strontium-radioisotopes and Breast-Neoplasms

The administration of a radionuclide in unsealed source whose radiation will destroy cells that have selectively accumulated product is called radiometabolic therapy. The management of bone pain is a major problem, particularly in cases of breast or prostate where the presence of metastases can remain compatible with long-term survival of cancer patients. In this context, the radiometabolic therapy reduces the pain secondary to bone metastases, in association or not with analgesics. This technique is rarely prescribed as first-line. It can also be combined with external beam radiotherapy or chemotherapy, if clinical conditions permit (due to the increased risk of hematologic toxicity). In this setting, the currently used substances are Metastron® and Quadramet®. Recently, a new product, radium chloride (or Alpharadin®) has shown efficacy in bone metastases from prostate cancer, particularly in terms of bone pain palliation, but also of increased overall survival. In addition, this product has virtually no hematologic toxicity.

Topics: Analgesics; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Prostatic Neoplasms; Radiopharmaceuticals; Radium; Strontium; Strontium Radioisotopes

The aim of this article was to review the available literature regarding to the use of strontium-89 in the palliation of osteoblastic bone pain. The data of many researchers showed that approximately 80% of patients with pain from osteoblastic lesions resulting from prostate or breast cancer experience significant pain relief by administration of strontium-89, with only mild levels of hematotoxicity. The duration of pain relief in some cases exceeded 3-6 months. Indications for administration of strontium-89, effectiveness and duration of the treatment, side effects are reviewed in this article.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Contraindications; Female; Humans; Karnofsky Performance Status; Male; Osteoblasts; Pain, Intractable; Palliative Care; Pregnancy; Prostatic Neoplasms; Radiotherapy Dosage; Strontium Radioisotopes; Time Factors; Treatment Outcome

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.. 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.. 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.. 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.. 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.

Topics: Bone Neoplasms; Breast Neoplasms; Cost-Benefit Analysis; Drugs, Investigational; Etidronic Acid; Female; Hematologic Tests; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Pain Measurement; Palliative Care; Patient Selection; Prostatic Neoplasms; Radioisotopes; Radiotherapy Dosage; Strontium; Strontium Radioisotopes

Strontium-89 chloride is a radiopharmaceutical that localizes to actively forming new bone, such as metastatic bone lesions from prostate and breast cancer. It provides effective systemic endo-osseous local radiation therapy to these painful lesions. Strontium-89 will soon be available to physicians in the United States for use in the palliative management of metastatic bone pain.

Topics: Bone Neoplasms; Breast Neoplasms; Clinical Trials, Phase III as Topic; Female; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

Bone metastases are a major problem in the clinical management of patients with breast or prostate cancer. Severe bone pain can be a particularly debilitating effect of metastatic disease, resulting in a growing dependency on opioid analgesics and a reduced quality of life in patients who have a short time to survive. The radiopharmaceutical strontium-89 has been demonstrated to be generally well tolerated as well as effective in reducing metastatic bone pain in breast or prostate cancer patients. Unlike other radioisotopes or external radiation treatments, it represents systemic, targeted therapy that is simple and fast to administer in an outpatient setting. Data accumulated over the last 15 years demonstrates that 89Sr provides pain relief in up to 80% of patients with bony metastases arising from breast or prostatic malignancies. Pain palliation is maintained for several months, along with improvements in functional status and quality of life. As many as one fifth of 89Sr-treated patients become pain free and require no further pain medication. The adverse effects of intravenous 89Sr are minimal. Bone marrow toxicity is observed in many patients, resulting in some reduction of platelet and white blood cell counts. Despite reductions of 20% to 30%, these hematologic effects are generally reversible and the majority of patients maintain platelet counts that are within normal limits. Strontium-89 is effective systemic radioisotopic therapy for the palliation of painful bony metastases from breast and prostate carcinoma.

Topics: Bone Neoplasms; Breast Neoplasms; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes

Bone scanning is a sensitive test for the detection of metastatic breast cancer, but not all abnormal findings on bone scan are diagnostic of skeletal metastasis. Recent studies have found a relatively low rate (less than or equal to 5%) of abnormal scans in patients with Stage I and II breast cancers, and only half of those with positive scans subsequently had documented bony metastasis. The overwhelming clinical experiences summarized here question the value of including bone scanning as part of the routine work-up of patients with early breast cancers.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphates; False Negative Reactions; False Positive Reactions; Female; Fluorine; Humans; Neoplasm Staging; Prognosis; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate

The observation by Subramanian and his co-workers that a 99mTc-labeled polyphosphate had excellent affinity for bone has led to widespread use of 99mTc-labeled phosphates as bone scanning agents. Initially, only polyphosphate was employed, but because of somewhat inconstant results and difficulty in preparation of this product, other phosphate compounds were sought. We soon discovered that an inorganic compound, pyrophosphate, appeared to have certain advantages over polyphosphate. Other workers formulated diphosphonates (organic phosphates) which also demonstrated advantages over polyphosphates. Comparison studies in rabbits utilizing 85Sr, 87mSr, 18F, and several phosphates (inorganic and organic) proved the 99mTc-labeled phosphates to be clearly superior in delineating normal skeletal anatomy. Studies in humans confirmed that excellent visualization of bone was obtained with 99mTc-labeled phosphates using either a gamma camera or a rectilinear scanner. What was not known, however, was just how reliable this class of agents would prove to be in detecting bone disease when compared to bone-seeking radiopharmaceuticals such as 85Sr, 87mSr, and 18F. Further comparative analyses have clearly demonstrated that both inorganic and organic 99mTc phosphate complexes are extremely sensitive in revealing more bone disease than the older bone scanning agents.

Topics: Adult; Aged; Animals; Bone Neoplasms; Breast Neoplasms; Carcinoma, Squamous Cell; Colonic Neoplasms; Diphosphates; Female; Fluorine; Hodgkin Disease; Humans; Kidney Neoplasms; Lung Neoplasms; Male; Middle Aged; Nasopharyngeal Neoplasms; Neoplasm Metastasis; Phosphates; Prostatic Neoplasms; Rabbits; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium

To evaluate the efficacy of radionuclide palliative therapy (RPT) in women suffering from painful metastatic bone disease (MBD) due to breast cancer (BrCa), and to investigate the possible relationship between the RPT efficacy and cytokines levels.. Sixty-three BrCa women patients with MBD enrolled in a prospective, nonrandomized study. Thirty were treated with Rhenium-186-hydroxyethylidenediphosphonic acid ((186)Re-HEDP), 21 with Strontium-89-Chloride ((89)Sr-Cl2), and 12 with Samarium-153-thylenediaminetetramethylenephosphonic acid ((153)Sm-EDTMP). Blood samples were collected pre- and post-therapy to assess the interleukin (IL)-2, IL-6 and tumor necrosis factor (TNF)-a titers. The palliative effect of the treatment was evaluated using a modified Wisconsin test.. All three radiopharmaceuticals were equally effective in pain relief. Pain palliation was complete in 52% of patients, partial in 31%, and absent in 16%. Responders to therapy had higher IL-2 and lower IL-6/TNF-a concentrations, compared with nonresponders, even though statistically significant difference in cytokines levels between responders and nonresponders before treatment was noted only for IL-6.. All used radiopharmaceuticals had the same therapeutic effect. Pretherapy low titers of IL-6 levels seems to have a favorable prognostic value for the therapeutic outcome, while IL-2 and TNF-a alterations pre- and post-therapy can only serve as markers of a better RPT response.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Cytokines; Female; Humans; Interleukin-6; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain, Intractable; Palliative Care; Prognosis; Prospective Studies; Radiopharmaceuticals; Rhenium; Strontium Radioisotopes

