strontium-radioisotopes and Neoplasm-Metastasis

Bone is one of the organs to which cancer metastasizes most frequently. However, it is not a vital organ, therefore, survival after the occurrence of osseous metastasis is relatively favorable. Improvements of medical treatment bring prolonged survival to patients with osseous metastases. But this makes us to recognize the importance of quality of life (QOL) due to several factors, including pain. It is important for oncologists to know how to deal with such painful osseous metastases, as pain relief may enable patients to live their remaining lives to the fullest. Strontium-89 (89Sr) has been used worldwide as in Japan, while being reported to have positive effects on pain relief and QOL improvement in patients with osseous metastases. This review paper is aimed to present not only the history, roles, and medical characters of 89Sr, but also new aspects, such as how to use bone turnover markers, which location of osseous metastases is suitable for effective use of 89Sr.

Topics: Bone Neoplasms; Combined Modality Therapy; Humans; Neoplasm Metastasis; Osteolysis; Pain; Strontium Radioisotopes

Strontium-89 (Sr-89) is a pure emitter with maximum beta energy of 1.46 MeV, average beta energy of 0.58 MeV, and a physical half-life of 50.5 days. It is rapidly taken up by bone and preferentially retained at the sites of osseous metastases. Its biological half-life is >50 days at the metastatic sites, but about 14 days only in the normal bone. The dose of its absorption in the tumor-bearing bone ranges from 21 +/- 4 to 231 +/- 56 cGy/MBq, 2-25 times higher than in the normal bone. Strontium-89 therapy is an effective palliative treatment of bone metastases from prostate cancer, with analgesic effectiveness in 80%.

Topics: Bone Neoplasms; Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms; Strontium Radioisotopes

This review provides an update on the management of painful bone metastases, with an emphasis on radionuclide therapy, and introduces oligometastases and quantitative imaging evaluations for clinical trials.. The current use of radionuclides, alone and in combination with chemotherapy and radiation therapy for painful bone metastases, is discussed, including toxicity, cost and overall outcomes.. Radionuclide therapy is shown to be a useful and cost-effective means of alleviating bone pain in metastatic disease and may be more effective when combined with chemotherapy, bisphosphonates and radiation therapy. Early use of radionuclides in pain therapy may limit cancer progression by inhibiting oligometastases development. Thus, radionuclides can significantly decrease patient morbidity, prolong patient survival, and may decrease the occurrence of new bone metastases.. Palliative pain therapy is critical for effectively managing bone metastases, with treatment options including analgesics, external beam radiotherapy, chemotherapy and radionuclides. Radionuclide therapy is underutilized. Recent studies using radionuclides with chemotherapy and bisphosponates, or using newer radionuclides or combinations of radionuclides and treatment paradigms (e.g., higher activities, repetitive or cyclic administration, chemo sensitization, chemo supplementation), are encouraging. A comprehensive, inter-disciplinary clinical approach is needed. Clinical collaborations will optimize radionuclide therapy for pain palliation and increase awareness of its benefits.

Topics: Bone Neoplasms; Combined Modality Therapy; Humans; Neoplasm Metastasis; Pain; Palliative Care; Radioisotopes; Rhenium; Samarium; Strontium Radioisotopes

Strontium-89 and samarium-153 are radioisotopes that are approved in the USA and Europe for the palliation of pain from metastatic bone cancer, whereas rhenium-186 and rhenium-188 are investigational. Radioisotopes are effective in providing pain relief with response rates of between 40% and 95%. Pain relief starts 1-4 weeks after the initiation of treatment, continues for up to 18 months, and is associated with a reduction in analgesic use in many patients. Thrombocytopenia and neutropenia are the most common toxic effects, but they are generally mild and reversible. Repeat doses are effective in providing pain relief in many patients. The effectiveness of radioisotopes can be greater when they are combined with chemotherapeutic agents such as cisplatin. Some studies with 89Sr and 153Sm indicate a reduction of hot spots on bone scans in up to 70% of patients, and suggest a possible tumoricidal action. Further studies are needed to address the questions of which isotope to use, what dose and schedule to use, and which patients will respond.

