Poole Hospital NHS Foundation Trust

Quadramet - Palliative Treatment for Bone Pain

What is Quadramet?

Quadramet is a treatment for patients with pain from cancer that has spread to their bones. Quadramet is a radiopharmaceutical, which means it is a drug that contains a radioisotope (in this case Samarium-153). Radioisotopes give off energy in the form of radiation. This information tells you what Quadramet is and how it is given. It describes what benefits you can expect after treatment with Quadramet. It also lists some possible side effects and what you need to do before and after treatment. Words in bold text are explained in the glossary at the end.

If you have other questions about your disease or treatment, speak to your GP, oncologist, nurse or medical physicist.

What is Quadramet used for?

Many people who have cancer have pain at some time. The pain is due to a number of causes. For example:

For some patients with cancer, bone pain can be a problem because cancer cells break away and travel (or metastasise) from the original site of the cancer to bone, where they can form new areas of cancer called metastases.

Prostate, breast, lung and other cancers often travel to bone, causing pain that can be very difficult to relieve.

What other treatments are available?

You may receive more than one type of treatment for your bone pain. Radiotherapy and different drug combinations are commonly used. Radiotherapy is particularly useful when the bone pain is concentrated in one area. Drugs for pain relief range from those like paracetamol for mild pain, to opiate drugs like morphine for severe pain. Other drugs used to relieve this kind of bone pain include steroids, chemotherapy, and biphosphonates. Ask your oncologist if you need more information about these treatments. In some cases, surgery may also be necessary.

How does Quadramet work?

As bone cancer grows it damages the bone. New bone cells grow faster than normal to try to repair the damage. Quadramet finds areas of increased bone growth and gives off radiation that reduces pain in more than half of patients. The more bone metastases you have, the more Quadramet will be taken up. The rest is removed from your body in your urine.

Because Quadramet is injected into your blood it can travel to bone cancers in different parts of your body.

How will I be given Quadramet?

Quadramet treatment is given as one injection into a vein, usually in your arm. The injection takes about one minute. The amount of Quadramet you receive depends on your weight. Your medical physicist will work out the correct dose for you.

What can I expect from Quadramet?

You may notice some pain relief within a week of your Quadramet injection and continue to notice improvement for up to four weeks. In patients who respond to Quadramet, pain relief lasts on average for four months.

If you have less pain because of Quadramet, you may be able to reduce the amount of other painkillers (like morphine) you take. This should mean you suffer fewer side effects from drugs like morphine such as constipation and drowsiness.

Is Quadramet a cure for bone cancer?

Quadramet is not a cure for bone cancer. It is used to control the pain you have. Controlling pain can help you stay involved in your cancer treatment and your daily activities.

Should I be given Quadramet?

Not all treatments are suitable for all patients. Your oncologist will have considered the type of cancer you have, the treatments you have had before any other options for treating you, and whether your body could cope with the side effects of Quadramet.

If you are pregnant you should not be given Quadramet. Ask your oncologist about other treatments for your pain. If you could become pregnant, you must use effective contraception (like the Pill) until your Quadramet treatment and follow-up is complete. Tell your oncologist if you are pregnant, trying to become pregnant or breast-feeding.

You should not be given Quadramet if you have had chemotherapy or radiotherapy in the last six weeks because you may not have recovered from that treatment yet.

Tell your oncologist if you have had an allergic reaction to a bone scan drug or any other drug for your bones, because you may also react to Quadramet.
If you have problems with kidney function your oncologist may need to reduce your Quadramet dose.

Tell your oncologist about any other medicine you are taking or have been given, even if it is one you have bought yourself. Other medicines may affect the way Quadramet works.

What are the risks?

After receiving Quadramet you may not get any pain relief. However, over half of patients treated get some sort of pain control. Soon after you are given Quadramet, you may have more pain than usual for a short while. This is called a 'flare' in bone pain and usually happens within three days of the Quadramet injection. Drugs like paracetamol usually relieve this pain. Ask your GP for advice or stronger painkillers if necessary.

Healthy bone and other normal tissues take up much less Quadramet than the tumours causing you pain, but some of your healthy cells may also be damaged by the radiation. White blood cells and platelets are types of cells in your blood that can be affected. You will have blood tests, probably every week from two to eight weeks after your Quadramet injection, to check your white blood cell and platelet numbers are increasing. Please make an appointment with your GP for a blood test one week after your treatment.

The number of white blood cells and platelets you have may decrease for about eight weeks but this may not make you feel any different. It may however limit the choice of treatments that your oncologist can give you until your blood cell numbers are the same as they were before Quadramet.

Are there any side effects?

You may have side effects from your treatment. These may include

Quadramet does not cause hair loss.

It is not known whether these symptoms are related to the Quadramet treatment or are general symptoms from your disease. A few patients may have more serious side effects like strokes, blood clotting disorders or compression (squeezing) of their spinal cord. It is important to tell your doctor or nurse if you think you have side effects, including back pain or unusual feelings like numbness or pins and needles.

Isn’t radiation dangerous?

Quadramet' gives off both beta and gamma radiation. The risk from this radiation is very small. Your doctor will have made sure that this is the right treatment for you and the risks are less than the benefits.

