strontium-radioisotopes and Prostatic-Neoplasms

To describe drugs used in the non-hormonal treatment of metastatic prostate cancer.. Bibliographical search was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned.. The metabolic radiotherapy although under-used for this indication, kept a place at the beginning of the disease. Radium-223 chloride seems to have to occupy an important place in the coming years. The chemotherapy, the only recourse until very recently in the castration-resistant prostate cancer, must redefine its place partially. The denosumab provide an interesting alternative to bisphosphonates.. The non-hormonal treatment of the metastatic disease of the prostate cancer is changing rapidly with the emergence of new molecules. Urologist must know perfectly these new drugs.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Bone Density Conservation Agents; Cisplatin; Denosumab; Docetaxel; Etoposide; Humans; Male; Mitoxantrone; Organometallic Compounds; Organophosphorus Compounds; Osteoporosis; Prostatic Neoplasms; Radiation Protection; Radioisotopes; Radium; RANK Ligand; Strontium; Strontium Radioisotopes; Taxoids

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

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

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

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

Metabolic radiotherapy is a new therapy for management of bone pain in patients with bone metastatic prostate carcinoma. Strontium-89 and Samarium-153 concentrate in bone metastases and radiate them. A pain decrease is obtained in 60-70% of cases. Side effects are a significant hematological depression without great clinical consequences if good therapeutic indications are respected. Our multidisciplinary experience of these radionuclides in 54 performed treatments shows a rate of good responders of 66% with a rate of excellent results (total decrease of pain) in 47%. The therapeutic effectiveness is correlated with pain intensity measured by Visual Analogic Scale (VAS) and equivalent dose of morphine. Radionuclide therapy should be applied to patients as early as possible after establishment of bone metastases.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Analgesics, Opioid; Bone Neoplasms; Clinical Trials as Topic; Double-Blind Method; Forecasting; France; Hematologic Diseases; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Phosphorus Radioisotopes; Prospective Studies; Prostatic Neoplasms; Radioisotopes; Radiopharmaceuticals; Rhenium; Samarium; Strontium; Strontium Radioisotopes; Treatment Outcome

Topics: Androgens; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Clinical Trials as Topic; Clodronic Acid; Cyclophosphamide; Dexamethasone; Docetaxel; Estramustine; Humans; Male; Neoplasms, Hormone-Dependent; Paclitaxel; Prostatic Neoplasms; Strontium Radioisotopes; Taxoids; Tegafur; Treatment Outcome

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

Strontium-89 is a pure Beta-emitting radioactive analogue of calcium that has been shown to be beneficial in the palliation of pain due to osseous metastases from adenocarcinoma of the prostate. The most significant reported toxicity is dose-related, reversible, myelosuppression characterized primarily by thrombocytopenia.. A report of two patients in whom acute myelogenous leukemia (AML) developed after treatment with strontium-89 and a review of the literature are presented.. The two patients described in the current study developed AML 17 months and 26 months, respectively, after exposure to strontium-89 for the treatment of prostate carcinoma. To the authors' knowledge these patients represent the first two reported cases of AML after strontium-89 therapy for prostate carcinoma.. The results of the current study suggest the leukemogenic potential of strontium-89 treatment in humans. To the authors' knowledge, the current study represents the first report of AML after therapeutic exposure to strontium-89. As this agent is used more frequently (and earlier in the disease course) in patients with prostate carcinoma, an increased incidence of secondary AML complicating the clinical management of patients with prostate carcinoma may be observed. [See editorial on pages 497-9, this issue.]

Topics: Adenocarcinoma; Aged; Beta Particles; Bone Neoplasms; Dose-Response Relationship, Radiation; Fatal Outcome; Follow-Up Studies; Humans; Leukemia, Myeloid, Acute; Leukemia, Radiation-Induced; Male; Neoplasms, Second Primary; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Strontium Radioisotopes; Thrombocytopenia

Most cases of advanced carcinoma of the prostate are hormonosensitive. The use of combined androgen blockade (CAB) seems to improve survival and quality of life, but only when combined with chemical castration by luteinizing-hormone-releasing hormone analog and without the use of steroidal antiandrogens. After CAB, further hormonal treatments remain efficacious, such as antiandrogen withdrawal followed by estrogens, aromatase inhibitors, and hormone-refractory prostate cancer multiple cytotoxic agents. For painful bone lesions, external beam radiotherapy, biphosphonates, and strontium 89 or samarium 153 provide pain relief. The use of new methods for the evaluation of response and quality of life will allow the rapid identification of effective treatments and permit powered phase III trials.