Topics: Bone Neoplasms; Humans; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Radiography; Radioisotopes; Radiotherapy Dosage; Rhenium; Samarium; Strontium Radioisotopes

Radiation therapy for locally advanced PCa continues to evolve. A current treatment recommendation for nonmetastatic, high-risk disease includes AS combined with RT. The precise duration and sequencing of AS has not been established but most frequently includes treatment in the neoadjuvant, concomitant and, occasionally, adjuvant periods. As technology allows higher doses without significant increases in morbidity and as clinical data provide proof of a radiation dose response, RT doses continue to escalate. The goal of therapy for metastatic disease continues to focus on the relief of pain and the improvement in quality of life. Multiple studies document the significant role RT plays in achieving these goals. Focal RT and systemic radioisotopes have become the mainstay of management in this patient group and the development of newer isotopes that cause less marrow toxicity will improve the therapeutic ratio and provide an opportunity for their use with systemic chemotherapy. As molecular and genomic technologies advance, directed targeting of critical cellular radiation-response pathways hold the promise of improved radiation response and individualized, tailored therapy.

Topics: Adenocarcinoma; Antineoplastic Agents, Hormonal; Biomarkers, Tumor; Brachytherapy; Chemotherapy, Adjuvant; Clinical Trials, Phase III as Topic; Combined Modality Therapy; Disease-Free Survival; Dose Fractionation, Radiation; Gene Deletion; Gonadotropin-Releasing Hormone; Hemibody Irradiation; Hormone Antagonists; Humans; Male; Neoplasm Metastasis; Neoplasm Proteins; Neoplasm Recurrence, Local; Neutrons; Palliative Care; Prostate-Specific Antigen; Prostatic Neoplasms; Proton Therapy; Radiation Tolerance; Radioisotope Teletherapy; Radiotherapy Dosage; Radiotherapy, Conformal; Randomized Controlled Trials as Topic; Samarium; Strontium Radioisotopes; Survival Rate; Treatment Outcome; Tumor Cells, Cultured

Systemic radionuclide therapy is gaining popularity in the radiotherapy community and changing the management of painful osseous metastases. This form of therapy has two major advantages: (i) it addresses all sites of involvement; and (ii) selective absorption limits normal tissue dose. As a result, toxicity is reduced and the therapeutic ratio increased. The biokinetics, dosimetry, and clinical experience with these compounds are reviewed. To date, the best studied and most commonly used radionuclide is strontium-89. Large, prospectively randomized clinical trials have demonstrated its efficacy as a first-line therapy or as an adjuvant to external-beam radiotherapy. It is particularly useful when external-beam therapy options have been exhausted, and normal tissue tolerance has been reached. In metastatic prostate cancer, our recent survey suggests the formation of a new paradigm: local field external-beam radiotherapy to the painful index site in combination with prophylactic administration of systemic radionuclides for clinically occult metastases.

Topics: Bone and Bones; Humans; Neoplasm Metastasis; Neoplasms; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Rhenium; Samarium; Strontium Radioisotopes; Treatment Outcome

Strontium-89 is a beta emitting radioisotope, avidly taken up by osteoblastic metastatic prostatic cancer. In both open and controlled studies, it has been shown to palliate metastatic pain effectively. It is as effective as conventional radiotherapy in palliation of the primary site(s) of pain, but in addition, it seems to delay pain progression. Its role is confined to palliation of pain in the absence of actual or impending complications (cord compression or pathological fractures). Bone marrow suppression makes it unsuitable for myelosuppressed patients. Cost is the main limitation to its use. It is a useful alternative to hemibody radiotherapy and to local treatment in selected patients. Its use in other tumour types (especially breast cancer) is currently under investigation. Trials investigating its use to delay onset of pain in symptom free relapsing patients should be considered.