In this study, we investigated the clinical and laboratory factors that may enhance (89)Sr uptake to strengthen its tumoricidal effect.. We enrolled 21 patients with multiple bone metastases (n = 23) from breast cancer and classified them into 2 groups according to their zoledronic acid (ZOL) treatment history. (89)Sr imaging with bremsstrahlung was performed 2 to 6 weeks after administration and (89)Sr index was measured using combined imaging with bone scintigraphy. We compared the Sr index with the levels of alkaline phosphatase, bone-specific alkaline phosphatase, serum cross-linked N-telopeptides, carboxy-terminal telopeptide of type 1 collagen, C-reactive protein, calcium, and hemoglobin on administration and evaluated the differences among the groups.. The (89)Sr index ranged from 0.01 to 2.0 and was significantly correlated with C-reactive protein and alkaline phosphatase and moderately correlated with carboxy-terminal telopeptide of type 1 collagen, serum cross-linked N-telopeptides, and bone-specific alkaline phosphatase. The (89)Sr index was not significantly correlated with calcium or hemoglobin. The group with less than 1 year of ZOL treatment demonstrated a mean (SD) (89)Sr index of 1.11 (0.59), and the group with 1 or more years of ZOL treatment showed a mean (89)Sr index of 0.36 (0.26). The Wilcoxon signed-rank test demonstrated a significant difference between the 2 groups (P < 0.001).. (89)Sr accumulation seemed to be associated with bone turnover, in particular bone resorption, and vascularization due to inflammation or tumor growth. Long-term ZOL treatment may reduce bone resorption and vascularization. To enhance the tumoricidal effect and palliation of bone pain by (89)Sr, combined therapy must be established.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Electromagnetic Radiation; Female; Humans; Imidazoles; Middle Aged; Pain Management; Radionuclide Imaging; Strontium Radioisotopes; Zoledronic Acid

Painful bone metastases are most frequent in patients with advanced prostate or breast carcinoma. The aim of this study was to compare the analgesic effect of radionuclide therapy using Sr and Sm-EDTMP in patients with painful bone metastases of these tumours.. One hundred patients treated with radionuclide bone palliation therapy were analysed. The study population consisted of 60 male patients with advanced prostate carcinoma and 40 female patients with advanced breast carcinoma. Fifty patients (30 men and 20 women) were treated with Sr (150 MBq). The other 50 patients were treated with Sm-EDTMP (37 MBq x kg). The treatment efficacy was evaluated by a visual analogue scale (VAS), Karnofsky performance scale, and dosage of analgesic drugs used.. Complete pain relief was found in 40% of women and 40% of men treated using Sm-EDTMP and in 25% of women and 33% of men treated with Sr. No analgesic effect occurred in 20% of patients. A better analgesic effect was found in cases of osteoblastic metastases compared to mixed metastases. Statistically significant reduction of pain intensity, use of analgesic drugs and improvement of performance in Karnofsky scale was found in cases of both radionuclides.. The analgesic effects of Sr and Sm-EDTMP was similar in both prostate and breast carcinoma. However, the effect was dependent on the type of metastases; better response was observed in cases of osteoblastic metastases than in patients with mixed metastases. Severe adverse reactions after this therapy were rare.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma; Female; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Strontium Radioisotopes; Treatment Outcome

To compare the clinical curative effects between 89Sr and its combination with the Guliu recipe (GLR, a Chinese herbal medicine) in treating multiple bone metastatic tumor of mammary cancer (MBM-MC).. By adopting the random sampling and grouping method, 89Sr alone (Sr) and 89Sr combined with CHM (Sr-GLR) were used in treating 86 and 40 patients with MBM-MC respectively. The efficacy of therapy were appraised according to the degree of ostalgia relieving and quality of life (QOF) in patients, and the effect of treatment on focal bone metabolism and bone marrow hematopoietic function were compared.. The effective rate of Sr and Sr-GLR in relieving ostalgia was 83.72% and 95.00%, respectively (P > 0.05), the QOF improving and stabilizing rate of them 80.23% and 95.00% (P < 0.05), the effective rate on focal bone metabolism 59.30% and 52.50% (P > 0.05) and their hemo-toxicity 28.00% and 30.00% (P > 0.05).. Sr-GLR is a combination therapy in treating MBM-MC with good effect, it could raise the patient's QOF, enhance the ostalgia relieving effect without increasing the hemo-toxicity of treatment.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Combined Modality Therapy; Drugs, Chinese Herbal; Female; Humans; Middle Aged; Phytotherapy; Quality of Life; Strontium Radioisotopes

The study evaluates the therapeutic efficacy of Strontium-89-chloride (89Sr) and 186Re-1,1-hydroxyethylidene diphosphonate (186Re-HEDP) in the palliation of painful bone metastases from breast cancer.. Fifty patients with painful multifocal bone metastases from breast cancer entered the study and were randomized into two groups according to the radiopharmaceutical used: 148 MBq 89Sr i.v. (Group A: 25 patients) and 1406 MBq 186Re-HEDP i.v. (Group B: 25 patients). Pain palliation was evaluated on the basis of the Wisconsin pain test improvement at two months and response was graded as complete, partial, minimal or absent. Hematological toxicity and side effects were reported according to WHO guidelines.. The global response rate was 84% (21/25) for 89Sr and 92% (23/25) for 186Re-HEDP, respectively. The onset of pain palliation appeared significantly earlier in Group B (p < 0.0001). The duration of pain relief ranged from two months to 14 months (mean of 125 days with a median value of 120 days) in Group A and from one month to 12 months (mean of 107 days with a median value of 60 days) in Group B (p = 0.39). A moderate hematological toxicity was apparent in both groups. Platelet and white blood cell counts returned to baseline levels within 12 weeks after 89Sr administration and 6 weeks after 186Re-HEDP administration (p < 0.01).. Both 89Sr and 186Re-HEDP are effective and safe in bone pain palliation in breast cancer with the latter showing a significantly faster onset of pain relief.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Disease-Free Survival; Etidronic Acid; Female; Humans; Infusions, Intravenous; Karnofsky Performance Status; Middle Aged; Organometallic Compounds; Pain Measurement; Pain, Intractable; Palliative Care; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Strontium Radioisotopes; Treatment Outcome

Most studies of prostate cancer have shown that strontium-89 chloride (89Sr) is effective in the palliation of metastatic bone pain, refractory to conventional analgesia. The aim of this study was to evaluate the usefulness of 89Sr for bone pain palliation in breast cancer patients. Forty women were treated with 148 MBq of 89Sr. Six patients were retreated, receiving two or more doses. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. The response was good in 60% of the patients and partial in 32%; there was no response in the remaining 8% (pre-treatment Karnofsky < or = 60). The duration of the response was 120+/-143 days. In the patients retreated, the response was good in 83% and partial in 17%, without significant differences compared with the first dose, but the pre-treatment Karnofsky and the duration of the efficacy were lower (P < 0.05). A transient and slight decrease of leukocyte and platelet counts after the first month of treatment with 59Sr was observed. In conclusion, breast cancer patients with metastatic bone pain can benefit from therapy with 89Sr. If necessary, the treatment may be repeated safely and with the same efficacy as is achieved after the first dose. A low functional performance status could be a cause of the lower effectiveness of 89Sr.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Leukocyte Count; Middle Aged; Pain Measurement; Pain, Intractable; Strontium Radioisotopes