Topics: Androgen Antagonists; Bone Neoplasms; Brachytherapy; Combined Modality Therapy; Estrogens; Humans; Leuprolide; Male; Pain; Patient Care Planning; Prostatic Neoplasms; Quality of Life; Radiotherapy; Strontium Radioisotopes

Topics: Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes

Topics: Bone Neoplasms; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

Many radiotherapeutic treatment options are available for the palliation of patients with metastatic prostate cancer. These include local field radiotherapy to symptomatic sites of metastasis and the use of radioisotope therapy either alone or in combination with local field radiotherapy. To date, the majority of patients treated with radioisotope therapy have been treated with 89Sr. Other agents, such as 153Sm-EDTMP are available now, also. Combined radioisotope therapy, cytotoxic chemotherapy, and biphosphonates hold great promise.

Topics: Bone Neoplasms; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

Four patients (men aged 75, 67, 65 and 69 years) with painful osseous metastases from prostate cancer were treated by intravenous radionuclide therapy using Strontium-89. All had secondary progression after initially successful hormonal treatment. Three of these four had good responses lasting from 5 to 9 months. One patient with rapidly progressive disease did not respond. Second and third injections were successful in two patients. Mild bone marrow suppression was observed in all, but was not clinically significant. The 70-80% chance of long-lasting pain alleviation through a single injection of Strontium-89 is a valuable addition in the treatment of painful bone metastases from prostate cancer, and probably also in such metastases from breast cancer.

Topics: Aged; Bone Marrow; Bone Neoplasms; Contraindications; Disease Progression; Humans; Injections, Intravenous; Male; Pain; Palliative Care; Prostatic Neoplasms; Radiotherapy; Recurrence; Strontium Radioisotopes; Treatment Outcome

Strontium-89 systemic radiotherapy can play a significant role in the palliation of symptomatic osseous metastases from prostate cancer. Given as a single injection, strontium's affinity for osteoblastic activity draws it to all sites of osseous involvement simultaneously. The metastases are bathed with beta-particles whose short range in tissues spares the surrounding normal structures. This article will review the rationale, physiology, and patient selection criteria for its use. Approximately 80% of patients will respond to treatment as documented by the authors experience and by a review of the literature.

Topics: Adult; Aged; Bone Neoplasms; Controlled Clinical Trials as Topic; Humans; Male; Middle Aged; Multicenter Studies as Topic; Palliative Care; Patient Selection; Prognosis; Prostatic Neoplasms; Strontium Radioisotopes; Survival Rate

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

To review the current use of strontium-89 (89Sr) to treat pain related to bony metastasis secondary to prostate cancer.. Published articles.. Prostate cancer is the most commonly diagnosed cancer in the United States. The disease's most common site of metastasis is the bones. Bone metastasis leads to unrelenting pain. If healthcare providers are able to manage a patient's pain successfully, the patient's quality of life improves.. When conventional therapies fail, 89Sr can be used as an alternative or an adjunct to pain management of bony metastasis in prostate cancer.. Nursing intervention primarily involves assessing pain, monitoring analgesics until 89Sr can begin to take effect, educating patients on using other medications with 89Sr, and assessing fatigue resulting from 89Sr-induced myelosuppression. As pain decreases, nurses also should monitor patients' activity levels, since they are at risk for pathologic fractures.

Topics: Bone Neoplasms; Humans; Male; Nursing Assessment; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radiotherapy Dosage; Strontium Radioisotopes; Treatment Outcome

Metastatic bone disease from hormone-refractory prostate cancer can lead to significant morbidity such as pain, nerve compression and fractures which diminishes the quality of life of these patients substantially. Pain from osteoblastic metastases can significantly be improved by both external radiotherapy and Strontium-89 (89Sr), whereas lytic metastases are only responsive to external irradiation. Pain relief is obtained in approximately 80% of patients. Toxicity is mild and retreatment is usually possible. External beam radiotherapy is indicated when spinal cord or nerve root compression is demonstrated, or when osteolytic metastases with danger of fracture are visualized. External radiotherapy and Strontium-89 are important treatments to palliate patients suffering from metastatic prostate cancer. Because of their mild toxicity and highly effective analgesic effect, implementation of irradiation and 89Sr should be start of early in the disease process of these patients in order to keep them ambulatory and pain-free as long as possible.

