.
The authorized user administers the radionuclide injection through the intravenous access over approximately 1 minute. The line is flushed with 20 to 30 mL of normal saline, and the access is removed by the procedure nurse. The patient is then given discharge instructions as well as recommendations to drink and urinate frequently for the first several hours. Typically, the injection is followed with weekly blood counts for up to 8 weeks to monitor the predictable transient decline and recovery of platelet and leukocyte counts.
The principal side effect of bone-seeking radiopharmaceuticals is transient myelosuppression. Thrombocytopenia is the most common form, with platelet counts generally exhibiting a nadir at 40% to 60% from baseline. In most patients, this event will lead to only grade 1 or 2 toxicity. Significant problems with neutropenia and anemia are even less common. Approximately 5% to 10% of patients will experience a "flare reaction," with a transient and self-limited increase in bone pain. This event is more common in patients with a significant burden of bone metastases visualized on bone scan. Other uncommon side effects may include nausea, loose stools, asymptomatic hematuria, and heart palpitations.
Administration and Side Effects of Radionuclides
In the United States, bone-seeking radionuclides are generally administered in the outpatient setting, as the lack of significant gamma emission makes radiation precaution isolation procedures unnecessary. In other countries, regulatory authorities may require patients to remain in the hospital for hydration and observation for several hours or overnight after the administration. Following informed consent, the patient is identified through two or more identifiers. Intravenous access is obtained and flushed prior to the procedure. Patients often are hydrated prior to the injection, either orally or with up to 500 mL of normal saline, to allow for an efficient elimination of radionuclide not incorporated into bone.
The authorized user administers the radionuclide injection through the intravenous access over approximately 1 minute. The line is flushed with 20 to 30 mL of normal saline, and the access is removed by the procedure nurse. The patient is then given discharge instructions as well as recommendations to drink and urinate frequently for the first several hours. Typically, the injection is followed with weekly blood counts for up to 8 weeks to monitor the predictable transient decline and recovery of platelet and leukocyte counts.
The principal side effect of bone-seeking radiopharmaceuticals is transient myelosuppression. Thrombocytopenia is the most common form, with platelet counts generally exhibiting a nadir at 40% to 60% from baseline. In most patients, this event will lead to only grade 1 or 2 toxicity. Significant problems with neutropenia and anemia are even less common. Approximately 5% to 10% of patients will experience a "flare reaction," with a transient and self-limited increase in bone pain. This event is more common in patients with a significant burden of bone metastases visualized on bone scan. Other uncommon side effects may include nausea, loose stools, asymptomatic hematuria, and heart palpitations.