strontium-radioisotopes and Pain--Intractable

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

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

Strontium-89 is a pure beta-emitting radioisotope, a chemical analogue of calcium, and it is therefore avidly concentrated by areas of high osteoblastic activity. Selective uptake and prolonged retention at sites of increased bone mineral turnover provide precise bone lesions targeting. 89Sr chloride (commercialised as Metastron) is typically administered in a single 150 MBq parenteral dose. Its radioactive emission poses very little radioprotection concerns. Overall, studies show pain relief in up to 80% of patients, of which 10 to 40% became effectively pain free. The mean duration of palliation was 3-4 months. The mechanism of pain relief is controversial ; it is probably, but not only, related to the absorbed dose in the tumour and bone. There is no clear dose-response relationship. The only reported toxicity is temporary myelosuppression. WBC and platelets should be monitored at least on a weekly basis until they return to baseline. It seems that only patients with a reasonably good general condition stand to benefit from this treatment. In conclusion, systemic radionuclide therapy using 89Sr represents a feasible, safe, effective, well tolerated and cost-effective palliative treatment in patients with refractory bone pain.

Topics: Bone Neoplasms; Dose-Response Relationship, Radiation; Female; Humans; Male; Pain, Intractable; Palliative Care; Strontium Radioisotopes

Topics: Bone Neoplasms; Controlled Clinical Trials as Topic; Humans; Male; New Jersey; Pain, Intractable; Palliative Care; Prognosis; Prostatic Neoplasms; Strontium Radioisotopes

Topics: Aged; Bone Neoplasms; Clinical Trials as Topic; Combined Modality Therapy; Dose-Response Relationship, Drug; Follow-Up Studies; Hormones; Humans; Male; Middle Aged; Orchiectomy; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Failure

Recent advances in targeted radiotherapy offer a new approach for the management of metastatic bone pain. This paper will review the scientific basis for radionuclide therapy and will examine the evidence for clinical efficacy. The therapeutic potential of targeted radiotherapy can only be appreciated by comparison with established treatments. Alternative treatment options will, therefore, be discussed, to bring the potential advantages and hazards of targeted radiotherapy into perspective and to define its place in routine management.

Topics: Analgesics; Bone Neoplasms; Combined Modality Therapy; Etidronic Acid; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain, Intractable; Palliative Care; Radioisotopes; Radiotherapy; Rhenium; Samarium; Strontium Radioisotopes

Management of bone pain in patients with multiple osseous metastases is a significant clinical problem. Phosphorus-32 has been used as systemic radioisotope therapy for the management of bone pain for over 40 years. However, significant hematological depression usually results and its use is limited. More recently, the bone-seeking radiopharmaceuticals strontium-89, samarium-153-ethylenediaminetetramethylene phosphonic acid, and rhenium-186-hydroxyethylidene diphosphonate have all been used as palliative treatment for patients with clinically significant bone pain. Excellent clinical responses with acceptable hematological toxicity have been observed. The clinical results rival those of external beam radiation therapy, with fewer systemic and hematological side effects. Systemic radionuclide therapy is indicated in the management of patients with painful metastatic prostate cancer in bone as soon as they escape primary hormonal management. This therapy also should play a role in the management of many patients with advanced breast cancer metastatic to bone. The role of radionuclidic therapy in osseous metastases from other malignancies is still being investigated. These compounds also hold promise as primary therapy for tumors of osseous origin. Systemic radionuclide therapy of painful bony metastases will become common in nuclear medicine practice in the next decade.

Topics: Bone Neoplasms; Humans; Pain, Intractable; Radioisotopes; Strontium Radioisotopes

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

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

It has been affirmed that observational studies give analogous results to randomised controlled ones.. A multicentre observational trial was conducted between 1996-1998 in order to evaluate the efficacy of palliative radionuclide therapy for bone metastases in a large number of patients. An evaluation was made on 510 patients with prostate cancer and painful bone metastases, treated with a single iv. dose of 89Sr-chloride (527 treatments) or 186Re-HEDP (83 treatments), in 29 Italian Nuclear Medicine Departments. Eighty-one patients received up to five injections, totalling 100 retreatments. Patients were followed up for a period of 3 months-2 years. Results were expressed at four levels of response: excellent, good, mild, and nil.. Responses were excellent in 26.4%, good in 33.3%, mild in 21.3% and nil in 19% of all treatments, while good and excellent responses were obtained in 48% of retreatments. No statistically significant correlations were found between response and age of patients, skeletal extension of tumour, pretherapeutic PSA levels, evidence of non-bony metastases, previous chemotherapy and/or external-beam radiotherapy; osteolytic lesions responded worse than osteoblastic or mixed ones. Hematological toxicity (mild to moderate), mainly affecting platelets, was observed in 25.5% of all treatments and in 38.9% of retreatments. No clear differences were found between the two radiopharmaceuticals employed.. Bearing in mind that observational studies can provide just as accurate results as randomised controlled trials, this study confirms the main findings of various limited monocentre trials.