Topics: Bone Neoplasms; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Radioisotope Teletherapy; Strontium Radioisotopes

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

To present the current state of systemic radiopharmaceutical therapy for the palliation of pain in individuals with metastatic cancer and to evaluate the palliative effect and degree of hemotoxicity of strontium chloride 89 (89Sr) in patients with painful osteoblastic metastases primarily from prostate and breast cancer.. A MEDLINE search through December 1994 was performed to identify English-language studies that met the following criteria. All eligible studies reported treatment of patients with painful osteoblastic bony metastases primarily from prostate or breast cancer treated with intravenous 89Sr. For study eligibility, evaluation of clinical response as assessed by the Karnofsky index, need for pain medication, or changes in mobility or sleep patterns was required. Hemotoxicity data were a requirement. A minimum of 10 prostate cancer cases was necessary for study inclusion. Only those studies assessing clinical response following one injection of 89Sr were included. Preliminary reports of cooperative studies were not included. Doses of 89Sr ranged from 0.6 MBq/kg (16 microCi/kg) to 400 MBq (10.8 mCi) per patient. Evaluation of patients for at least 3 months following 89Sr treatment was required. In addition, two studies examining issues of cost with regard to 89Sr treatment were identified.. Baseline pain assessment and periodic pain estimates as measured by the Karnofsky index, medication diaries, changes in mobility, sleep patterns, and/or ability to work were the basis for assessment of response. Baseline and periodic complete blood cell counts were the basis for hemotoxicity evaluation.. Palliation and hemotoxicity data were analyzed separately for each study. Some improvement occurred in as many as approximately 80% of patients. Several studies demonstrated complete relief of pain in at least 10% of patients The nadir of platelet and white blood cell counts appears at approximately 4 to 8 weeks following injection, with a partial return to baseline by 12 weeks. As many as 10 injections spaced 3 months apart have been given to some patients with repeated palliative effect and without serious hemotoxicity. Reinjection may be limited by a platelet count below 60 x 10(9)/L, a white blood cell count below 2.4 x 10(9)/L, or the absence of osteoblastic skeletal metastasis as seen on bone scan. Studies examining treatment costs suggest that 89Sr may decrease costs associated with palliation of pain due to metastatic disease.. As many as 80% of selected patients with painful osteoblastic bony metastases from prostate or breast cancer may experience some pain relief following 89Sr administration. In addition, as many as 10% or more may become pain free. Duration of clinical response may average 3 to 6 months in some cases. Hemotoxicity is mild. A decrease in treatment costs with administration of 89Sr to patients with painful osteoblastic bony metastases from prostate cancer may occur. These observations reflect the preliminary nature of knowledge in this field and point to the need for larger clinical trials of the use of 89Sr palliation.

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

Strontium-89 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

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

Bone metastases that develop in patients with advanced prostate cancer often cause deep, unremitting pain. Palliative options for the control of this pain include analgesic support, cytotoxic chemotherapy and external-beam radiotherapy. In addition to external irradiation, interest in intravenously injected radioisotopes that are preferentially localized to bone has been mounting. Metastron (an isotope of strontium) imitates the biodistribution of calcium in vivo and is avidly taken up into bony metastases where it has a biological half-life of just over 50 days. The biological half-life in undiseased bone is far shorter, approximately 14 days. Various studies have been conducted to evaluate the role of Metastron in metastatic prostate cancer. An optimum dose has yet to be finalized, but it is clear that the change of haematological toxicity becomes more significant at much larger doses. In the large, randomized Trans Canada study in which Metastron or placebo was given to patients as an adjunct to local field irradiation, those patients treated with Metastron had a significantly reduced intake of analgesics. Furthermore, progression of pain, as measured either by sites of new pain or by the requirement for further palliative radiotherapy, demonstrated statistically significant differences in favour of Metastron. There is thus increasing evidence of a useful role for Metastron in the treatment of prostate cancer metastatic to bone.

