Abstract
Although trace amounts of radioactivity are routinely used to detect osteosarcoma, the use of larger therapeutic amounts of radiation is often an unrecognized opportunity to treat metastatic osteosarcoma. This chapter will review a number of approaches to use ionizing radiation in the form of injectable radiopharmaceuticals. Since bone metastases are a common pattern of metastatic spread of cancer in general, a number of bone-seeking radiopharmaceuticals have been developed and FDA approved for treatment of bone metastases. Although osteosarcoma, a bone-forming cancer, would seem ideally suited to be treated with bone seekers, patterns of relapse involving non-ossifying metastases remain a major problem to be overcome. Thus, this review will not only describe experience using a number of bone-seeking radiopharmaceuticals such as 153-samarium-EDTMP, 153-samarium-DOTMP, and 223-radium against osteosarcoma, but also approaches to identify patients who may benefit as well as some means to the improve overall efficacy including combination therapy with routine agents and using nuclear imaging to develop best strategy for use. These include imaging with not only 99mTc-MDP standard bone scans, but also 99mTc-MDP bone scans with SPECT CT, bone-specific sodium fluoride PET-CT (Na18F), and 18FDG-PET-CT. Accurate knowledge of oligometastatic active disease can facilitate more effective use of combination therapy, including radiosensitizers and local control measures, for example, stereotactic body radiotherapy (SBRT) and/or cryoablation to reduce disease burden as well as manage and prevent micrometastatic disease from growing and metastasizing. Finally, a new tumor-specific radiopharmaceutical, CLR 131, may also provide another radiopharmaceutical to treat both osteoblastic and non-ossifying areas of osteosarcoma.
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Acknowledgments
The author is extremely grateful for the efforts of Doretha Pendleton and Samantha Garzone for facilitating virtual visits, Taylor Buss and Shauna Sartoski for being helping hands to make things happen such as travel, appointments, and pre-authorization in kind and friendly ways, and Dr. Sankaran Shrikanthan, Andy Miller, Nick Jordan, Kanak Amin, and Rick Full for Nuclear Medicine studies and facilitating 223-radium ordering, 153-Sm-DOTMP dosimetry and administration appointments. Finally, it has been a pleasure to learn more about a new radiopharmaceutical, CLR 131, from Jarrod Longcor and Kate Oliver at Cellectar Biosciences and Mario Otto at the University of Wisconsin.
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Anderson, P.M. (2020). Radiopharmaceuticals for Treatment of Osteosarcoma. In: Kleinerman, E.S., Gorlick, R. (eds) Current Advances in Osteosarcoma . Advances in Experimental Medicine and Biology, vol 1257. Springer, Cham. https://doi.org/10.1007/978-3-030-43032-0_4
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