Topics: Bone Neoplasms; Etidronic Acid; Humans; Male; Organometallic Compounds; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Rhenium; Strontium; Strontium Radioisotopes; Tin Radioisotopes

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

One hundred and eighteen patients with painful skeletal metastases of malignant diseases (predominantly prostate, breast and lung cancer) were treated with 150 MBq of strontium-89 chloride (Metastron, Amersham, UK) intravenously. The results were evaluated according to a score considering pain relief, mobility, analgesic intake and general feeling. In only five patients (4.2%) was no improvement observed; mild improvement was noted in 48 (40.7%), and substantial or complete improvement in 56 (47.5%) and 9 (7.6%), respectively. The mean painless period after a single 89SrCl dose was 3.3 +/- 2.28 months (in patients with prostate, lung, breast and other types of cancer it was 3.65 +/- 2.11, 3.29 +/- 1.27, 3.08 +/- 0.48 and 3.44 +/- 1.36 months, respectively). During a 3-year study, 89SrCl treatment was successively repeated up to 5 times in some patients (total number of Metastron applications was 256) who benefited from the first Metastron administration and did not show signs of myelosuppression. Even after repeated treatment, relief was consistent and the duration of the period without pain increased (in particular in patients with breast cancer, in whom the period of relief was prolonged from 3.08 +/- 0.48 months after the first dose to 5.33 +/- 2.36 months after the fifth 89SrCl administration). The increased painless period was not observed after repeated treatment in the patient group comprising miscellaneous types of cancer, and the degree of improvement was less apparent. During the course of successive 89SrCl treatments, transient signs of myelosuppression indicated by a decrease in white cell and thrombocyte counts of at least 25% were observed 10 times after Metastron administration (twice in two patients), i.e. in 3.9% of all 89SrCl administrations; these transient haematological changes of moderate grade were closely connected with Metastron administration. Palliative treatment of metastatic skeletal pain with 89SrCl improves the quality of life in most patients suffering from prostate, lung and breast cancer and may be safely repeated with the same benefit and without significant myelosuppression. The beneficial effect of 89SrCl treatment seems to be less pronounced in other types of cancer with painful skeletal metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Leukocyte Count; Male; Middle Aged; Pain, Intractable; Palliative Care; Platelet Count; Strontium Radioisotopes; Treatment Outcome

A Phase I and II study has been conducted of the safety and efficacy of 89Sr (injected i.v. as the chloride) to alleviate bone pain due to osseous metastatic disease. Potential attendant hematologic toxicity was also examined. Strontium-90 impurities were always less than 1.5%, employing a new quality control technique which detects the 90Y "daughter". Thirty-eight patients with pain due to osseous metastases requiring regular narcotic more than twice a day, documented by an abnormal bone scan and radiography, received 45 doses (1-4.5 mCi, 16-70 microCi/kg) of 89Sr after informed consent. The performance status (Karnofsky scale) ranged from 20-80%. One patient had complete pain relief while 22 other doses yielded at least a 25% reduction in narcotic requirement lasting at least 1 mo and/or 20% improvement in Karnofsky scale rating. Two patients had marked to complete relief in tumor sites which were not fractured, with no change in fracture pain. Twenty-two did not respond. Response was independent of narcotic requirements, tumor type, or Karnofsky status. No hematologic toxicity occurred. Strontium-89 may be useful as adjuvant therapy for diffuse bone pain, but a double-blind study comparing it to other nonnarcotic modalities is required.