Topics: Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms; Strontium Radioisotopes

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

Bone scanning is most useful in the detection of bone metastases. The recent introduction of new radiopharmaceuticals and instrumentation has reduced the time needed to perform the study and its relative cost, while increasing the usefulness of the study in detecting roentgenographically occult diseases. Metastatic disease is used as the pathophysiologic model for understanding the principles of bone scanning. When a tumor invades bone, in addition to causing bone destruction, it also causes reactive bone formation or repair. It is here that radioisotopes are of considerable value, since some radionuclides are incorporated into the hydroxyapatite crystals of reactive bone. Bone repair is described as occurring in three phases. In Phase I, the roentgenogram shows no change in bone density, but the scan is abnormal. In Phase II, both scintigraphic and roentgenographic abnormalities increase, and in Phase III, when the osteoid has calcified completely, the roentgenogram shows radiodensities and the scan appears almost normal. Fewer than 5 per cent of patients have a normal scan in the presence of an abnormal roentgenogram. Presently, most bone scans are performed with phosphate compounds labeled with -99m-Tc. In the past, 85-Sr, 87M-Sr, and 18-F were more broadly used. Scanning may be performed on either a rectilinear scanner or a scintophoto (gamma) camera. Areas which are abnormal on bone scan should be interpreted with current roentgenograms in the light of clinical findings.

Topics: Autopsy; Biopsy; Bone Diseases; Bone Neoplasms; Female; Fluorine; Half-Life; Humans; Lumbar Vertebrae; Male; Middle Aged; Neoplasm Metastasis; Radiography; Radioisotopes; Radionuclide Imaging; Strontium Isotopes; Strontium Radioisotopes; Technetium

93 patients with hormone refractory metastatic prostate cancer were entered on a prospective study to measure reduction in pain and changes in quality of life (QoL) after the administration of 150 MegaBequerel (MBq) Strontium-89 (Sr-89). QoL was assessed using a validated instrument, the Functional Living Index - Cancer (FLIC) questionnaire. Pain response was measured using the Radiation Therapy Oncology Group scoring system. Overall there was limited QoL improvement over 3 months following Sr-89. However, in the 53 patients (63%) achieving pain responses, QoL did significantly improve within 6 weeks of receiving Sr-89 compared to patients with stable or worsening bone pain, and this was independent of other parameters that might influence QoL outcomes, such as performance status, baseline PSA and extent of skeletal disease (P = 0.004). PSA 'response' occurred in 30 patients (37%) over 4 months after Sr-89. This did not appear to correlate with clinical improvement. This study supports the presumption that improvement in pain following Sr-89 is accompanied by better QoL. The lack of correlation of PSA response and clinical parameters indicates that in the palliative setting, PSA may not provide a useful surrogate for treatment outcome.

Topics: Bone Neoplasms; Diarrhea; Follow-Up Studies; Hematologic Diseases; Humans; Male; Nausea; Neoplasm Metastasis; Pain; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Quality of Life; Spinal Cord Compression; Strontium; Strontium Radioisotopes; Surveys and Questionnaires; Treatment Outcome; Vomiting

Topics: Chondroma; Chondrosarcoma; Clinical Trials as Topic; Diagnosis, Differential; Exostoses; Humans; Neoplasm Metastasis; Radionuclide Imaging; Scintillation Counting; Strontium Radioisotopes

Throughout the years, the palliative treatment of bone metastases using bone seeking radiotracers has been part of the therapeutic resources used in oncology, but the choice of which bone seeking agent to use is not consensual across sites and limited data are available comparing the characteristics of each radioisotope. Computational simulation is a simple and practical method to study and to compare a variety of radioisotopes for different medical applications, including the palliative treatment of bone metastases. This study aims to evaluate and compare 11 different radioisotopes currently in use or under research for the palliative treatment of bone metastases using computational methods.. Computational models were used to estimate the percentage of deoxyribonucleic acid (DNA) damage (fast Monte Carlo damage algorithm), the probability of correct DNA repair (Monte Carlo excision repair algorithm), and the radiation-induced cellular effects (virtual cell radiobiology algorithm) post-irradiation with selected particles emitted by phosphorus-32 ((32)P), strontium-89 ((89)Sr), yttrium-90 ((90)Y ), tin-117 ((117m)Sn), samarium-153 ((153)Sm), holmium-166 ((166)Ho), thulium-170 ((170)Tm), lutetium-177 ((177)Lu), rhenium-186 ((186)Re), rhenium-188 ((188)Re), and radium-223 ((223)Ra).. (223)Ra alpha particles, (177)Lu beta minus particles, and (170)Tm beta minus particles induced the highest cell death of all investigated particles and radioisotopes. The cell survival fraction measured post-irradiation with beta minus particles emitted by (89)Sr and (153)Sm, two of the most frequently used radionuclides in the palliative treatment of bone metastases in clinical routine practice, was higher than (177)Lu beta minus particles and (223)Ra alpha particles.. (223)Ra and (177)Lu hold the highest potential for palliative treatment of bone metastases of all radioisotopes compared in this study. Data reported here may prompt future in vitro and in vivo experiments comparing different radionuclides for palliative treatment of bone metastases, raise the need for the careful rethinking of the current widespread clinical use of (89)Sr and (153)Sm, and perhaps strengthen the use of (223)Ra and (177)Lu in the palliative treatment of bone metastases.