Topics: Antineoplastic Agents; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium; Strontium Radioisotopes

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

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

Reports published in the English literature of clinical trials utilizing intravenous strontium 89 (89Sr) in the treatment of patients with prostatic adenocarcinoma metastatic to bone were reviewed. Correlation coefficients were calculated for increasing dose of 89Sr and complete pain relief and complete and partial pain relief. Statistically significant positive correlations were obtained for complete relief of pain. Positive correlations were also found between those patients who had at least partial pain relief (defined as at least a 50% reduction in analgesia requirement), but these did not reach significance. This analysis suggests that a dose response relationship may exist between the dosage of 89Sr administered, and complete relief of pain due to skeletal metastases. The optimal dosage of 89Sr in this clinical situation has not been established, and prospective, carefully executed and analyzed randomized trials will be required to test whether and to what extent dose intensity of 89Sr determines outcome independently of other factors.

Topics: Adenocarcinoma; Bone Neoplasms; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Infusions, Intravenous; Male; Pain; Palliative Care; Prostatic Neoplasms; Research Design; Strontium Radioisotopes

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

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

This contribution on the biology and management of bone metastases from prostatic cancer is divided into three parts. The first details a study conducted at Stanford University on the prevention of bone metastases in the lumbar spine, in patients in whom the lumbar spine has been irradiated coincidental to the radiation treatment of the paraaortic lymph nodes. The incidence of metastases was significantly reduced in 71 patients in whom the apparently normal lumbar spine was irradiated, as compared to the incidence of metastases in 65 patients who received no lumbar irradiation. The implications of these observations on developing strategies for early, or preemptive, irradiation for bone metastases are discussed. In the second part, the optimum radiation dose and fractionation scheme for the palliation of overt bone metastases is addressed. Drawing largely from the work of Arcangeli et al., a total dose of 40-50 Gy*, fractionated at 2 Gy per day, seems to be the regimen of choice for enduring pain relief for most patients with prostatic metastases to bone. Finally, the recent utilization of strontium-89 in the palliation of advanced bone metastases is addressed. *The Gy is the current international unit of radiation. 1Gy = 100 Rad; 1cGy (centigray) = 1 Rad.

Topics: Bone and Bones; Bone Neoplasms; Humans; Incidence; Life Tables; Lumbar Vertebrae; Lymphatic Metastasis; Male; Pain; Palliative Care; Pelvis; Prostatic Neoplasms; Radioisotope Teletherapy; Radiotherapy Dosage; Retrospective Studies; Spinal Neoplasms; Strontium Radioisotopes

The palliation of bone pain is a common clinical problem once metastatic prostate cancer has escaped from hormonal control. This retrospective study compares the results of treatment using hemibody irradiation (HBI) at the Royal Marsden Hospital (27 cases) with isotope therapy using the bone-seeking isotope strontium-89 (89Sr) at Southampton General Hospital (51 cases). Prior to analysis patients were matched for potential prognostic factors (performance status, bone scan extent of disease, age, histology and duration of hormone response) to minimize the effect of treatment selection bias. Pain control assessed at 3 months was similar for HBI and matched 89Sr cases, with 63% and 52% respectively showing some benefit. Median survival was similar for these groups at 20 and 21 weeks respectively. The unmatched 89Sr group, which had more favourable prognostic factors, had a better outcome with 96% showing improvement in pain and with a median survival of 59 weeks. Subsequent univariate analysis demonstrated that performance status and extent of disease on bone scan were of overriding importance in determining outcome. Transfusion requirements were higher for the HBI group than for the matched 89Sr group (50% and 25% respectively) but other bone marrow toxicity was similar. Despite routine anti-emetic therapy 37% of patients treated with HBI had some nausea or vomiting. Although expensive, 89Sr appears as effective a treatment option as HBI. Response is most likely with either approach when patients have a good performance status and a limited extent of disease.