Topics: Bone Neoplasms; Clinical Trials as Topic; Dose-Response Relationship, Radiation; Etidronic Acid; Female; Humans; Male; Organotechnetium Compounds; Pain, Intractable; Strontium; Strontium Radioisotopes; Technetium; Time Factors; Yttrium Radioisotopes

A 77-year-old man was diagnosed as having cholangiocellular carcinoma. The patient underwent partial right hepatectomy in June 2008, and multiple bone metastases occurred approximately 9 months after surgery. He refused salvage chemotherapy and radiation therapy. Although he had been treated with opiate analgesics, he was unable to sit up owing to severe pain in the left ilium. He was hospitalized because of buttock pain and left leg numbness. Even a combination of fentanyl patch, gabapentin, and subarachnoid block was ineffective in controlling pain. Strontium-89 (89Sr) therapy was successful in eliminating the intractable pain, and there were no serious side effects during therapy. The patient was discharged from the hospital, and he received palliative care at home for a short period.

Topics: Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Bone Neoplasms; Cholangiocarcinoma; Humans; Male; Pain, Intractable; Palliative Care; Strontium Radioisotopes

We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time.

Topics: Adult; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Pain, Intractable; Phenol; Strontium Radioisotopes; Subarachnoid Space; Urinary Bladder Neoplasms

To evaluate the efficacy of strontium-89 (89Sr) in the treatment of painful bone metastases of prostate cancer.. A total of 116 patients with painful bone metastases of prostate cancer received bilateral orchiectomy and incretion, followed by intravenous injection of 89Sr at the dose of 1.48-2.22 MBq (40-60 microCi)/kg. The clinical effects were evaluated by follow-up analysis.. After the 89Sr treatment, appetite and sleep were evidently improved in 33.6% and 56.0% of the patients respectively, the applied dose of anodyne reduced in 61.2%, pain alleviated in 83.6%, with an absolute palliation rate of 24.1%. Pain relief started at 3-21 (10.2 +/- 6.5) days and lasted 3-12 (5.3 +/- 2.2) months. Flare ache occurred in 31.9% of the patients. Compared with pre-treatment, the mean score on Karnofsky's performance status (KPS) was 20.0% higher, and the WBC count decreased to 3.0-3.9 x 10(6)/L in 18.1% of the patients. Whole body bone scintigraphy of 53 followed-up patients showed that 39 (73.6%) of them exhibited an obvious decrease in the number of metastases, 10 (18.9% remained in a stabilized state and only 4 (7.5% deteriorated.. 89Sr, capable of inhibiting bone metastasis, palliating pain and improving the quality of life with few adverse effects, can be used as a desirable therapeutic for painful bone metastases of prostate cancer.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Follow-Up Studies; Humans; Male; Middle Aged; Pain, Intractable; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome

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

To investigate the therapeutic effects of strontium-89 against osseous metastases of lung cancer.. A total of 126 patients with osseous metastases of lung cancer received strontium-89 treatment ((89)SrCl(2)) at the dose of 148 MBq given through a single intravenous injection. The analgesic effect was evaluated by the changes in the degree, frequency and scores of the pain, and the therapeutic effect assessed by observing the changes in the number and volume of osseous lesions after therapy and compared between different pathological types of lung cancer by Ka-square test.. Within 6 months after the injection, the total pain relief rate was 70.6% (89/126), including 25 (19.8%) cases with pain vanished, suggesting significant alleviation of the pain intensity by the treatment (u=5.361, P<0.01). The frequency of pain was reduced in 78.6% (99/126) of the cases (u=4.589, P<0.01), and the average score of pain decreased significantly from 7.54+/-3.29 to 4.19+/-4.38 (t=6.865, P<0.001). The number and size of lesions decreased by more than 25% in 57 cases, showing a total efficacy rate of 45.2% (57/126). No significant difference was noted in the therapeutic effects among the 4 pathological types of lung cancer (P>0.05).. Strontium-89 is effective for pain relief and tumor focus confinement in osseous metastases of lung cancer. No significant difference has been found in its effect between 4 different pathological types of lung cancer.

Topics: Adenocarcinoma; Adult; Aged; Bone Neoplasms; Carcinoma, Squamous Cell; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pain, Intractable; Strontium Radioisotopes

