You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 274 No. 5, August 2, 1995 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Review
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Strontium 89 Therapy for the Palliation of Pain Due to Osseous Metastases

Ralph G. Robinson, MD; David F. Preston, MD; Margi Schiefelbein, BHS, RT(N); Kirkman G. Baxter, MD

JAMA. 1995;274(5):420-424.


Abstract

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 intravenous89Sr. 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 of89Sr were included. Preliminary reports of cooperative studies were not included. Doses of89Sr ranged from 0.6 MBq/kg (16 µCi/ kg) to 400 MBq (10.8 mCi) per patient. Evaluation of patients for at least 3 months following89Sr treatment was required. In addition, two studies examining issues of cost with regard to89Sr 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 60x109/L, a white blood cell count below 2.4x109/L, or the absence of osteoblastic skeletal metastasis as seen on bone scan. Studies examining treatment costs suggest that89Sr 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 following89Sr 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 of89Sr 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 of89Sr palliation. (JAMA. 1995;274:420-424)



Author Affiliations

From the Department of Radiology, Division of Nuclear Medicine, University of Kansas Medical Center, Kansas City.


Footnotes

Deceased.

Reprint requests to University of Kansas Medical Center, 3910 Rainbow Blvd, Kansas City, KS 66160-7234 (Dr Preston).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

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  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1995 American Medical Association. All Rights Reserved.