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Samarium-153

What is Samarium-153 Used For?

palliative therapy

Primarily, Samarium-153 is combined with ethylenediaminetetra-methylenephosphate (EDTMP) to form a radiopharmaceutical known as Lexidronam. This radiopharmaceutical is administered intravenously to relieve bone pain associated with metastasized prostate, breast, and lung cancers. When combined with EDTMP, Samarium-153 has a high affinity for bone tissue and thus travels to areas of high bone turnover; a common occurance at the site of an osseous metastasis. Samarium-153 then releases therapeutic radiation as it undergoes beta minus decay; however, the exact mechanism by which the radiation from Samarium-153 relieves cancer-related bone pain is unknown.

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(Above) Radiopharmaceutical label for Quadramet. (Below and left) Strontium-89 scan showing patient with osseous metastases that is being treated with Samarium-153.

 

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Lexidronam is a sterile, non-pyrogenic, clear, colorless to light amber isotonic solution with a pH of seven to eight and a half; that should be stored frozen in a lead lined container. The radiopharmaceutical should be used within eight hours of thawing. Prior to injection, the patient should ingest a minimum of one liter of fluids to minimize radiation exposure to the bladder. Following injection via intravenous catheter, a saline flush is performed to ensure the entire dose has been administered. A typical appointment for samarium-153 therapy lasts around two to three hours to ensure the patient experiences no adverse affects and to allow the level of activity to decrease to permissible levels. Due to its forty-six hour half-life, patients generally experience pain relief for up to four months. In addition, some patients have a transient reduction in tumor marker levels. This indicates a decrease in the likelihood of recurrence and increase in the chance for recovery.

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(Below) Strontium-89 scan showing patient with osseous metastases that is being treated with Samarium-153.

 

Side effects may include

  • thrombocytopenia (low blood platelet count)

  • leukopenia (low white blood cell count)

  • decreased hemoglobin

  • marrow toxicity

  • temporary pain flare

  • nausea or vomiting

  • abdominal pain

  • hematuria

  • fever or chills

  • myasthenia

  • paresthesia

  • rash

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(Above, clockwise) Medical emesis bag, Typical setup for radiopharmaceutical injection, Man with a fever.

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