We studied the correlation between the efficacy of local external beam radiotherapy and the efficacy of strontium-89 in the palliation of osteoblastic metastatic bone pain in 43 patients with cancer. All 43 had been treated with hormonal or chemotherapy according to the primary malignancies and analgetic pharmacotherapy as needed, 36 received local external beam radiotherapy as a palliative before strontium-89 injection, and all 43 were ultimately treated with strontium-89 as salvage therapy. Responses to the first strontium treatment, and to the first radiation treatment if given, were taken from patient files. Pain was evaluated by Karnofsky performance status, analgesic dosage, and duration of response to treatment translated into numeric scores on a pain duration scale and an integrated response scale. The efficacy of limited field external radiation in metastatic bone pain palliation was 80.6% versus 58.1% for strontium-89. Patients treated with both external radiation and strontium had a positive correlation of 0.4 with a probability of P = 0.0158 between the responses to the 2 treatments, indicating that response to external radiotherapy could be viewed as an indicator of strontium-89 efficacy in metastatic osteoblastic bone pain palliation in the same patient. No significant correlation was found between strontium efficacy and gender, location of metastases to weight-bearing bones, duration of hormonal therapy or chemotherapy, or type of primary neoplasm.

Topics: Bone Neoplasms; Female; Humans; Male; Pain Measurement; Pain, Intractable; Palliative Care; Radiopharmaceuticals; Retrospective Studies; Salvage Therapy; Strontium Radioisotopes

Topics: Aged; Bone and Bones; Bone Neoplasms; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

Topics: Analgesics, Non-Narcotic; Animals; Bone Neoplasms; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain, Intractable; Palliative Care; Phosphorus Radioisotopes; Radioisotopes; Samarium; Strontium; Strontium Radioisotopes

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

Strontium-89 is effective in the palliation of bone pain caused by skeletal metastases. Its primary side effect is mild thrombocytopenia that typically recovers in 3 or 4 months. Subclinical disseminated intravascular coagulation is reported to be present in approximately 10% to 20% of patients with advanced prostate cancer. These patients may be at increased risk for severe marrow depression after radionuclide therapy for bone pain palliation. This report describes a patient with painful bony metastases resulting from prostate carcinoma. He had a normal platelet count and no clinical evidence of a coagulation disorder at the time of strontium-89 therapy, and a severe disseminated intravascular coagulation developed and lead to death after treatment. A normal platelet count before strontium-89 therapy does not preclude subsequent disseminated intravascular coagulation, and we support the Society of Nuclear Medicine's bone pain treatment procedure guideline that patients referred for bone palliation should be screened for disseminated intravascular coagulation before therapy.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Disseminated Intravascular Coagulation; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

The authors report the cases of two patients in whom strontium-89 (89Sr) was used to relieve diffuse metastatic bone pain. The type of cancer involved, thymic carcinoid tumor, is itself rare and the risk of its metastasizing to the bone is very low. Both patients showed a measure of response to treatment, suggesting that this analgesic method has value for some patients. The marked benefit of one patient for a total of 9 months was attributable to two 89Sr injections, whereas the other patient improved for only 5 weeks after one injection.

Topics: Adult; Analgesics; Bone Neoplasms; Carcinoid Tumor; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Intractable; Radiopharmaceuticals; Strontium Radioisotopes; Thymus 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

Topics: Bone Neoplasms; Female; Humans; Male; Nuclear Medicine; Pain, Intractable; Palliative Care; Societies, Medical; Strontium Radioisotopes

Strontium-89 chloride is widely available in the U.S. and Europe for patients afflicted by bone metastasis associated with pain. 89Sr is a pure beta-emitter and it is thought to be difficult to estimate its distribution externally. We tried to image the distribution of 89Sr uptake with bremsstrahlung from beta-minus decay of 89Sr by using Nal scintillation camera. Pronounced 89Sr depositions in the bone metastatic sites were imaged in the energy windows from 50 keV to 150 keV bremsstrahlung. The distribution of these depositions corresponded to 99mTc-HMDP image may be suspected to the effectiveness of this therapy. The identification of 89Sr distribution might be useful in evaluating the bone marrow radiation dose too.

Topics: Aged; Bone and Bones; Bone Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Pain, Intractable; Radionuclide Imaging; Radiotherapy, High-Energy; Scattering, Radiation; Scintillation Counting; Strontium Radioisotopes; Technetium Tc 99m Medronate

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

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

Topics: Bone Neoplasms; Female; Georgia; Humans; Male; Pain, Intractable; Palliative Care; Physicians; Strontium Radioisotopes; Surveys and Questionnaires

Topics: Bone Neoplasms; Humans; Osteoblasts; Pain, Intractable; Palliative Care; Strontium Radioisotopes

Topics: Bone Neoplasms; Etidronic Acid; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain, Intractable; Palliative Care; Radioisotopes; Rhenium; Samarium; 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

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

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

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

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

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