Several radiopharmaceuticals were compared previously with regard to the efficiency in pain palliation of bone metastases. Furthermore, first results were reported on the suitability for such kind of therapy of the generator produced radionuclide rhenium-188.. Influence of Rhenium-188-HEDP (Re-188), Rhenium-186-HEDP (Re-186) and Strontium-89 (Sr-89) on pain symptoms and bone marrow function were obtained in 44 patients (pts). These were 16 pts. with Re-188 (2943 +/- 609 MBq), 13 pts. with Re-186 (1341 +/- 161 MBq) and 15 pts. with Sr-89 (152 +/- 18 MBq) (6 woman with breast cancer and 38 men with prostata cancer).. 81 of pts. after Re-188, 77% after Re-186 and 80% after Sr-89 reported relief of pain. The Karnofsky-Index established by pts. increased from 74 +/- 9% to 85 +/- 11% after Re-188, from 70 +/- 11% to 76 +/- 11% after Re-186 and from 62 +/- 10% to 69 +/- 10% after Sr-89. However, the difference between the pre- and the post-therapeutic value is only statistically significant in the case of Re-188 therapy (p = 0.001). A decrease of platelets of 30 +/- 14% after 2.8 +/- 0.7 for pts. treated with Re-188, of 39 +/- 20% after 3.7 +/- 1.0 weeks for pts. treated with Re-186 and of 34 +/- 26% after 4.4 +/- 1.0 weeks for pts. treated with Sr-89 compared to the value before therapy was observed. The difference was not significant between the 3 groups of pts. (p = 0.125 to 0.862).. All tried radiopharmaceuticals were effective in pain palliation. The various radionuclides had no significant difference in the pain relief or the bone marrow impairment. If only the Karnofsky-Index after Re-188 HEDP seems to be a little more increase.

Topics: Bone Neoplasms; Breast Neoplasms; Etidronic Acid; Female; Humans; Leukocyte Count; Male; Middle Aged; Organometallic Compounds; Pain; Palliative Care; Platelet Count; Prostatic Neoplasms; Radioisotopes; Rhenium; Strontium Radioisotopes; Tomography, X-Ray Computed

Strontium-89 (89Sr) is currently used for the treatment of painful bone metastases. This study reports the use of low-dose carboplatin as a radiosensitizer in 89Sr radioisotope therapy. The study design comprised two groups: 15 patients treated with 89Sr (148 MBq) followed by carboplatin (100 mg m-2 at 7 and 21 days) and 15 patients treated with 89Sr alone. Their pain response was assessed 8 weeks post-injection. Follow-up was continued for up to 1 year in the survivors. Twenty-seven patients were evaluable. A pain response was observed in 20 of 27 (74%) patients. The pain response in the patients treated with 89Sr and carboplatin was clearly superior to that seen in the patients treated with 89Sr alone (P = 0.025), whereas survival was only marginally better in the combined treatment group (8.1 vs 5.7 months, P = 0.19). No clinically significant adverse effects or myelosuppression by carboplatin were observed. Low-dose carboplatin enhances the effects of 89Sr radioisotope therapy on pain from bone metastases.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Carboplatin; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radiation-Sensitizing Agents; Strontium Radioisotopes

Bone metastases are a major problem in the clinical management of patients with breast or prostate cancer. Severe bone pain can be a particularly debilitating effect of metastatic disease, resulting in a growing dependency on opioid analgesics and a reduced quality of life in patients who have a short time to survive. The radiopharmaceutical strontium-89 has been demonstrated to be generally well tolerated as well as effective in reducing metastatic bone pain in breast or prostate cancer patients. Unlike other radioisotopes or external radiation treatments, it represents systemic, targeted therapy that is simple and fast to administer in an outpatient setting. Data accumulated over the last 15 years demonstrates that 89Sr provides pain relief in up to 80% of patients with bony metastases arising from breast or prostatic malignancies. Pain palliation is maintained for several months, along with improvements in functional status and quality of life. As many as one fifth of 89Sr-treated patients become pain free and require no further pain medication. The adverse effects of intravenous 89Sr are minimal. Bone marrow toxicity is observed in many patients, resulting in some reduction of platelet and white blood cell counts. Despite reductions of 20% to 30%, these hematologic effects are generally reversible and the majority of patients maintain platelet counts that are within normal limits. Strontium-89 is effective systemic radioisotopic therapy for the palliation of painful bony metastases from breast and prostate carcinoma.

Topics: Bone Neoplasms; Breast Neoplasms; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes

Topics: Bone Neoplasms; Breast Neoplasms; Female; Hand; Humans; Strontium Radioisotopes

Topics: Bone Neoplasms; Breast Neoplasms; Female; Hand; Humans; Strontium Radioisotopes

Extravasation of various imaging tracers during administration was not a rare complication during nuclear medicine practice. However, the occurrence of extravasation of therapeutic radiopharmaceutical was rarely reported. Here we reported a 60-year-old woman with breast cancer and diffuse painful bone metastases who received strontium chloride (SrCl2) therapy to palliate her bone pain. Accidental subcutaneous extravasation in the injection site occurred. The extravasated Sr was absorbed rapidly by arm elevation, squeezing a stress ball, local warming, and gently massaging. Follow-up results showed the patient's bone pain significantly relieved and her right arm remained normal.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Injections; Male; Middle Aged; Palliative Care; Radionuclide Imaging; Strontium; Strontium Radioisotopes

The patient was a 47-year-old female with stage IV breast cancer and multiple bone metastases. She received various systemic therapies (hormone therapy and chemotherapy) and underwent mastectomy between 2013 and 2018; in the beginning of 2018, she started experiencing bone metastatic pain in the right hip joint and neural pain on the dorsal side of the left thigh. These symptoms worsened gradually, and nonsteroidal anti-inflammatory analgesics or narcotic analgesics were not effective for treating this pain. Strontium-89 (

Topics: Bone Neoplasms; Breast Neoplasms; Fatal Outcome; Female; Humans; Middle Aged; Neuralgia; Pain Management; Quality of Life; Strontium Radioisotopes; Treatment Outcome

89Sr is useful for the palliation of painful bone metastasis, but its antitumor activity as a monotherapy has not been shown by 18F-FDG PET. Here, we report a case of a 75-year-old woman with multiple bone metastases of breast cancer in which 18F-FDG PET demonstrated a significant reduction in uptake of 18F-FDG after administration of 89Sr.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Multimodal Imaging; Positron-Emission Tomography; Strontium Radioisotopes; Tomography, X-Ray Computed

A 51-year-old woman diagnosed as having left breast cancer with axillary lymph node and liver metastases seven years earlier was seen in our office because of severe pancytopenia. She had received chemotherapy including several cycles of doxorubicin plus cyclophosphamide and docetaxel followed by hormone therapy containing leuprorelin and tamoxifen over four years. For management of bone pain due to metastasis, she had also undergone stereotaxic radiation therapy of the neck one and a half years earlier and unsealed internal radiation therapy with (89)Sr injection five months prior to the current presentation, Subsequently, myelosuppression progressively worsened and she finally required a blood transfusion. Although bone marrow examination showed severe hypoplasia, but neither blastic nor dysplastic, a test for PML-RARA fluorescence in situ hybridization was positive. After administration of all-trans retinoic acid, hematogenesis improved within three weeks. Neither disseminated intravascular coagulation nor retinoic acid syndrome was observed during the course of her illness. This is the first report describing acute promyelocytic leukemia after administration of (89)Sr, to our knowledge, and with an atypical onset and progression. As the number of cancer survivors increases due to improvements in medical intervention, clinicians must take more notice of special characteristics of therapy-related leukemia modified by previous treatments.

