Collins C, Eary JF, Donaldson G, et al. Samarium-153-EDTMP in bone metastases of hormone refractory prostate carcinoma: a Phase I/II trial. J Nucl Med 1993; 34:1839-1844. Grade 3 (of 4) hematologic toxicity occurred in 35-40% of patients at dosages of 2.5-3.0 mCi/kg. No dosage response relationship was statistically significant.

deKlerk JMH, van Dieren EB, van het Schip AD, et al. Bone marrow absorbed dose of rhenium-186-HEDP and the relationship with decreased platelet counts. J Nucl Med 1996; 37:38-41. Myelotoxicity correlated well with mean marrow absorbed dose.

deKlerk JMH, van het Schip AD, Zonnenberg BA, et al. Dose escalation study of rhenium-186 hydroxyethylidene diphosphonate in patients with metastatic prostate cancer. Eur J Nucl Med 1994; 21:1114-1120. Well designed study using dimensions of pain response, medication index, activity scale to describe responses to Re-186 etidronate.

deKlerk JMH, van het Schip AD, Zonnenberg BA, et al. Evaluation of thrombocytopenia in patients treated with rhenium-186-HEDP. Guidelines for individual dosage recommendations. J Nucl Med 1994; 35:1423-1428. Careful examination of radiotoxicity of Re-186 etidronate which is greater with more bone involvement.

deKlerk JMH, van het Schip, Zonnenberg BA, et al. Phase I study of rhenium-186-HEDP in patients with bone metastases originating from breast cancer. J Nucl Med 1996; 37:244-249. Thrombocytopenia was the dose-limiting toxicity with maximum tolerated administered activity 65 mCi (2405 MBq).

deKlerk JMH, Zonnenberg BA, Krouwer HGJ, et al. Transient cranial neuropathy in prostatic cancer with bone metastases after rhenium-186-HEDP treatment. J Nucl Med 1996; 37:465-467. Transient cranial neuropathy is possible if metastases occur to the sites of foramina through which cranial nerves pass.

Deutsch E, Libson K, Vanderheyden JL, et al. The chemistry of rhenium and technetium as related to the use of isotopes of these elements in therapeutic and diagnostic nuclear medicine. Nucl Med Biol 1986; 13:465-477. Excellent chemical review of Re-186 and Tc-99m chemistry.

Eary JF, Durack L, Williams D, et al. Consideration for imaging Re-188 and Re-186 isotopes. Clin Nucl Med 1990; 15:1911-1916. Medium energy collimator recommended.

Englaro E, Schroder, LE, Thomas SR, et al. Safety and efficacy of repeated sequential administrations of Re-186(Sn)HEDP as palliative therapy for painful skeletal metastases. Clin Nucl Med 1992; 17:41 -44. Two patients received 5 and 7 injections of Re-186 etidronate for pain with a good clinical response. The platelet count slowly fell to 40-50% of initial levels.

Mathieu L, Chevalier P, Galy G, et al. Preparation of rhemium-186 labeled HEDP and its possible use in the treatment of osseous neoplasms. Int J Appl Rad

Isotopes 1979; 20:725-727. The earliest description of Re-186 etidronate preparation for therapy.

Maxon HR, Schroder LF, Washburn LC, et al. Rhenium-186(Sn)-HEDP for treatment of osseous metastases. J Nucl Med 1998; 39:659-663. Biodistribution and dosimetry of Re-188 etidronate is similar to that of Re-186 etidronate. A wofram-188//rhenium-188 generator may be used.

Maxon HR, Thomas SR, Herzberg VS, et al. Rhenium-186 hydroxyethylidene diphosphonate for the treatment of painful osseous metastases. Sem Nucl Med 1992; 22:33-40. Summary of Re-186 etidronate efficacy in the first site to use this therapy.

Quirijen JMSP, Han SH, Zonnenberg BA, et al. Efficacy of rhenium-186 etidronate in prostate cancer patients with metastatic bone pain. J Nucl Med 1996; 37:1511 — 1515. Sophisticated study of Re-186 etidronate efficacy in prostate cancer showed 55 responses (lower than usual) when stringent criteria are applied.

Samartunga RC, Thomas SR, Hinnefeld JD, et al. A Monte Carlo simulation model for radiation dose to metastatic skeletal tumor from rhenium-186(Sn)-HEDP. J Nucl Med 1995; 36:336-350. Uniform lesion model calculations underestimate the radiation dose to blastic lesions by a factor as high as 1.8.

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