Quadramet can only be given by people specially trained in the safe use of radiopharmaceuticals. The dose you receive will be checked before it is given to you so you receive the right amount for your body.

Do I need to do anything before having Quadramet?

The hospital will need to know your weight so they can calculate how much Quadramet to give you. They will also need to know if you have problems controlling your bladder. Tell Nuclear Medicine Department if you wear pads or have a catheter (a tube that drains your urine into a bag) so they can give you the right advice.

You should drink at least two glasses of water or other fluid just before you receive Quadramet. This will fill your bladder and help protect it from radiation.
If you normally take other medicines, like painkillers, please take these to the hospital on the day of your treatment.

Make sure you follow any advice your oncologist, nurse or medical physicist gives you.

Can I take someone with me on the day of my treatment?

Yes, but please don't take anyone who is pregnant or any children under 18 years old.

Do I need to do anything after Quadramet treatment?

You may have to stay in hospital for a few hours after your Quadramet injection. Your doctor or-nurse will tell you about this.

For about 12 hours after your injection Quadramet will pass out of your body into your urine. This means your urine will give off small amounts of radiation, although it should not look or feel any different when you urinate. Because of the radiation you should go straight home after you leave hospital, so you do not urinate in toilets used by the public. Once home, drink plenty of fluids and urinate as often as possible. If you are a man, sit down on the toilet rather than using a urinal. Flush the toilet twice when you are finished, clean up any spilled urine straight away and wash your hands well.

If you cannot control when you urinate, you will need to have a catheter fitted to drain your urine away safely for at least six hours. If any urine, blood or vomit gets on your clothing, don't touch it. Wash the clothes separately, or store them for a couple of weeks before washing them.

For at least four weeks after treatment you should tell any nurse, doctor, dentist, or pharmacist that you visit that you have been given Quadramet. You will have blood tests, probably every week, to check your blood cell numbers are increasing.

Feel free to eat and drink what you normally do unless your doctor tells you otherwise.

Will the radiation I receive be dangerous for people around me?

Because Quadramet treatment involves radiation you will be given special advice before leaving the hospital. The advice will depend on how much Quadramet you are given. As a general rule, you should stay at least one metre (about three feet) away from children or pregnant women for 24 hours after your injection, so you should not cuddle them.

For about five days after your Quadramet injection you should not share a bed with a child or pregnant woman but can cuddle them for about 15 minutes per day.

These simple steps protect people around you from the radiation in your body.

Will I be able to drive?

Your ability to drive a car or operate machinery should not be affected by Quadramet. Of course, you should not drive if you feel dizzy, unwell or tired.

Will I have more Quadramet injections?

Quadramet is not meant to be given regularly over a long time. However, the injection can be repeated after eight weeks depending on how well you are.

Further Information

Cancerhelp UK

cancerBACUP
3 Bath Place
Rivington Street
London EC2A 3JR
Tel: (020) 7 613 2121

Society on Nuclear Medicine

European Association of Nuclear Medicine

References

Most of this information has been provided by CIS bio international.
Adapted for this information by the Head of Nuclear Medicine Mr L Jansson
Date Produced: February 2007
Review Date: February 2008

Glossary

Analgesic
A drug that relieves pain.---Mild analgesics include aspirin and paracetamol Strong analgesics include morphine and pethidine.

Becquerel (Bq)
A unit used to measure radioactivity.

Benign
A tumour that is not cancer. These tumours tend to grow slowly in one place. If they are removed they tend not to come back. This is the opposite to malignant.

Catheter
A hollow tube inserted to drain fluids from the body. Catheters are often used to collect urine in a bag, so that patients do not have to go to the toilet each time they need to urinate.

Chemotherapy
The treatment of disease with chemicals. Chemotherapy is often used to treat cancer.

Diagnosis
Identification of a disease or condition.

External Beam Radiation
Treatment involving a beam of X-rays pointed at a tumour. This is a very common cancer treatment.

Hormonal Therapy
Hormones are natural chemicals in our blood that help control growth, reproduction and other functions. Some types of cancer depend on hormones to grow (eg cancer of the prostate, breast, thyroid and womb). Drugs made from hormones can also be used to control the growth of these cancers.

Malignant
Malignant tumours are cancer. If they are not treated they will get worse and may spread to other parts of the body.

Metastases
The new tumours that are formed when a cancer spreads from one part of the body to another.

Metastasise
The spread of cancer from one part of the body to another.

Morphine
A strong drug used to relieve severe pain.

Myelosuppression
Many cancer treatments suppress the activity of bone marrow (the inside of bones). This can lead to lower numbers of red cells, white cells and platelets in the blood.

Opiates
The group of drugs like opium. This group includes morphine.

Palliation
The treatment, but not cure, of a disease.

Platelets
Platelets are present in blood. Their sticky surface lets them, along with other substances, form clots to stop bleeding.

Radioisotope
An element that emits radiation, eg. Samarium-153.

Radiopharmaceutical
Any product used in medicine that contains one or more radioisotopes.

Radiotherapy
Treatment of disease by radiation (eg X-rays or radioisotopes).

White blood cells (WBC)
Cells in the blood which help fight infection.

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