Strontium 89 therapy for the palliation of pain due to osseous metastases
R. G. Robinson, D. F. Preston, M. Schiefelbein and K. G. Baxter
Department of Radiology, University of Kansas Medical Center, Kansas City 66160-7234, USA.
OBJECTIVE--To present the current state of systemic radiopharmaceutical
therapy for the palliation of pain in individuals with metastatic cancer
and to evaluate the palliative effect and degree of hemotoxicity of
strontium chloride 89 (89Sr) in patients with painful osteoblastic
metastases primarily from prostate and breast cancer. DATA SOURCES AND
STUDY SELECTION--A MEDLINE search through December 1994 was performed to
identify English-language studies that met the following criteria. All
eligible studies reported treatment of patients with painful osteoblastic
bony metastases primarily from prostate or breast cancer treated with
intravenous 89Sr. For study eligibility, evaluation of clinical response as
assessed by the Karnofsky index, need for pain medication, or changes in
mobility or sleep patterns was required. Hemotoxicity data were a
requirement. A minimum of 10 prostate cancer cases was necessary for study
inclusion. Only those studies assessing clinical response following one
injection of 89Sr were included. Preliminary reports of cooperative studies
were not included. Doses of 89Sr ranged from 0.6 MBq/kg (16 microCi/kg) to
400 MBq (10.8 mCi) per patient. Evaluation of patients for at least 3
months following 89Sr treatment was required. In addition, two studies
examining issues of cost with regard to 89Sr treatment were identified.
DATA EXTRACTION--Baseline pain assessment and periodic pain estimates as
measured by the Karnofsky index, medication diaries, changes in mobility,
sleep patterns, and/or ability to work were the basis for assessment of
response. Baseline and periodic complete blood cell counts were the basis
for hemotoxicity evaluation. DATA SYNTHESIS--Palliation and hemotoxicity
data were analyzed separately for each study. Some improvement occurred in
as many as approximately 80% of patients. Several studies demonstrated
complete relief of pain in at least 10% of patients The nadir of platelet
and white blood cell counts appears at approximately 4 to 8 weeks following
injection, with a partial return to baseline by 12 weeks. As many as 10
injections spaced 3 months apart have been given to some patients with
repeated palliative effect and without serious hemotoxicity. Reinjection
may be limited by a platelet count below 60 x 10(9)/L, a white blood cell
count below 2.4 x 10(9)/L, or the absence of osteoblastic skeletal
metastasis as seen on bone scan. Studies examining treatment costs suggest
that 89Sr may decrease costs associated with palliation of pain due to
metastatic disease. CONCLUSIONS--As many as 80% of selected patients with
painful osteoblastic bony metastases from prostate or breast cancer may
experience some pain relief following 89Sr administration. In addition, as
many as 10% or more may become pain free. Duration of clinical response may
average 3 to 6 months in some cases. Hemotoxicity is mild. A decrease in
treatment costs with administration of 89Sr to patients with painful
osteoblastic bony metastases from prostate cancer may occur. These
observations reflect the preliminary nature of knowledge in this field and
point to the need for larger clinical trials of the use of 89Sr palliation.
High-Linear Energy Transfer Irradiation Targeted to Skeletal Metastases by the {alpha}-Emitter 223Ra: Adjuvant or Alternative to Conventional Modalities?
Bruland et al.
Clin. Cancer Res. 2006;12:6250s-6257s.
ABSTRACT
| FULL TEXT
Systemic radionuclide therapy in pain palliation
Liepe et al.
AM J HOSP PALLIAT CARE 2005;22:457-464.
ABSTRACT
Symptom Management in the Elderly Cancer Patient: Fatigue, Pain, and Depression
Rao and Cohen
J Natl Cancer Inst Monogr 2004;2004:150-157.
ABSTRACT
| FULL TEXT
Clinical Approaches to Osseous Metastases in Prostate Cancer
Morris and Scher
The Oncologist 2003;8:161-173.
ABSTRACT
| FULL TEXT
Caring for the Dying Patient With Lung Cancer*
Silvestri et al.
Chest 2002;122:1028-1036.
FULL TEXT
The Placorhen Study: A Double-Blind, Placebo-Controlled, Randomized Radionuclide Study with 186Re-Etidronate in Hormone-Resistant Prostate Cancer Patients with Painful Bone Metastases
Han et al.
JNM 2002;43:1150-1156.
ABSTRACT
| FULL TEXT
American Society of Clinical Oncology Clinical Practice Guidelines: The Role of Bisphosphonates in Multiple Myeloma
Berenson et al.
JCO 2002;20:3719-3736.
ABSTRACT
| FULL TEXT
Significant Antitumor Effect from Bone-seeking, {alpha}-Particle-emitting 223Ra Demonstrated in an Experimental Skeletal Metastases Model
Henriksen et al.
Cancer Res. 2002;62:3120-3125.
ABSTRACT
| FULL TEXT
Effects of Low-Dose Cisplatin on 89Sr Therapy for Painful Bone Metastases from Prostate Cancer: A Randomized Clinical Trial
Sciuto et al.
JNM 2002;43:79-86.
ABSTRACT
| FULL TEXT
Advances in radionuclide imaging: radionuclide imaging as a guide to therapy
Clarke
Imaging 2001;13:171-184.
ABSTRACT
| FULL TEXT
Marrow-Sparing Effects of 117mSn(4+)Diethylenetriaminepentaacetic Acid for Radionuclide Therapy of Bone Cancer
Bishayee et al.
JNM 2000;41:2043-2050.
ABSTRACT
| FULL TEXT
American Society of Clinical Oncology Guideline on the Role of Bisphosphonates in Breast Cancer
Hillner et al.
JCO 2000;18:1378-1391.
ABSTRACT
| FULL TEXT
Cancer and Bone
Guise and Mundy
Endocr. Rev. 1998;19:18-54.
ABSTRACT
| FULL TEXT
Pharmacologic Treatment of Cancer Pain
Levy
NEJM 1996;335:1124-1132.
FULL TEXT