Topics: Actuarial Analysis; Blood Cells; Bone Neoplasms; Cobalt Radioisotopes; Humans; Male; Palliative Care; Particle Accelerators; Prognosis; Prostatic Neoplasms; Radiotherapy; Radiotherapy Dosage; Remission Induction; Retrospective Studies; Strontium Radioisotopes; Time Factors

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

Radiopharmaceutical use may improve the survival time of patients with castrate-resistant prostate cancer and bone metastases. Whether androgen-deprivation therapy (ADT) combined with bone-targeted therapy provides a clinical benefit to patients with advanced castrate-sensitive prostate cancer has not been investigated.. Eighty male patients were enrolled, and 79 were randomized: 40 to the control arm and 39 to the strontium-89 (Sr-89) arm. After randomization, patients in both study arms received ADT, doxorubicin, and zoledronic acid. Kaplan-Meier methodology was used to evaluate the progression-free survival (PFS) time. Multivariate Cox proportional hazards regression was used to evaluate the effects of Sr-89 after controlling for the number of bone metastases.. The median follow-up time for the 29 patients alive at the last follow-up was 76.9 months (range, 0.07-103.4 months). The median PFS time was 18.5 months (95% confidence interval, 9.7-49.4 months) for the control arm and 12.9 months (95% confidence interval, 8.9-72.5 months) for the Sr-89 arm (P = .86). No patient developed myelodysplastic syndrome or a hematologic malignancy. An unplanned subgroup analysis suggested increased efficacy of bone-targeted therapy with a greater extent of bone involvement (ie, >6 bone metastases vs ≤6 bone metastases on the bone scan).. The data showed that bone-targeted therapy using 1 dose of Sr-89 combined with chemohormonal ablation therapy did not favorably affect the PFS of patients with castrate-sensitive prostate cancer. The combined therapy was feasible and safe. Whether such bone-targeted therapy provides a favorable outcome for those patients with a greater tumor burden in the bone warrants further investigation.

Topics: Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Combined Modality Therapy; Diphosphonates; Doxorubicin; Humans; Imidazoles; Male; Prostatic Neoplasms; Strontium Radioisotopes; Survival Analysis; Treatment Outcome; Zoledronic Acid

Approximately 80% of patients with prostate cancer will develop bone metastases, which often lead to bone pain and skeletal-related events. Sr-89 is an established alternative for the palliation of bone pain in prostate cancer. We aimed to assess the effect of Sr-89 radionuclide therapy on quality of life (QOL) in prostate cancer patients with painful bone metastases.. Thirteen patients received a single intravenous injection of Sr-89 at a dose of 2.0 MBq/kg. All patients underwent QOL evaluation prior to Sr-89 treatment and 1, 2, and 3 months afterward using the Japanese version of the EORTC QLQ-BM22, EORTC QLQ-C30, a VAS, and face scale. We also evaluated PSA and ALP response and toxicity of the Sr-89 therapy.. The pain characteristics subscale of the EORTC QLQ-BM22 was significantly reduced from 1 month onward compared with the baseline. The functional interference and psychosocial aspects subscales were significantly higher than baseline from 2 months onward. At 2 months, VAS indicated a significant reduction in pain as compared to the baseline. Sr-89 therapy caused a nonsignificant reduction in PSA and ALP levels. No patients had leukocyte toxicity, and one patient had grade 3 platelet toxicity.. Sr-89 radionuclide therapy can provide not only reduced pain characteristics but also better psychosocial aspects and functional interference in patients with painful bone metastases of prostate cancer.

Topics: Alkaline Phosphatase; Bone Neoplasms; Humans; Male; Pain; Prostate-Specific Antigen; Prostatic Neoplasms; Quality of Life; Strontium Radioisotopes

Bone-targeted therapy that combines strontium-89 (Sr-89) with alternating weekly chemohormonal therapy may improve clinical outcomes in patients with metastatic hormone-refractory prostate cancer. This phase II study investigated the addition of Sr-89 to an alternating weekly regimen of doxorubicin and ketoconazole with paclitaxel and estramustine in patients with progressive prostate cancer and bone involvement.. Twenty-nine patients with progressive adenocarcinoma of the prostate and osteoblastic bone metastases who failed conventional hormonal therapy were registered for the study. Of those, 27 were treated with Sr-89 on day 1 of week 1. On weeks 1, 3, and 5, patients received doxorubicin (20 mg/m on day 1) and oral ketoconazole (400 mg 3 times a day for 7 days). On weeks 2, 4, and 6, patients received paclitaxel (100 mg/m(2)) and oral estramustine (280 mg 3 times a day for 7 days). No treatment was given during weeks 7 and 8. Cycles were repeated every 8 weeks.. A > or =50% reduction in prostate-specific antigen level was maintained for at least 8 weeks in 77.7% of the patients (21 patients) at 16 weeks and in 66.6% (18 patients) at 32 weeks. The median progression-free survival was 11.27 months (range, 1.83-29.53), and the median overall survival was 22.67 months (1.83-57.73+). Two patients died during study because of disease progression. Overall, the chemotherapy combined with Sr-89 was well tolerated.. Our results demonstrate that the combination of alternating weekly chemohormonal therapies with Sr-89 demonstrates a prolonged progression-free and overall survival with acceptable toxicity. Further investigation of combination therapies with Sr-89 is warranted.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Combined Modality Therapy; Doxorubicin; Estramustine; Humans; Ketoconazole; Male; Middle Aged; Paclitaxel; Prostate-Specific Antigen; Prostatic Neoplasms; Strontium Radioisotopes; Survival Rate; Treatment Outcome

