Case Report: Gangrene after one dose of investigational stannic pentetate radiopharmaceutical
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By
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Zin W. Myint
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Riham H. El Khouli
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Bryan P. Lemieux
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Charles A. Kunos
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May 4, 2026
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Clinical Scorecard: Case Study: Development of Gangrene Following a Single Administration of Investigational Stannic Pentetate Radiopharmaceutical
At a Glance
| Category | Detail |
|---|
| Condition | Gangrene following radiopharmaceutical treatment in an elderly male patient |
| Key Mechanisms | Radiation-related adverse events from bone-seeking radiopharmaceuticals, including potential for gangrene |
| Target Population | Elderly men with advanced mCRPC and extensive skeletal metastases |
| Care Setting | Clinical trial setting with emphasis on post-treatment monitoring |
Key Highlights
- Gangrene developed 24 days post-administration of Sn-117m-DTPA, following significant pain relief.
- Complications included leukopenia, respiratory decompensation, and sepsis, leading to patient death.
- Prompt intervention is critical due to narrow window of reversibility for gangrene, necessitating immediate surgical action.
Guideline-Based Recommendations
Diagnosis
- Monitor for skin integrity changes post-radiopharmaceutical treatment, with evaluations at 1, 2, and 4 weeks.
- Assess for signs of gangrene in patients receiving bone-seeking agents, particularly in the first month post-treatment.
Management
- Immediate surgical intervention for gangrene is necessary, ideally within 24 hours of diagnosis.
- Supportive care including broad-spectrum antibiotics and vasopressors may be required, with close monitoring of vital signs.
Monitoring & Follow-up
- Regular evaluation of blood counts for leukopenia, at least weekly for the first month.
- Close observation for signs of infection and skin integrity, with daily assessments in the initial post-treatment period.
Risks
- Potential for serious radiation-related adverse events, including late-onset complications.
- Increased risk of infection and complications in patients with compromised health, particularly the elderly.
Patient & Prescribing Data
Elderly men with advanced mCRPC and extensive skeletal metastases, particularly those with prior treatment failures.
Pain relief observed with Sn-117m-DTPA despite serious adverse events, highlighting the need for careful patient selection.
Clinical Best Practices
- Educate patients on potential late-onset adverse effects of radiopharmaceuticals, including signs of infection and skin changes.
- Implement a multidisciplinary approach for managing complications, involving oncologists, surgeons, and infectious disease specialists.
References
