Treatment Option not Mentioned
We would like to draw attention to an additional therapeutic option in the form of intracavitary radionuclide therapy with colloidal β-emitters. This procedure consists of intrapleural injection of radionuclides, that achieve a targeted irradiation of pleural epithelial and carcinosis cells with an optimal depth of penetration (mostly <5 mm) and a consecutive decrease in effusions. The advantage: a painless and safe modality with high effectiveness and—in contrast to chemical pleurodesis—a local antineoplastic component.
Although no original article on this method has been published in recent years, it still represents an option and is characterized by good tolerability and effectiveness (1, 2). High rates of remission of >80% have been described with the β-emitters Y-90 or P-32 in colloidal compounds (3). The limitations that hampered the use—after initial popularity—were the efforts involved, the limited availability, and the inpatient stay in a nuclear medicine institution according to radiation protection regulations. After simple, non-radioactive treatment alternatives were introduced the radioisotope approach gradually decreased in clinical practice and eventually disappeared from oncologists’ radar. Since the newer approaches (talcum, tetracycline, doxycycline) sometimes cause side effects or are unsuccessful in individual cases, knowledge about the radiopharmaceutical option, which may be complex in handling, but simple and well tolerated by patients, can prove very helpful.
It is therefore our great ambition to raise awareness of this procedure. The Y-90 colloid preparation can be administered in any institution for nuclear medicine, with the relevant permissions for handling, expertise, and an available therapeutic ward.
In summary, radionuclide therapy, as described above, is an effective therapeutic alternative with few adverse effects for refractory malignant pleural effusion that has been unfairly consigned to oblivion. It is important to draw attention to this palliative treatment option, which does have its merits in individual cases.
PD Dr. med. Samer Ezziddin
Prof. Dr.med. Hans-Jürgen Biersack
Klinik und Poliklinik für Nuklearmedizin,Uniklinik Bonn
|1.||Biersack HJ, Bender H: Nuklearmedizinische Therapie in der Onkologie: Intrakavitäre Nuklidtherapie. Stuttgart: MMP-Verlag 2004.|
|2.||Aulbert E, Nauck F, Radbruch L: Lehrbuch der Palliativmediziin. Stuttgart: Schattauer Verlag 2011 MEDLINE|
|3.||Austgen M: Palliative Therapie tumorbedingter Pleuraergüsse mit Radioisotopen. [Palliative therapy of tumor-induced pleural effusions with radioisotopes]. Pneumologie 1989; 43: 88–91 MEDLINE|
|4.||Ried M, Hofmann HS: The treatment of pleural carcinosis with malignant pleural effusion. Dtsch Arztebl Int 2013; 110(18): 313–8 VOLLTEXT|