Topics: Algorithms; Beta Particles; Bone Neoplasms; Computer Simulation; DNA; DNA Damage; DNA Repair; Humans; Lutetium; Monte Carlo Method; Neoplasm Metastasis; Palliative Care; Radioisotopes; Radiopharmaceuticals; Radium; Rhenium; Samarium; Strontium Radioisotopes

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

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

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

We review the results of treatment of small to medium-sized choroidal malignant melanomas after high-dose-rate brachytherapy with a strontium-90 applicator.. The applicator is positioned against the sclera using an afterloading technique. Brachytherapy is completed in a single session lasting 2-4 h with the patient under local anaesthesia. From September 1983 until March 1995, 46 eyes were treated in this way. Most tumours were 7-11 mm in diameter (range from 4.5-15 mm) with a mean height of approximately 3 mm (range from 1.5-7 mm). Follow-up ranged from 6 months to 12 years (mean 49 months).. Thirty of the 46 eyes had at the final evaluation a nonevolutive scar (20 of these after a single application, the others with some additional treatment). In 13 eyes the tumours were in involution but their complete destruction was not yet certain, and 3 eyes were enucleated for local recurrence. Three patients developed systemic metastases. No radiogenic complications were noticed.. Strontium-90 brachytherapy is a valuable and safe treatment technique for small to medium-sized choroidal malignant melanomas. In addition the use of a strontium-90 applicator is inexpensive thanks to this element's long half-life and the short application time.

Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Choroid Neoplasms; Eye Enucleation; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Male; Melanoma; Middle Aged; Neoplasm Metastasis; Radiotherapy Dosage; Retrospective Studies; Strontium Radioisotopes; Survival Rate; Treatment Outcome

We report a study of strontium kinetics in two patients who received 89Sr therapy for disseminated osteogenic sarcoma, together with estimates of absorbed dose to the principal metastases and to bone marrow. In neither patient did tumour uptake of strontium have a significant effect on whole-body retention. In one patient, whole-body strontium kinetics agreed closely with the ICRP standard model, while in the second, retention was extremely prolonged, probably due to hypertrophic osteoarthropathy. Strontium-85 scintigraphy, surface counting and high-resolution whole-body profiles agreed in showing that in both patients tumour turnover of strontium was very rapid, with a biological half-life of only a few days. Absorbed dose to tumour was found to be comparable in magnitude to the mean bone-marrow dose. We have no reason to believe that 89Sr therapy was of clinical benefit to either patient.

Topics: Adolescent; Adult; Bone Marrow; Bone Neoplasms; Humans; Kinetics; Neoplasm Metastasis; Osteosarcoma; Radiation Dosage; Soft Tissue Neoplasms; Strontium Radioisotopes