Topics: Breast Neoplasms; Combined Modality Therapy; Female; Humans; Iatrogenic Disease; Leukemia, Promyelocytic, Acute; Leukemia, Radiation-Induced; Middle Aged; Neoplasm Metastasis; Strontium Radioisotopes

Many radiopharmaceuticals used for medical diagnosis and therapy are beta emitters; however, the mechanism of the cell death caused by beta-irradiation is not well understood. The objective of this study was to investigate the apoptosis of human breast carcinoma MCF-7 cell lines induced by Strontium-89 (⁸⁹Sr) and its regulation and control mechanism. High-metastatic Breast Carcinoma MCF-7 cells were cultured in vitro using ⁸⁹Sr with different radioactive concentration. The inhibition rate of cell proliferation was measured by MTT color matching method. The cell cycle retardation, apoptosis conditions, mitochondrion transmembrane potential difference and Fas expression were tested and analyzed. The genes P53 and bcl-2 expressions was also analyzed using immunity histochemical analysis. After being induced by ⁸⁹Sr with various of radioactive concentration, it was found that the inhibition of cell proliferation of MCF-7 cells was obviously, the retardation of cell cycle occurred mainly in G2-M. It was also found that the obvious apoptosis occurred after being induced by ⁸⁹Sr, the highest apoptosis rate reached 46.28%. The expressions of Fas acceptor and P53 gene increased, while bcl-2 gene expression decreasesd. These findings demonstrate that in the ranges of a certain radioactive concentration, the inhibition rate of MCF-7 cell proliferation and retardation of cell cycle had positive correlation with the concentration of ⁸⁹Sr. And the mitochondrion transmembrane potential decrease would induce the apoptosis of MCF-7 cell notably, which were controlled by P53 and bcl-2 genes, involved with the Fas acceptor.

Topics: Apoptosis; Breast Neoplasms; Carcinoma; Cell Cycle; Cell Line, Tumor; Cell Proliferation; Dose-Response Relationship, Radiation; fas Receptor; Female; Gene Expression Profiling; Humans; Membrane Potentials; Mitochondria; Proto-Oncogene Proteins c-bcl-2; Radiopharmaceuticals; Strontium Radioisotopes; Tumor Suppressor Protein p53

The radiation exposure to bystanders from 89SrCl2, 186Re-HEDP and 153Sm-EDTMP, is generally thought to be caused by "bremsstrahlung" and gamma-radiation, with negligible contribution from beta-radiation. The latter assumption may be erroneous. The aim of this prospective study was the investigation of radiation safety after treatment with these radiopharmaceuticals. The radiation field around treated patients was characterized and the magnitude estimated.. 33 patients (30 prostate carcinoma, 3 breast carcinoma) were treated with 150 MBq 89SrCl2 (9 patients), 1295 MBq 186Re-HEDP (12 patients) or 37 MBq/kg 153Sm-EDTMP (12 patients). External exposure rates at 30 cm from the patient were measured at times 0 to 72 h post-injection. To evaluate the respective contribution of Bremsstrahlung, beta- and gamma-radiation, a calibrated survey meter was used, equipped with a shutter. For each patient, the measured exposure rate-versus-time data were fit to a curve and the curve integrated (area under the curve) to estimate the total exposure.. For 29/33 patients the total ambient equivalent doses (mean+/-1 standard deviation [SD]) based on the integral of the fitted curve were 2.1+/-1.2 mSv for 89SrCl2, 3.3+/-0.6 mSv for 186Re-HEDP and 2.8+/-0.6 mSv for 153Sm-EDTMP. Beta-radiation contributes significantly to these doses (>99% for 89SrCl2, 87% for 186Re-HEDP and 27% for 153Sm-EDTMP). The effective doses (at 30 cm) are <0.1 mSv for 89SrCl2, 0.3 mSv for 186Re-HEDP and 1.6 mSv for 153Sm-EDTMP.. Patients treated with 89SrCl2, 186Re-HEDP or 153Sm-EDTMP emit a spectrum of radiation, including non-negligible beta-radiation. With specific instructions effective doses to bystanders are acceptable.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Etidronic Acid; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Organophosphorus Compounds; Prostatic Neoplasms; Radiation Injuries; Radioisotopes; Rhenium; Safety; Samarium; Strontium; Strontium Radioisotopes

The aim of this study was to evaluate changes in the peripheral blood CD(4)(+) and CD(8)(+) T-lymphocyte populations following strontium-89 chloride ((89)SrCl(2)) therapy for painful bone metastases and to relate these changes to a therapeutic response. Forty-two (42) patients with painful bone metastases were treated with 148 MBq (4 mCi) of (89)SrCl(2). Blood samples were drawn before and monthly for 6 months after the treatment. CD(4)(+) and CD(8)(+) T-lymphocyte levels were measured using flow cytometry. The number of bone metastases and the pain score were used to assess the effect of therapy. Before the administration of (89)SrCl(2), the ratio of CD(4)(+) to CD(8)(+) T-lymphocytes was lower in patients with bone metastases than in the control subjects (p < 0.01); after therapy, the ratio increased up to the fourth month and then gradually declined to pretreatment levels. Responders had higher post-therapeutic ratios of CD(4)(+) to CD(8)(+) than nonresponders. There was a good correlation between the ratio of CD(4)(+) to CD(8)(+) and both the number of bone metastases and the pain score. The ratio of CD(4)(+) to CD(8)(+) T-lymphocytes correlated strongly with the response of bone metastases to (89)SrCl(2), and therefore, may be used as an indicator of (89)SrCl(2) efficacy.

Topics: Bone Neoplasms; Breast Neoplasms; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Female; Humans; Lymphocyte Count; Male; Middle Aged; Pain; Radiography; Radiotherapy Dosage; Reference Values; Strontium Radioisotopes; Treatment Outcome; Whole-Body Irradiation

We evaluated the pain response and daily discomfort in patients with painful bone metastases treated by merging 89Sr-chloride and zoledronic acid. The results were compared with those of patients who received 89Sr-chloride or zoledronic acid separately.. 25 patients (12 women; mean age 65+/-13 years) chronically treated with zoledronic acid underwent bone pain palliation with 150 MBq of 89Sr-chloride at least 6 months later that bisphoshonate therapy started (group A). 13 patients (6 women; mean age 70+/-12 years) received 89Sr-chloride alone (group B) and 11 patients (5 women; mean age 69+/-12 years) were chronically treated and continued to receive only zoledronic acid therapy (group C), both constituted the control groups. Patients kept a daily pain diary assessing both their discomfort and the pain of specific sites by using a visual analog scale (VAS), rating from 0 (no d iscomfort-no pain) to 10 (worst discomfort-pain). These diaries were reviewed weekly for 2 months and three different physicians rated the pain response on a scale of -2 (considerable deterioration) to +2 (considerable improvement).. Baseline characteristics were similar in the three groups. The reduction of total discomfort and of bone pain in the group A was significantly greater as compared to group B (P<0.01) and group C (P<0.01). During the monitored period, a significant improvement of clinical conditions was observed in the group A, varying the rate from -1 to 1 as compared to both groups B and C in which the rate changed from -1 to 0.. Our findings indicate that combined therapy of 89Sr-chloride and zoledronic acid in patients with painful bone metastases is more effective in treating pain and improving clinical conditions than 89Sr-chloride or zoledronic acid used separately.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Combined Modality Therapy; Diphosphonates; Female; Follow-Up Studies; Humans; Imidazoles; Male; Middle Aged; Neoplasm Metastasis; Pain; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes; Time Factors; Treatment Outcome; Zoledronic Acid

