[en] Background: With a population of 22 million people Romania is one of the largest countries in Eastern Europe. Nuclear medicine was introduced as diagnostic and therapeutic technique in Romania in the late 1950s and has evolved as independent specialty in 1992. Introduction of PET-CT in Romania was a difficult process, mainly because of the cost of equipment, lack of medical cyclotrons at the beginning and reimbursement issues. Methodology: In this paper we have reviewed the main steps that were made in Romania with implementing PET-CT in the medical system and in the management of oncologic patients. Data were collected from websites of each PET-CT centre, from the Romanian Society of Nuclear Medicine and from the National Insurance Company website. Results: First PET-CT scanners were installed in the private sector in 2008, in Bucharest and Oradea. The number of procedures and requests increased continuously. The installation of a cyclotron and a unit of 18F-FDG production in a private facility were followed by an increase in PET-CT projects both in private but also in public hospitals. At present there are 5 PET/CT scanners installed in the private sector (2 in Bucharest, 1 in Oradea, 1 in Cluj-Napoca and 1 in Constanta) and 2 in public hospitals (one in Bucharest and one in Craiova). On the other side, this year there are at least 3 more projects where PET-CT scanners are expected to be installed. First cyclotron in public system was installed in Horia Hulubei IFIN Institute in Magurele, near Bucharest, which has developed many projects with the IAEA. At this facility production is expected to start soon, the main advantage being the possibility of obtaining more radiopharmaceutical compounds beyond 18F-FDG. In May 2010 National Insurance Company approved reimbursement of PET-CT procedures for many oncologic indications. Since 2010 there was an increase in number of indications for reimbursement. There was also a continuous increase in the budget and number of investigations approved for reimbursement on an annual basis. At present only oncologic indications are included on the list of procedures. None of the centres is performing other studies such as cardiology or neurology. However there are several projects which include installation of PET-CT scanners in some university-related hospitals where new procedures including cardiology, neurology and inflammation will be introduced. Conclusions: Increased use and widening of PET-CT applications in Romania will require a larger number of nuclear medicine specialists to increase their skills by accessing dedicated courses/trainings. Efforts should be made in this respect, to ensure high quality investigations and improve diagnostic management. (author)

[en] Full text: Bone metastases are the most common cause of pain in patients with cancer, and postmortem studies have been shown that up to 85% of patients with breast or prostate cancer have bone metastases at the time of death. The palliation of bone pain is one of the goals of treatments in oncologic patients, due to the fact that patients with bone metastases may survive many years with severe pain and serious impaired mobility. Bone pain palliation can be attempt by using different modalities - analgesics (nonsteroid, opioides), biphosphonates, external beam radiotherapy or radionuclide therapy. The aim of our study was to review the database and to analyze the results of the treatments performed in our department, in the field of radionuclide metastatic bone pain palliation with ⁸⁹Sr. Eleven patients (47-73 years old) were treated with ⁸⁹Sr in the past two years in our department. All patients had confirmed prostate adenocarcinoma and refractory bone pain due to skeletal metastasis involving more than one site, associated with osteoblastic response on bone scan. All patients had a good hematological and renal status (Hb> 9 mg/dl, leukocytes > 4000/ μl, platelets > 150.000/ μl, GFR > 30 ml/min), an increased alkaline phosphatase and recent bisphosphonate therapy interrupted within 48h before treatment. The standard administered dose was 150 MBq [4 mCi] of ⁸⁹Sr (Metastron - Amersham). In 8 cases single dose was given, while in 3 patients a second dose was administered at 4, 6 and 9 months after the first injection. Clinical and biological evaluation was repeated at 3 weeks and 3-6 months after treatment. The most important criteria of pain relief was objective pain score. Significant improvement of life quality was seen in 4 patients with major reduction of analgesic needs. In 3 patients in addition to external beam radiotherapy we obtained a stable effect of more than 6 months. 3 patients had moderate response, one of them with an early need of a second dose at four months. No response was seen in one patient. Pain flare occurred in two cases. Temporary myelosuppression was seen in 5 cases (45,46%) with recovery in 2-11 weeks Respecting the criteria of evaluating patients who might be candidates for treatment using ⁸⁹Sr, the significant clinical improvement of life quality can be obtained with an easy procedure, minor side effects and a good compliance of patient. In a country with limited resources for an extensive medical research it is important to introduce new strategies of treatment that have proved their efficacy, to try to promote the cost effective use of high quality therapeutic procedures and the recommended guidelines. (author)

[en] Full text: Bone metastases are the most common cause of pain in patients with cancer, and postmortem studies have been shown that up to 85% of patients with breast or prostate cancer have bone metastases at the time of death. The palliation of bone pain is one of the goals of treatments in oncologic patients, due to the fact that patients with bone metastases may survive many years with severe pain and serious impaired mobility. Bone pain palliation can be attempt by using different modalities analgesics (nonsteroid, opioides), biphosphonates, external beam radiotherapy or radionuclide therapy. The aim of our study was to review the database and to analyze the results of the treatments performed in our department, in the field of radionuclide metastatic bone pain palliation with 89Sr 12 patients (47-73 years old) were treated with 89Sr in the past two years in our department. All patients had confirmed prostate adenocarcinoma and refractory bone pain due to skeletal metastasis involving more than one site, associated with osteoblastic response on bone scan. All patients had a good hematological and renal status (Hb> 9 mg/dl, leukocytes > 4000/il, platelets > 150.000/ il, GFR > 30 ml/min), an increased alkaline phosphatase and recent bisphosphonate therapy interrupted within 48h before treatment. The standard administered dose was 150 MBq [4 mCi] of 89Sr (Metastron Amersham). In 8 cases single dose was given, while in 4 patients a second dose was administered at 4, 6 and 9 months after the first injection. Clinical and biological evaluation was repeated at 3 weeks and 3-6 months after treatment. Hematological assessment was performed monthly at all patients. The most important criterion of pain relief was objective pain score. Significant improvement of life quality was seen in 4 patients with major reduction of analgesic needs. In 4 patients in addition to external beam radiotherapy we obtained a stable effect of more than 6 months. 3 patients had moderate response, one of them with an early need of a second dose at four months. No response was seen in one patient. Pain flare occurred in 7 cases (58.3%). The most serious side effect noticed at these patients was myelosuppression, which occurred in 9 patients (75%), 2 of them receiving transfusion. Respecting the criteria of evaluating patients who might be candidates for treatment using 89Sr, the significant clinical improvement of life quality can be obtained with an easy procedure, controllable side effects and a good compliance of patient. In a country with limited resources for an extensive medical research it is important to introduce new strategies of treatment that have proved their efficacy, to try to promote the cost effective use of high quality therapeutic procedures and the recommended guidelines. (author)