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General information
Gallium is a metallic element (symbol Ga; atomic no. 31) that has been used in the form of a radiopharmaceutical ( 67 Ga as the citrate) in diagnostic imaging of cancers, inflammation, and infection [ ]. The mechanisms of the therapeutic activity of gallium have been reviewed [ ].
Gallium nitrate has been used as a therapeutic agent in certain malignancies [ ], since it is concentrated in various neoplasms in both animals and man and has antitumor activity [ ]; the anticancer activity of new compounds, such as gallium maltolate, doxorubicin gallium transferrin conjugate, and trisquinolinolato gallium, has been explored [ ].
Abnormal uptake of 67 Ga is reported as an adverse effect in diagnostic procedures, as in three cases:
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A 72-year-old man with acute lymphocytic leukemia who had normal 67 Ga uptake in all tissues except the liver [ ].
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A 26-year-old pregnant woman with a mediastinal lymphoma that did not accumulate 67 Ga [ ].
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A 49-year-old man with fever and increased 67 Ga uptake in the lungs but no other evidence of infection or cancer [ ].
Gallium nitrate has been used as an alternative to bisphosphonates in hypercalcemia of malignancy [ ], in which it is effective but associated with a higher frequency of renal toxicity (10%) and of nausea and vomiting (14%) than the bisphosphonates. The pathophysiology and treatment of hypercalcemia of malignancy has been reviewed and the role of gallium nitrate considered [ , ].
An early phase I evaluation and subsequent reports presented similar pictures, with predominant renal and hematological adverse effects [ , ], but as a rule gallium has been used alongside other cytostatics and it is not possible to determine which of these has produced any particular effect. Other adverse effects observed have been nausea and/or vomiting, maculopapular rash, a metallic taste, and diarrhea [ ].
Gallium alloys are still considered to be useful alternatives to amalgams in dental medicine, in spite of their tendency to corrosion, their controversial biocompatibility, and lack of knowledge about gallium’s environmental impact [ ].
Organs and systems
Sensory systems
Ototoxicity has been reported in a few patients taking gallium nitrate [ ].
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A patient developed bilateral visual loss after systemic administration of gallium nitrate [ ]. The condition worsened after oral corticosteroid therapy and partial recovery of optic nerve function in both eyes was present only after 12 months of oral ferrous sulfate administration.
Hematologic
Hematological toxicity of gallium nitrate has been noted, for example granulocytopenia and anemia [ ].
Mouth and teeth
Gallium is used in dental prostheses and is a source of increased sensitivity to postoperative dental pain [ ]. In a pilot study of a direct-placement gallium alloy (Galloy) in nine patients, 30 dental restorations were inserted and assessed over 3 years [ ]. The initial 18-month results were encouraging, but at 21 months there was one fractured tooth and within another year two molars had the cracked-tooth syndrome (incomplete tooth fracture). The fractured teeth were restored with amalgam. Tarnish and a rough surface were noted on many of the gallium restorations. These results suggest that Galloy, used with either of two sealing resins, is not a suitable dental restorative material.
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