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

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

The objectives of the current study were to determine the maximum tolerated dose and to evaluate the efficacy of gemcitabine given in combination with strontium-89 to patients with androgen independent prostate carcinoma.. Patients with androgen-independent prostate carcinoma and painful osteoblastic bone metastases were eligible. On a 12-week course, patients received gemcitabine (600 mg/m(2) or 800 mg/m(2)) on Days 1, 8, 15, 43, 50, and 57. A single dose of strontium-89 (55 microCi/kg) was administered on Day 8.. Fifteen patients were registered, and all were assessable for response and toxicity. Four patients were treated at Dose Level 1 (gemcitabine 600 mg/m(2)) without dose-limiting toxicity. Eleven patients received a total of 13 courses at Dose Level 2 (gemcitabine 800 mg/m(2)). Platelet nadirs of 25000-50000 platelets per microL were common at Dose Level 2, and 1 patient had Grade 4 thrombocytopenia that was dose-limiting. Granulocyte nadirs up to < 500 granulocytes per microL occurred in 4 patients at Dose Level 2 and were reversible. There were no responses, as measured by prostate specific antigen concentration, although 6 patients (40%) had stable disease.. The authors concluded that 800 mg/m(2) gemcitabine was the maximum tolerated dose for the combination. The study was terminated on the basis that an overall response rate > than 10% was unlikely. Further study at this dose level and schedule is not warranted. .

Topics: Aged; Bone Neoplasms; Carcinoma; Combined Modality Therapy; Deoxycytidine; Drug Administration Schedule; Gemcitabine; Humans; Injections, Intravenous; Male; Maximum Tolerated Dose; Middle Aged; Neoplasms, Hormone-Dependent; Prostate-Specific Antigen; Prostatic Neoplasms; Radiation-Sensitizing Agents; Strontium; Strontium Radioisotopes; Testosterone

To compare toxicity, subjective response rate, time to subjective progression and overall survival in patients with painful bone metastases of hormone-resistant prostate cancer (HRPC) treated with a single intravenous injection of 150MBq (4mCi) Strontium(89) Chloride (S) or palliative local field radiotherapy (R) with the usual radiotherapy regimen used at each centre. The costs of both treatments were also assessed.. 101 patients were randomized to S and 102 to R. Time to event endpoints were compared with the Logrank test and Kaplan-Meier curves, in the intent-to-treat population (2-sided alpha=0.05).. Baseline characteristics of both groups were comparable. There was a borderline statistically significant difference in overall survival in favour of the local field radiotherapy (R: 11 months; S: 7.2 months; p=0.0457). There was no difference in progression-free survival or time to progression. Subjective response was seen in 34.7% in the S-arm and in 33.3% in the R-arm. A biochemical response was observed in 10% and 13% of the R- and S-groups, respectively. There was no difference in treatment toxicity between the two groups.. In symptomatic HRPC, pain treatment with local field radiotherapy is associated with a better overall survival compared to Strontium(89). The lower costs of local field radiotherapy also favour the use of this treatment in patients with HRPC. The reason for the apparent survival benefit of localised radiation treatment is not clear.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Bone Neoplasms; Chi-Square Distribution; Disease Progression; Humans; Injections, Intravenous; Male; Middle Aged; Pain Measurement; Prostatic Neoplasms; Statistics, Nonparametric; Strontium Radioisotopes; Survival Rate; Treatment Outcome

This study evaluated the effects of low-dose cisplatin plus 89Sr versus 89Sr alone in the treatment of painful bone metastases from prostate cancer, addressing both pain palliation and cytostatic effects.. