1. Polycythemia Vera
   1. Used in certain chronic hematologic disorder where there is significant increase in erythrocytes, myeloid, megakaryocytic, and fibroblastic cells
   2. Elevated Hct level is not a specific indication for this disease. The over production of red cells can be best determined by an exam know as Red Cell Mass. This procedure will be discussed later this semester
   3. Treat with ³²P phosphate (Important! this is a clear solution)
      1. This pure beta emitter goes to RBC production sites (bone marrow) and destroys a certain amount of cells, reducing the bodies ability to produce RBCs
         1. It is used for the treatment of: Polycythemia vera
         2. While it has been used to treat chronic myelocytic leukemia, and lymphocytic leukemia, it appears that other chemotherapy agents have replaced this agent¹
      2. A concern - destroying to many production sites
      3. Meuret G, et al.²
         1. Treated 52 patients that had Polycythemia vera
         2. 45% went into complete remission that lasted 3.5 (mean) years
         3. 55% went into partial remission with the more severe having a shorter remission time
         4. Dose given 2.4 mCi
      4. Comments on the procedure
         1. Setup an IV and allow sterile saline to drip into the vein
         2. Make sure that the IV is clearly established in order to prevent subcutaneous infiltration of the dose which will cause a radiation burn
         3. 3-5 mCi of ³²P phosphate is injected into the IV tubing (again note that it is a clear liquid)
         4. Patient is re-evaluated in 10-12 weeks
         5. If a second dose is required then no more than 6 mCi is administered during any 6 month interval
2. Intracavitary therapy
   1. Application
      1. Used to control recurrent effusions in the pleural and peritoneal cavities caused by malignant disease
      2. Stage I and II ovarian carcinoma may require this type of treatment
      3. Introduces a colloid tagged to ³²P with beta radiation the macrophages engulf the particles and become radiated
      4. Material will also become involved with the lymphatic system
3. ³²P chromic phosphate is used for this study (Important! the color of this solution is brownish-green)
1. Procedure
2. Using a sterile field the physician using a 1% lidocaine solution to anesthetize the point of entry
3. Using a 19 gauge syringe the cavity is penetrated
4. A three-way stopcock is used

5. 1-3 mCi of ^99mTc-sulfur colloid is injected and images are taken to determine if a pathway to the cavity has been established. In the abdomen, look for the "gutters"
6. Once the pathway has been established 15 mCi of ³²P chromic phosphate is injected

Package insert - ³²PO₄ and Cr³²PO₄

Reference

1. Treatment of the myeloproliferative disorders with 32P. by Berlin NL (200)
2. ³²P-therapy in polycythemia vera. by Meuret g, et al. (1975)

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Intracavitary Therapy Procedure

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