The short range tissue destruction of beta-emitting radioisotopes can be utilized in painful metastatic disease of the skeleton by employing a radionuclide that is specifically metabolized in or adjacent to these lesions. Sodium phosphate P 32 has been used for this purpose for the past 25 yr. It uptake in skeletal tumor and in osteoblastic new bone adjacent to tumor can be markedly increased by pharmacologic stimulation using androgenic steroids, or during rebound deposition after a course of parathyroid hormone. Although efficacy in terms of subjective pain relief is high, more objective signs of success are often lacking, and survival, while more confortable, is not prolonged. Marrow depression is the most significant side effect. A beta-emitting, bone-seeking isotope, 89Sr, may have a better therapeutic/toxic ratio, and should receive further trial. Radiation-induced necrosis has also been applied, though more hesitantly, to the proliferative, destructive, but nonmalignant synovium in rheumatoid disease. Here, a number of colloidal preparations, most commonly 198Au, have been employed. Again, relief of symptoms, particularly recurrent joint effusions, is quite high, although the basic disease process is not reversed. The major hazard here appears to be leakage of material to regional lymph nodes, resulting in irradiation of circulating lymphocytes. Although chromosomal damage can be detected when such cells are then cultured, the actual consequences of this, if any, are not presently known. Both shorter-lived (165Dy) and longer-lived (32P) larger-size colloids are being evaluated, which may prove safer in this regard than 198Au.

Topics: Bone Marrow; Bone Neoplasms; Gold Radioisotopes; Humans; Joint Diseases; Neoplasm Metastasis; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Radiation Dosage; Radioisotopes; Strontium Radioisotopes; Synovial Membrane

By well organized preventive examinations early tumour stages can be recognized. The diagnosis of prostatic cancer has to be secured by biopsy. The primary reliability of aspiration biopsies (cytology) was 94% compared with punch biopsies (histology) amounting to 73%. Indications and results of aspiration biopsies, radiological and nuclear medical techniques in diagnosing prostatic cancer are described. The combined anti-androgenic hormonal therapy (infusions of cytonal, subcapsular orchiectomy, permanent administration of oestrogen) is considered to be the unchanged basis of treatment. Comparative cytologic investigations in therapy indicate that high-voltage treatment connected with hormonal therapy seems to be superior to exclusive hormonal treatment. Observations after additional therapy by a radionuclid (89-Strontium) for affecting metastases are encouraging. Indications of a therapy by cytostatica in progressive prostatic cancer are explained.

Topics: Antineoplastic Agents; Biopsy, Needle; Castration; Diethylstilbestrol; Estrogens; Humans; Male; Methods; Neoplasm Metastasis; Prostatic Neoplasms; Radiotherapy, High-Energy; Strontium Radioisotopes

In chronic strontium-90 administration into rats aged 8--10 months osteosarcomas did not develop, while in animals at the age of 3--4 months osteosarcomas incidence was 6.7%. In single injection of the radionuclide in 8--10 months old animals osteosarcomas developed in 2.2% of observations, whereas in 3--4 months old animals--in 45.7%. The most early appearance of osteosarcomas (at the 193d--316th day) was noted in 3--4 months old animals subjected to a single exposure to strontium-90.

Topics: Administration, Oral; Age Factors; Animals; Neoplasm Metastasis; Neoplasms, Experimental; Osteosarcoma; Rats; Strontium Radioisotopes; Time Factors

Following a firm diagnostic and therapeutic schedule for patients with prostatic carcinoma. 89Strontium therapy was introduced for multiple metastases. Positive skeletal scintigraphy with 99mTc-EHDP induced check for affinity to Sr using 85Sr scintigraphy. Of 80 patients, multiple metastases were found in 26. Therapy with 1 mCi of 89Sr-chloride was started in 20 cases. In 8 patients, relief from severe pain appeared shortly afterward, and a further 8 it was possible to prevent the development of pain. Moderate success in 3 cases and a failure to provide relief in 1 were observed.

Topics: Bone Neoplasms; Diphosphonates; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Prostatic Neoplasms; Radionuclide Imaging; Radiotherapy Dosage; Strontium Radioisotopes; Technetium

Topics: Bone and Bones; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Thyroid Neoplasms

In order to allay pains or make them cease, fifteen patients with extended tumors and generalized formation of skeleton metastases were submitted in 1976 to an internal palliative radiotherapy. They received between 0.8 and 2.7 mCi of Sr-89, five patients were treated again after four to five months because the pains had reappeared. The results were relatively good. Two patients showed a prompt effect and were completely free of pains within 48 hours, three patients did not present any demonstrable effect. The analgetic effect remained from four days to four months. Due to the utilization of the pure beta emitter Sr-89, the radiation doses measured in the patients after the application are relatively small: after the application they amount at most to 0.5 mR/h in a distance of 1 m.

Topics: Adult; Aged; Bone Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Palliative Care; Radiotherapy Dosage; Strontium Radioisotopes; Time Factors

The intravenous application of 89-strontium for the relief of pain in 43 patients with breast cancer, bronchogenic cancer, carcinoma of the prostate, hypernephroma and lymphoma with generalized bone metastases is reported. A remarkable clinical improvement was achieved in 33 (76.7%) patients. In four patients a transient analgesic effect was observed. In six cases no response could be achieved. The therapeutic effect usually was long-lasting. At the same time, an increase of alkaline phosphatase was observed, which was interpreted as an indication for the stimulation of osteoblasts and osteoid peripheral zones owing to beta-emission of the radioisotope in the affected areas. There was a significant correlation between the concentration of 85Sr in the bone scan and the therapeutic result of 89Sr-therapy. The indication for such therapy and possible late adverse effects of bone-seeking isotopes are discussed.

Topics: Bone and Bones; Bone Neoplasms; Half-Life; Humans; Liver Neoplasms; Neoplasm Metastasis; Pain, Intractable; Radionuclide Imaging; Strontium Radioisotopes

Topics: Bone Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Pain; Palliative Care; Radiotherapy Dosage; 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

Topics: Bone Neoplasms; Castration; Cortisone; Cryosurgery; Estrogens; Humans; Hypophysectomy; Male; Neoplasm Metastasis; Prostatic Neoplasms; Radiotherapy, High-Energy; Strontium Radioisotopes

In primary bone tumors the possibilities of bone scans are discussed. Exact differentiation between malignant and benign disease by this method is impossible. However, scanning provides important information about extent of the disease, metastases, multiplicity of benign lesions and influence of adjoining diseases to the bone. A special indication exists in cases of cerebral meningiomas and an absolute indication for searching osteoplastic metastases, e.g. in carcinomas of the breast and the prostate gland.

Topics: Bone Diseases; Bone Neoplasms; Child; Fluorine; Granuloma; Hemangiosarcoma; Humans; Male; Meningioma; Neoplasm Metastasis; Osteitis Deformans; Osteoma; Radioisotopes; Radionuclide Imaging; Sarcoma, Ewing; Strontium; Strontium Isotopes; Strontium Radioisotopes; Technetium

The therapeutic application of 89strontium for the relief of pain in 11 cases of carcinoma of the prostate with skeletal metastases is reported. A significant clinical improvement could be observed in 8 of the 11 patients with generalized osseous metastases of prostatic carcinoma after the application of 30 muCi. 89strontium per kg. The effect was long lasting. At the same time an increase of alkaline phosphatase was observed, which was interpreted as an indication of the reactivation of osteoblasts and osteoid peripheral zones owing to beta-emission of the radioisotope in the affected areas. The indications for such therapy are discussed.

Topics: Alkaline Phosphatase; Bone Neoplasms; Humans; Male; Neoplasm Metastasis; Pain, Intractable; Prostatic Neoplasms; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Time Factors

Topics: Bone Neoplasms; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

Bone imaging techniques are a sensitive and accurate method for the detection of primary and secondary neoplastic disease of the skeleton. Such procedures have been demonstrated to be superior to evaluation via blood chemistry levels or routine skeletal radiographic surveys. These techniques are also helpful in establishing sites for biopsy and for objective evaluation of therapeutic modalities. They suffer the disadvantage of being nonspecific, and as a result, all positive areas identified by scanning techniques should be correlated with radiographic changes.

Topics: Bone Neoplasms; Fluorine; Humans; Neoplasm Metastasis; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Technetium

A total of 146 patients were investigated for the presence of osseous metastases with 99mTc polyphosphate or 99mTc pyrophosphate bone scans. Results of bone imaging were retrospectively compared to roentgenographic results surveying similar anatomic areas in 128 patients. This comparison revealed that roentgenographic interpretations were in error in 19% of the cases. Thirty-three patients had bone scans and roentgenograms that were in agreement and considered abnormal, but in more than one third of these cases the patients had multiple abnormalities that were shown by the bone scan but were not recognized roentgenographically. In consideration of the low toxicity, ready availability, economy, shortened procedure time, and low radiation dose associated with the use of these new bone-seeking agents, it is concluded that they are superior to roentgenograms and previously utilized radionuclides for early detection of osseous metastases.