To evaluate the clinical value of (89)SrCl(2) (Ke xing Inc, Shanghai) as a palliative therapy modality for cancer patients with bone metastasis.. In 504 cancer patients with painful limitation of movement due to bony metastasis, a dose of 1.48-2.22 MBq/kg (40-60 uCi/kg) iv infusion of (89)SrCl(2) was given.. In 97 patients (19.2%) there was no improvement in pain and life quality, 298 patients (59.1%) showed mild to moderate improvement (moderately effective), 109 patients (21.6%) became free of pain and were subsequently fully ambulatory (markedly effective). The pain relief appeared from D1-D46 after (89)SrCl(2) administration, most frequently from D5-D14. The palliative effect could last for about 56 days to 13 months. Repeated bone scans of some patients showed that the metastatic foci in the bone became smaller or even disappeared gradually after the administration of (89)SrCl(2). Approximately 55% of patients experienced grade I approximately III bone marrow depression attributable to (89)SrCl(2), which would return to the pre-treatment level within 3 approximately 9 months.. (89)SrCl(2) is effective and safe for the relief of bone pain and improvement of quality of life in cancer patients with painful bony metastasis.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pain Measurement; Pain, Intractable; Quality of Life; Strontium Radioisotopes

We report our experience in the use of radionuclides in the treatment of bone metastases in patients with various primary cancers: breast cancer, prostate cancer, lung cancer, etc.. Eighty-seven patients (53 women, 34 men) with bone metastases were treated for pain relief with either 32-P (71 patients) or 89-Sr (16 patients). Fifty-three of the patients had breast cancer, 27--rostate cancer, 6--lung cancer and 1--kidney cancer. The patients were examined for side effects when 32-P was administered perorally and 89-Sr injected intravenously. We also studied the changes in the levels of hemoglobin, white blood cells (WBCs) count and platelets count.. We found a significant decrease in the WBC and platelet count in the patients treated with 32-P (U = 2.20, P < 0.05 and U = 4.57, P < 0.001) one month after the therapy. These parameters showed no significant decrease in the group treated with 89-Sr. The pain, which was the rationale to use the radioactive isotopes, was relieved and the patients restored their previous mobility.. The fact that 32-P alleviated the grave symptom of pain at the relatively weak radiation dose used (2 mCi) is a strong indication that this radiopharmaceutical can be used successfully for such a purpose, although some authors argue against its use in view of the myelosuppresion it causes. This myelosuppression, however, is mild and transient even without treatment and patients could benefit from this adjuvant treatment to manage the pain syndrome. 89-Sr administered intravenously in a dose of 4mCi also relieves pain efficiently but its use is limited by the cost of the quantity needed for 1 patient and for a single dose. The National Health Insurance Fund currently reimburses for a very limited quantity of this substance which makes the cost of the procedure 15 times as expensive as that using radioactive phosphorus.. Using the radiopharmaceuticals 32-P and 89-Sr provides an additional, easy and efficacious means for palliation of cancer patients with bone metastases, especially those who are refractory to percutaneous irradiation.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Leukocyte Count; Lung Neoplasms; Male; Pain; Pain Measurement; Phosphorus Radioisotopes; Platelet Count; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome

A clinical test of strontium-89 chloride effect was carried out in 150 patients with bone metastases and bone pain from different patterns of tumor. Different types of bone lesions were considered. Pain-relieving effect was reported in 77%, irrespective of lesion gravity. There was no response to strontium-89 chloride in 150 patients with bone metastases. It mostly occurred in cases of lysis. Strontium-89 chloride therapy contributed to partial bone tissue repair. It is indicated as a component of complex treatment for bone metastases.

Topics: Analgesics; Antineoplastic Agents; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Strontium; Strontium Radioisotopes

More than two-thirds of the patients with osseous metastases experience debilitating bone pain, requiring some form of pain relief. Analgesics are limited in their efficacy. Palliative application of hemi-body external beam radiation therapy in the treatment of multiple osseous metastases also is limited due to toxicity associated with large treatment ports. Intravenous injections of bone seeking radioisotopes are effective in the palliation of pain with fewer side effects. Forty-one patients with multiple osseous metastases due to prostate and breast cancer were treated with strontium chloride 89 (89Sr) at the department of radiation oncology, in a university hospital. A retrospective analysis of these patients indicated that all subjects had severe pain that diminished their quality of life. Most of these patients had multiple co-morbid factors. Many were on opioids leading to adverse effects such as nausea, constipation, and drowsiness that required additional medication. Objective findings and evaluation of the responses were not always available for all patients. Following treatmentwith 89Sr, over two-thirds of the patients responded favorably and required lower doses of opioids.

Topics: Black or African American; Bone Neoplasms; Breast Neoplasms; Female; Hospitals, University; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Retrospective Studies; Strontium; Strontium Radioisotopes

To investigate the influence of 89Sr on the cell immune function in patients with multiple bone metastases.. Patients with multiple bone metastases were treated with in vivo radiation of 89Sr. The T cell subsets, NK cell activities, and lymphocyte transformation rate (LTR) of multiple bone metastases before and after the 89Sr treatment were measured.. With the palliation of the pain of the patients after the 89Sr treatment, the T cell subset level, NK cell activities, and LTR increased. There was no significant change in the patients with the pain.. Treating multiple bone metastases with 89Sr can improve the cell immune function of the patients to a certain extent.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Immunity, Cellular; Killer Cells, Natural; Male; Middle Aged; Prostatic Neoplasms; Strontium Radioisotopes; T-Lymphocyte Subsets

This work was done to evaluate the indication, effectiveness, and side effects of internal radiotherapy with radioactive nuclide strontium-89 (89Sr) in patients with malignant metastasis in the bone.. Fifty-six patients with skeletal metastasis received this internal radiotherapy. The patients were observed and followed up with respect to pain control, lesion improvement and side effects.. The overall effective rate of pain control was 76.8% with the effective rate of prostatic cancer and breast cancer higher than 80%. The lesions in 81.8% patients as assessed by SPECT imaging, were improved. The mild lowering of white cells, platelets and red cells was the main side effect.. Internal radiotherapy with 89Sr is very useful for patients with malignant cancer metastasis in the bone.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Prostatic Neoplasms; Strontium; Strontium Radioisotopes; Treatment Outcome

Topics: Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Male; Palliative Care; Strontium Radioisotopes; Tomography, Emission-Computed

The aim of this retrospective study was to evaluate the efficacy of 85Sr in the palliation of metastatic bone pain. 85Sr decays by electron capture with a gamma emission of 514 keV and associated x-ray emissions of 10-15 keV; physical half-life is 64 d.. Between 1977 and 1992, 119 doses of 85Sr chloride (mean activity 335 MBq [9 mCi]) were intravenously administered to 108 patients with hyperalgic generalized bone metastases from prostatic carcinoma (52 patients), breast carcinoma (41) or other cancers (15). Pain, performance status, blood and urinary excretion values were investigated during follow-up, and survival time was recorded. Strontium bone scans were obtained up to 8 wk after injection to document isotope biodistribution and to estimate absorbed doses.. At 12 wk, 72.2% of patients showed significant benefit from treatment, i.e., enhanced quality of life and pain relief; 49.1% became free of pain. These beneficial effects lasted from 1 to 36 mo (mean 4.3 mo). The best symptomatic improvement was seen in patients treated at an early stage of metastatic skeletal disease and in prostate cancer patients. No evidence of a significant dose-response relationship was found in the data analysis. The mean absorbed dose ratio of metastases to marrow was estimated at 8.2. We found no evidence that hematological toxicity was a major problem; however, all patients experienced a reduction in blood counts, especially in platelets.. Systemic radionuclide therapy using 85Sr is a feasible, effective and well-tolerated palliative treatment in patients with refractory bone pain. We attained at least the same response rate as that reported with bone-seeking beta-emitting radionuclides such as 89Sr. The patients who benefited the most from 85Sr treatment were in an early stage of metastatic disease or had prostate cancer. Our clinical findings could not be linked to either the total injected activity of 85Sr or the estimated absorbed dose delivered to metastases.

Topics: Bone Neoplasms; Breast Neoplasms; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Retrospective Studies; Strontium; Strontium Radioisotopes

Systemic radionuclide therapy with strontium chloride Sr 89 is a rediscovered alternative to relieve pain from bony metastases. Although numerous advances have been made in the diagnosis and treatment of cancer, pain remains a serious and debilitating disease complication. An increasing number of clinical trials are reporting satisfactory results with 89Sr-chloride therapy, now available for widespread clinical use. We have treated 11 patients with this radionuclide; of these patients, 8 had excellent to dramatic pain relief and 3 had mild to moderate improvement. Clinical response was based on subjective pain relief, increased mobility, decreased analgesic uptake, and/or improvement in daily activities, including work habits.

Topics: Activities of Daily Living; Bone Neoplasms; Breast Neoplasms; Humans; Male; Pain; Prostatic Neoplasms; Radiopharmaceuticals; Strontium Radioisotopes; Treatment Outcome

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Remission Induction; Strontium Radioisotopes; Technetium Tc 99m Medronate; Terminal Care; Thyroid Neoplasms

We have used strontium-89 chloride (89Sr) for the palliative treatment of metastatic bone pain. Seventy-six patients (50 males with prostate carcinoma and 26 females with breast cancer) were treated with 148 MBq of 89Sr. Sixteen patients were retreated, receiving two or three doses; the total number of injected doses was consequently 95. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. Three levels of response were considered: good - when there was an increase in the Karnofsky status and a decrease in the pain score (equal to or higher than 4) or analgesic score (equal to or higher than 1); partial - when there was an increase in the Karnofsky status and a decrease in the pain score (2 or 3 points) without significant changes in the analgesic score; no response - if no variation or deterioration in these parameters was observed. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). In the patients who were retreated the effectiveness was as good as after the first dose of 89Sr. A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. It is concluded that 89Sr is an effective agent in palliative therapy for metastatic bone pain in patients with prostate or breast carcinoma. If required, retreatment can be administered safely and with the same efficacy as is achieved by the first dose.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Karnofsky Performance Status; Male; Middle Aged; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radiotherapy Dosage; Strontium; Strontium Radioisotopes

The aim of this study was to optimise the parameters affecting the Bremsstrahlung scintigraphy of patients injected with strontium-89 chloride. The parameters considered were : (1) instrumental detection efficiency, and (2) tissue attenuation factor for 89Sr calibrated sources, which permit quantitative evaluation of the activity in a given bone lesion. Some typical examples of in vivo 89Sr imaging are presented to illustrate the clinical utility of the imaging procedure developed by us, which is implemented in our department for all patients treated with 89Sr chloride.

Topics: Bone Neoplasms; Breast Neoplasms; Calibration; Gamma Cameras; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

Strontium-89 chloride (Metastron) is an FDA-approved treatment for palliation of cancer pain. We evaluated blood count changes and pain relief in 28 patients with widespread painful bony metastasis treated with strontium-89 at the University of Minnesota Hospital and Clinics. Eighteen patients had prostate cancer (all hormone-refractory cancer), seven patients had breast cancer, and three patients had lung cancer, all previously treated with either radiation, chemotherapy, or a combination of the two. Serial blood counts were performed weekly up to 8 weeks and at 12 weeks after administering Metastron. Pain scale and blood values were monitored simultaneously. The mean baselines of hemoglobin (Hgb), white blood count (WBC), and platelets (Plts) were 11.4, 5900, and 258,000, respectively. The mean dose of Metastron was 3 mCi (range 2.2-4.4). The median time (range) to nadir was about 6 weeks. The percentage reductions relative to baseline were 32% (range 0-72%) for WBC; 14% (range 0-50%) for Hgb; 15% (range 0-47%) for the red blood cell (RBC) count; and 40% (range 0-85%)for Plts. We did not find a close relationship among the baseline blood count, reduction of subsequent blood counts, or previously irradiated active bone marrow volume. The median time of survival was 23 weeks (range 2-66 weeks). At 12 weeks, 29% of patients had moderate to dramatic improvement of pain, 32% had some relief of pain, and 50% had no improvement in pain. Thirty-two percent of the treated patients required additional palliative external beam radiation to their bony lesions within the study period. Our results show that Metastron for palliation for bony metastases should be used with caution because of moderate to severe bone marrow toxicity, especially in platelets, associated with its use. Careful evaluation of patients given Metastron is needed to assess accurately its full benefit.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Erythrocytes; Female; Follow-Up Studies; Hemoglobins; Humans; Leukocyte Count; Lung Neoplasms; Male; Middle Aged; Minnesota; Pain; Palliative Care; Platelet Count; Prostatic Neoplasms; Radiotherapy Dosage; Strontium; Strontium Radioisotopes; Survival Rate

Radioactive strontium chloride (89Sr) was administered for pain relief in 6 patients with bone metastases (4 prostate cancer and 2 breast cancer patients). Out of 6 patients, 2 showed apparent relief of bone pain and improvement of QOL, and 3 showed slight relief of the pain with or without improvement of QOL; that is, 83% was effective. Side effects were seen in 2 patients; transient deterioration of bone pain in one patient and bone marrow suppression in the other patient. The patient who showed bone marrow suppression had rather more lesions of bone metastasis (diffuse metastasis) and least urinary excretion of the radioactivity. Urinary excretion for 2 days varied 5 to 40% of the administered dose and was less in the patients with more metastatic lesions.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain, Intractable; Prostatic Neoplasms; Radiotherapy, High-Energy; Strontium; Strontium Radioisotopes

The systemic administration of 89Sr has proven effective in the palliation of painful osseous metastases. Biodistribution studies with the gamma-emitter 85Sr suggest that both its uptake and retention are increased in bone metastases, where increased mineral turnover takes place. To study the pattern and nature of this process further, bones containing metastatic deposits were obtained from three patients who had previously been treated with 148 MBq of 89Sr. The bones were cut into 0.5-1.0 cm sections. The cut surfaces which faced together were marked with India ink, and adjacent sections were submitted for histology and autoradiography. Strontium deposition and retention were observed in regions which exhibited significant osteoblastic activity, mostly in areas adjacent to metastatic deposits, but also in subchondral and endosteal locations, as well as in an area corresponding to a pathological fracture with callus formation. With these exceptions, strontium deposition was not observed in histologically normal bone or within the marrow. Our findings demonstrate directly the selective nature of accumulation and retention of 89Sr and confirm previous clinical impressions.

Topics: Adenocarcinoma; Biopsy; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes; Tissue Distribution

The total absorbed dose after systemic administration of 89Sr has been determined by measuring directly its activity in bone metastases. Autoradiography was performed on sections of bones obtained from patients treated with 89Sr to study the pattern of deposition. Discs of 5 and 8 mm diameter were cut from metastatic sites and normal bone. The beta-ray activity was determined with a scintillation counter, which was calibrated using similar bovine cancellous bone discs, onto which a known activity of 89Sr was transferred by pipette. From the activity measured, the initial activity (at the time of 89Sr administration) was calculated. The absorbed dose was estimated using the methodology described in NCRP Report No. 58. The estimated initial activity of 89Sr in the bone metastases varied from 2.3 to 240 MBq kg-1, with a mean value of 31 +/- 27 MBq kg-1. The total absorbed dose ranged from 1.3 to 64 Gy, with a mean of 18 +/- 16 Gy. The average total dose to normal bone sites was 1.1 +/- 0.4 Gy. The metastases to normal bone dose ratio in individual samples varied from 8 +/- 4 to 40 +/- 25. These estimates are in agreement with those obtained previously by indirect methods.

Topics: Autoradiography; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Models, Theoretical; Radionuclide Imaging; Strontium Radioisotopes

Fifteen patients with breast cancer and skeletal metastases who had bone pain refractory to opioid analgesics and who were not eligible for or had not responded to local field radiotherapy, were treated with strontium-89. All patients had received previous treatment with chemotherapy and radiotherapy for bone metastases. Severity of bone pain, sleeping pattern, mobility and dependency on analgesics were evaluated before and 4, 8 and 12 weeks after 89Sr administration. Patients received 2 MBq/kg (118-148 MBq) of 89Sr by i.v. injection. Pain relief and a reduction in analgesic requirements were observed in 7 of the 15 (47%) patients, with a reduction in the severity score from 34% to 71%. Duration of the response varied from 3 to 7 months. A decrease in peripheral blood cell count was observed in 11 patients: a 15%-66% reduction in white cell count and a 14%-75% reduction in platelet count were detected at 12 weeks after treatment in these patients. We conclude that 89Sr is effective (47% response rate) for bone pain palliation in patients with bone metastases from breast cancer. Dependency on opioid analgesics may be reduced in patients with refractory bone pain.

Topics: Aged; Aged, 80 and over; Analgesics, Opioid; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Pain, Intractable; Palliative Care; Prospective Studies; Strontium Radioisotopes

Measurement of radioactivity levels in the urine of patients undergoing strontium-89 therapy can be used to evaluate the efficacy of therapy or for patient's management (radiation protection rules and waste disposal). The complex beta counting procedures require extensive sample manipulation during preparation of the liquid scintillation cocktail. The high activity levels that may be found permit one to measure 89Sr activity sample by counting the low yield gamma emission (909 keV) of the radionuclide. However, the contamination of 85Sr due to the reaction for producing 89Sr, if measured with sufficient precision, could be used to evaluate 89Sr activity in urine samples. In other words, the contaminant 85Sr can be used as a tracer of 89Sr. This method was tested in four patients and the accuracy was found to be sufficient to obtain the individual time-activity curves of the urinary excretion.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Monitoring, Physiologic; Neoplasms, Unknown Primary; Palliative Care; Strontium Radioisotopes

Two hundred and two patients with bone pain from metastatic cancer were treated with 40 microCi/kg of Sr-89. Patients were followed with pain diaries, records of medication taken, sleep patterns, serial bone scans and a Karnofsky Index. One hundred and thirty-seven patients with adequate followup survived at least 3 months, including 100 with prostate and 28 with breast carcinoma. Eighty of the 100 patients with prostate cancer responded, and 25 of the 28 breast cancer patients improved. Ten patients with prostate cancer and five with breast cancer became pain free. Little hematologic depression was noted. Sr-89 kinetic studies showed that strontium taken up in osteoblastic areas remained for 100 days. The tumor-to-marrow absorbed dose ratio was 10:1.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

We have utilized 89Sr as palliative treatment for bone pain secondary to metastatic cancer in the skeleton of over 200 patients. The best results have been in patients with carcinoma of the prostate (80% response rate) and breast (89%). Results in a small number of patients with a variety of other cell types were not nearly as encouraging. Strontium-89 provides excellent palliation in the management of bone pain secondary to prostate and breast carcinoma.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Pain; Prostatic Neoplasms; Strontium Radioisotopes

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Strontium Radioisotopes

The dynamics of uptake of osteotropic radionucleides in normal and abnormal bone were studied by means of sequential and functional scans. Various phosphate and phosphonate complexes were compared in vivo and in vitro. Only phosphonates were considered as suitable for bone scanning. In normal bones in beagles, radioactivity after HEDP fell to 65% after two hours, but was 105% with 18F. In relation to healing fractures, the curves differ quantitatively and qualitatively. In this situation, functional curves derived from dynamic scans provide a better parallel with histological findings than does static scintigraphy with an uptake quotient. Sequential and functional scanning are able to document the therapeutic effect of irradiation of bone metastases.

Topics: Animals; Bone and Bones; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Dogs; Female; Fluorine; Humans; Male; Neoplasm Metastasis; Phosphates; Prostatic Neoplasms; Pseudarthrosis; Radioisotopes; Radionuclide Imaging; Strontium; Strontium Radioisotopes; Technetium

Experiments with phantoms have shown that there is a higher probability of showing areas of increased uptake when using a camera than with a scanner. In 49 patients with suspected bone metastases, scans were performed during their pre-operative work-up, under identical conditions, using a whole body scintigraphic scanner with a 5-inch double head and a scintillation camera with total body facility. The scintillation camera showed a significantly higher sensitivity to bone metastases, but there was no difference in the pick-up rate of distant metastases. Despite the possibly more frequent use of the camera, its cost is no higher than that of the scanner. Both on diagnostic and economic grounds, we consider the scintillation camera, with a total body facility, to be the instrument of choice for total skeleton scintigraphy.

Topics: Bone Neoplasms; Breast Neoplasms; Cost-Benefit Analysis; Diagnostic Errors; Evaluation Studies as Topic; Female; Humans; Male; Methods; Neoplasm Metastasis; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Whole-Body Counting

Data now available on the risks of radiation-induced fatal cancer and hereditary disease and radionuclide metabolism suggest that limits on the rates of intake of 90Sr, 226Ra and 239Pu at work, presently recommended by the International Commission on Radiological Protection, might be in need of considerable revision one with another and with the limit for uniform exposure of the whole body.

Topics: Body Burden; Breast Neoplasms; Carcinoma; Dose-Response Relationship, Radiation; Female; Genetic Diseases, Inborn; Humans; Leukemia; Lung Neoplasms; Male; Maximum Allowable Concentration; Neoplasms, Radiation-Induced; Nuclear Warfare; Occupational Medicine; Osteosarcoma; Paranasal Sinus Neoplasms; Plutonium; Radiation Injuries; Radiation Tolerance; Radium; Strontium Radioisotopes; Thyroid Neoplasms

The concentration of 99mTc-pyrophosphate was determined in the lower extremities of rabbits (normal, abacterial and bacterial affected soft tissues), in osteoarthritis of the hip joint (capsule and muscle) as well as in knee joint effusions. Compared with the 85Sr-concentration, reflecting the calcification capacity, concentrations of 99mTc-pyrophosphate in soft tissues were found to be lower 2 hours p.i., but were up to elevenfold higher 24 hours p.i. These findings should be due to a fixation of 99mTc-pyrophosphate in collagen containing tissues as in the soft tissue tumors (myosarcoma, synvialioma, breast cancer) presented. A mechanism of delayed equilibration could explain augmented uptake in lymph-edema, ascites and effusions in florid osteoarthritis of the knee joint. The possible dependence of 99mTc-pyrophosphate concentration in bone and soft tissue on collagenous contents is discussed.

Topics: Animals; Ascites; Bone and Bones; Breast Neoplasms; Diphosphates; Disease Models, Animal; Extremities; Freund's Adjuvant; Hip; Humans; Joint Diseases; Joint Prosthesis; Joints; Knee; Osteoarthritis; Phosphates; Rabbits; Rhabdomyosarcoma; Sarcoma, Synovial; Strontium; Strontium Radioisotopes; Technetium; Tibial Fractures; Time Factors; Tin

Strontium 87m bone scanning was used in the assessment of 162 patients with breast cancer. Seventy-two patients had abnormal bone scans and in 63 (87 percent) these findings were subsequently confirmed. More metastases were detected by scanning and radiology than by radiology alone. There was a false positive rate of 7 percent. Of the 90 negative scans 23 showed evidence of metastasis either radiologically or at autopsy. This represented a false negative rate of 26 percent. The reasons for the false results are discussed particularly in relation to the problems of imaging the dorsal spine.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnostic Errors; Female; Humans; Neoplasm Metastasis; Radiography; Radionuclide Imaging; Spinal Neoplasms; Strontium Radioisotopes

The value of bone scanning with 99mTc-polyphosphate was assessed in 186 patients with various types of tumors. The sensitivity of this technique was greater than that of metastatic roentgenographic series and the reported results of 85-Sr-bone scans, in the detection of osseous involvement by tumors. Three cases with normal bone scans and abnormal roentgenographic studies illustrated the necessity and complementary value of comparing bone scan findings with radiographic studies. Patients with carcinoma of the breast, lung, or prostate displayed characteristic patterns of bone involvement by their tumors. The importance of clinical information, including bone symptoms, antecedent bone disease, and serum calcium and alkaline phosphatase, was stressed in the detection and interpretation of bone scan abnormalities.

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Hypercalcemia; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Pelvic Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Skull Neoplasms; Spinal Neoplasms; Strontium Radioisotopes; Technetium

Strontium nitrate Sr 87m bone scans were made preoperatively in a group of women with suspected breast cancer, 35 of whom subsequently underwent radical mastectomy. In 3 of the 35 (9%), the scans were abnormal despite the absence of clinical or roentgenographic evidence of metastatic disease. All three patients has extensive axillary lymph node involvement by tumor, and went on to have additional bone metastases, from which one died. Roentgenograms failed to detect the metastases in all three. Occult bone metastases account in part for the failure of radical mastectomy to cure some patients with breast cancer. It is recommended that all candidates for radical mastectomy have a preoperative bone scan.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Mammography; Mastectomy; Middle Aged; Neoplasm Metastasis; Nitrates; Preoperative Care; Radionuclide Imaging; Strontium Radioisotopes; Thermography; Time Factors

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Breast Neoplasms; Calcium Radioisotopes; Female; Fluorine; Hodgkin Disease; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Adenocarcinoma; Adult; Aged; Arthritis; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Colonic Neoplasms; Female; Fluorine; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Neoplasm Metastasis; Osteitis Deformans; Prostatic Neoplasms; Radiation Dosage; Radiation Monitoring; Radiography; Radioisotopes; Radionuclide Imaging; Ribs; Shoulder; Skull Neoplasms; Strontium Radioisotopes; Technetium; Thoracic Neoplasms

Topics: Adrenalectomy; Adult; Anabolic Agents; Androgens; Antineoplastic Agents; Bone Neoplasms; Breast Neoplasms; Castration; Cyclophosphamide; Estrogens; Ethinyl Estradiol; Female; Humans; Hypophysectomy; Methods; Middle Aged; Neoplasm Metastasis; Strontium Radioisotopes

Topics: Adolescent; Adult; Bone and Bones; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Chondroma; Female; Fractures, Bone; Hodgkin Disease; Humans; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Sarcoma, Ewing; Spinal Neoplasms; Strontium Radioisotopes; Time Factors

Topics: Alkaline Phosphatase; Bone and Bones; Bone Marrow Examination; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Metastasis; Radiography; Strontium Radioisotopes; Technetium

Topics: Bone Neoplasms; Breast Neoplasms; Feces; Female; Hodgkin Disease; Humans; Injections, Intravenous; Kinetics; Male; Neoplasm Metastasis; Osteolysis; Osteoporosis; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Strontium; Strontium Radioisotopes; Time Factors

Topics: Acetabulum; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; False Negative Reactions; Femoral Neoplasms; Half-Life; Humans; Lung Neoplasms; Neoplasm Metastasis; Osteoporosis; Pelvic Neoplasms; Posture; Pubic Bone; Radiography; Radionuclide Imaging; Ribs; Spinal Neoplasms; Strontium Radioisotopes

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Brain Neoplasms; Breast Neoplasms; Child; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Radiography; Radioisotopes; Radionuclide Imaging; Selenium; Strontium Radioisotopes; Technetium; Thoracic Neoplasms

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Female; Hematopoiesis; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Prostatic Neoplasms; Radiation Effects; Strontium Radioisotopes; Time Factors

Topics: Acute Disease; Bone and Bones; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Chronic Disease; Citrates; Female; Femur Head Necrosis; Humans; Neoplasm Metastasis; Osteomyelitis; Phosphates; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Whole-Body Counting

Topics: Ankle Joint; Arthritis, Rheumatoid; Bone and Bones; Breast Neoplasms; Diphosphates; Female; Humans; Kinetics; Knee Joint; Male; Phosphates; Prostatic Neoplasms; Radionuclide Imaging; Rheumatic Fever; Spondylitis, Ankylosing; Strontium Radioisotopes; Technetium; Whole-Body Counting

Topics: Acid Phosphatase; Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Bone Resorption; Breast Neoplasms; Female; Hematologic Diseases; Humans; Injections, Intravenous; Male; Middle Aged; Movement; Multiple Myeloma; Neoplasm Metastasis; Pain, Intractable; Radionuclide Imaging; Remission, Spontaneous; Strontium Radioisotopes; Urinary Bladder Neoplasms; Uterine Neoplasms

Topics: Adenocarcinoma; Bone Neoplasms; Breast Neoplasms; Carcinoma; Female; Humans; Male; Neoplasm Metastasis; Phosphates; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Bone Neoplasms; Breast Neoplasms; Humans; Neoplasms; Spinal Cord Neoplasms; Spine; Strontium; Strontium Radioisotopes