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Radioactive synovectomy with 90 yttrium and 153 samarium hydroxyapatite in haemophilic joints: preliminary study on radiation safety
Author(s) -
Thomas S.,
Mendes J. D.,
Souza S. A.,
Lorenzato C. S.,
Assi P. E.,
Pacheco L. R. L.,
Gabriel M. B.,
Bordim A.,
Gutfilen B.,
da Fonseca L. M. B.
Publication year - 2013
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.12122
Subject(s) - medicine , synovitis , malignancy , surgery , cancer , synovectomy , radiation therapy , arthroscopy , nuclear medicine , arthritis , rheumatoid arthritis
Summary Most countries still do not achieve 1 IU of factor VIII /capita sufficient for survival. Although primary prophylaxis prevents synovitis, is not universally used. Chronic synovitis is treated with arthroscopy at expense of considerable amount of coagulation factors, and specialized surgeons. Radioactive synovectomy ( RS ) is a minimally invasive and cost effective alternative to arthroscopy, often considered first the option for persistent synovitis. Even without established causation with cancer, RS is avoided by some, due to this concern. We aim contributing to the understanding of RS safety regarding malignancy, presenting a large number of treated patients, and a single case of cancer. Three centres in B razil applied RS with 90 Y ttrium C itrate, 90 Y ttrium hydroxyapatite or 153 S amarium hydroxyapatite in haemophilic joints and performed a survey addressing cancer in these patients. Four hundred and eighty eight patients (ages 3–51) received 1–3 RS (total 842) and follow‐up was 6 months to 9 years. One patient aged 14 years presented E wing sarcoma, 11 months after RS . The tumour was treated successfully with surgery and chemotherapy. Causality of cancer by RS is improbable in this case. Accordingly, latency here is far below minimum 5–10 years for radio‐induction of solid tumours. Moreover, ES is not a typically radio‐induced tumour, even at high doses. In agreement with others, though recognizing limitations, this study suggests RS is safe regarding cancer induction. Synovitis is a known burden for patients. The decision of making reasonable usage of RS should be outweighed with the risks of leaving synovitis untreated.