Topics: Bone Neoplasms; Carcinoma; Diphosphates; Fluorine; Humans; Lung Neoplasms; Male; Neoplasm Metastasis; Phosphates; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Scintillation Counting; Strontium Radioisotopes; Urinary Bladder Neoplasms

Topics: Bone and Bones; Bone Neoplasms; Diphosphates; Drug Evaluation; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Scanning is based on the uptake of a nuclide by the crystal lattice of bone and is related to bone blood flow. Cancer cells do not take up the tracer. Normally, the scan visualizes the highly vascular bones. Scans are useful and are indicated in metastatic bone disease, primary bone tumors, hematologic malignancies and some non-neoplastic diseases. The scan is more sensitive than x-ray in the detection of malignant diseases of the skeleton.

Topics: Adult; Bone Diseases; Bone Neoplasms; Child; Diagnosis, Differential; Evaluation Studies as Topic; Femoral Fractures; Fluorine; Humans; Lymphoma; Multiple Myeloma; Neoplasm Metastasis; Osteitis Deformans; Osteosarcoma; Pelvic Bones; Phosphates; Radiography; Radioisotopes; Radionuclide Imaging; Skull Neoplasms; Strontium Isotopes; Strontium Radioisotopes; Technetium

Comparative studies between radiological (equals R; x-ray, thermography, angiography) and nuclear medical examinations (equals NM; scanner-, scintillation camera-sequential scintigraphy) in 339 patients with different bone diseases led to the following results: Thermography proved to be inferior to scanning in detecting of bone diseases. Angiography was the procedure of choice in detecting malignant bone tumors. Sequential scintigraphy performed by means of the Anger-HP-scintillation camera and Intertechnique-Cine-System allowed to establish the kinetic behaviour of tumors: an early increased TcPoP accumulation was observed in tumors with high perfusion (sarcoma), a late accumulation in those with low perfusion (osteoid osteoma).

Topics: Angiography; Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Diagnostic Errors; Femoral Neoplasms; Humans; Kinetics; Neoplasm Metastasis; Osteoma, Osteoid; Osteosarcoma; Phosphates; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Thermography; Tibia

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

Malignant disease very often spreads to the skeleton. This is particularly true for carcinomas of the breast, the lungs, the prostate, and the thyroid. Knowledge of the state of the skeleton in these disorders is therefore desirable since patient management will largely depend on the early detection of bony deposits. Primary bone disease often spreads to soft tissue (lungs), and the early detection of this may alter significantly the therapeutic approach to the primary lesion. Traditionally, X-ray skeletal surveys and serum enzyme measurements provide indices which can be used in the staging of these disorders. Complementary techniques such as mammography, xeroradiography, thermography, and radionuclide imaging have been used to provide further relevant information. A number of benign bone diseases need early assessment in order to institute the best form of treatment. It is of importance to assess the circulation in localized areas of bone and to predict the appearance of avascular necrosis, to understand the healing mechanisms involved in fractures, and to predict the outcome of bone grafting. In this paper the clinical role of bone scanning is reviewed, particular attention being given to the recent advances brought about by the introduction of the 99mTc compounds. It is important that the non-specialist should be aware of the great improvement in the results obtained and in the help they can give him in deciding on the best management of each patient as an individual.

Topics: Bone and Bones; Bone Diseases; Bone Neoplasms; Fluorine; Humans; Kidney Diseases; Neoplasm Metastasis; Osteolysis; Phosphates; Radioisotopes; Radionuclide Imaging; Strontium Isotopes; Strontium Radioisotopes; Technetium

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: Angiography; Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Fluorides; Follow-Up Studies; Humans; Methods; Neoplasm Metastasis; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Thermography

Topics: Abdominal Neoplasms; Adenocarcinoma, Mucinous; Aged; Citrates; Gallium; Humans; Indium; Male; Neoplasm Metastasis; Phosphates; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Transferrin

Topics: Administration, Oral; Aged; Bone Neoplasms; Diethylstilbestrol; Humans; Hydroxyproline; Injections, Intravenous; Male; Methods; Middle Aged; Neoplasm Metastasis; Neoplasm Regression, Spontaneous; Phosphoric Monoester Hydrolases; Prostatic Neoplasms; Radiography; Strontium Radioisotopes; Time Factors

Topics: Bone Marrow; Bone Neoplasms; Densitometry; Diphosphates; Humans; Male; Neoplasm Metastasis; Phosphates; Prostatic Neoplasms; Radiation Dosage; 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; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Thermography

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: Bone Neoplasms; Female; Giant Cell Tumors; Humans; Male; Neoplasm Metastasis; Osteoma, Osteoid; Radiography; Radionuclide Imaging; Scintillation Counting; Strontium Radioisotopes

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: Adult; Bone Neoplasms; Female; Humans; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Thermography

Topics: Bone Neoplasms; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

Topics: Autopsy; Bone and Bones; Bone Diseases; Bone Neoplasms; False Negative Reactions; Fluorine; Half-Life; Humans; Neoplasm Metastasis; Radiography; Radionuclide Imaging; Strontium Isotopes; Strontium Radioisotopes; Technetium

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: Bone Neoplasms; Humans; Methods; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

Topics: Acid Phosphatase; Aged; Biopsy, Needle; Bone and Bones; Bone Marrow; Bone Neoplasms; Castration; Humans; Ilium; Male; Middle Aged; Neoplasm Metastasis; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes

Topics: Animals; Bone Diseases; Bone Neoplasms; Bony Callus; Diagnosis, Differential; Female; Fractures, Bone; Half-Life; Humans; Injections, Intravenous; Male; Neoplasm Metastasis; Rabbits; Spinal Neoplasms; Strontium Radioisotopes

Topics: Colonic Neoplasms; Humans; Liver Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

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

Topics: Bone Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

Topics: Age Factors; Bone and Bones; Bone Diseases; Bone Neoplasms; Calcification, Physiologic; Fluorine; Fractures, Bone; Humans; Infections; Necrosis; Neoplasm Metastasis; Osteitis; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Sclerosis; Strontium Radioisotopes; Technetium; Time Factors; Whole-Body Counting

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: Bone Diseases; Bone Neoplasms; Humans; Neoplasm Metastasis; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Bone Neoplasms; Diphosphates; Humans; Neoplasm Metastasis; Radionuclide Imaging; Remission, Spontaneous; Strontium Radioisotopes; Technetium; Tomography, X-Ray

Topics: Adult; Bone Neoplasms; Female; Humans; Hydronephrosis; Middle Aged; Neoplasm Metastasis; Pelvic Neoplasms; Radionuclide Imaging; Strontium Isotopes; Strontium Radioisotopes; Ureteral Obstruction

Topics: Alkaline Phosphatase; Bone Neoplasms; Clinical Enzyme Tests; Evaluation Studies as Topic; Humans; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Adult; Bone Diseases; Bone Neoplasms; Female; Humans; Male; Methods; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Strontium Radioisotopes

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: Adolescent; Adult; Bone Neoplasms; Female; Gallium; Humans; Male; Middle Aged; Neoplasm Metastasis; Pelvic Neoplasms; Radioisotopes; Radionuclide Imaging; Spinal Neoplasms; Strontium Radioisotopes

Topics: Adolescent; Adult; Child, Preschool; Dimethyl Sulfoxide; Female; Humans; Keloid; Male; Middle Aged; Neoplasm Metastasis; Neoplasms; Penile Induration; Skin Neoplasms; Strontium Radioisotopes; Vitamin A

Topics: Arteriovenous Malformations; Astrocytoma; Brain; Brain Neoplasms; Cerebral Angiography; Cerebrovascular Disorders; Chlormerodrin; Chondroma; Craniopharyngioma; Diagnosis, Differential; Glioblastoma; Hematoma, Subdural; Humans; Mercury Isotopes; Neoplasm Metastasis; Pituitary Neoplasms; Pneumoencephalography; Radionuclide Imaging; Strontium Radioisotopes; Technetium