טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentKedar Zohar
SubjectQuantitative Bone SPECT in the Evaluation of Bone Turnover
in Diseases of the Skeleton and in Monitoring
Response to Treatment
DepartmentDepartment of Medicine
Supervisor Professor Emeritus Ora Israel


Abstract

Uptake of diphosphonates in the skeleton reflects bone metabolism. The purpose of the current work is to assess bone metabolism measurement using the quantitative bone scintigraphy (QBS) as a tool for predicting bone loss and response to treatment. Present research project evaluated three study populations reflecting three different bone conditions: 1. Patients under bone preserving treatment. This study group consists of breast cancer patients recieving therapy with Tamoxifen. Study results show that QBS can be used to identify subgroups of patients in whom high bone turnover is not affected by bone preserving treatment, thus potential candidates for further bone loss. Based on the use of QBS early during such treatment, early clinical decision can be made, leading to preventing or diminishing further bone loss and discontinuation of unnecessary treatment. 2. Patients receiving pharmacological treatment with a known effect on bone destruction. This study group consists of thyroid cancer patients receiving high dose Eltroxin suppressive therapy. Study results show that QBS can be used to identify subgroups of patients with increased bone turnover as a result of such treatment and are at risk for subsequent accelerated bone loss and the development of osteoporosis. Based on present results early change in management of patients at risk may lead to the prevention of further bone loss. 3. Patient receiving systemic radionuclide therapy for metastatic bone pain. This study group consists of cancer patients with painful bone metastases who received systemic treatment with Re-186 Etidronate (HEDP). The value of quantitative SPECT for measuring radiation doses to painful metastatic sites was investigated. SPECT measured radiation doses were compared with the degree of pain relief obtained in each patient. Based on current study results, this method identifies the patients who will benefit from treatment and also identifies patients in whom such treatment is not effective. The use of QBS could increase the rate of successful pain palliation in metastatic bone disease and improve cost effective cancer management.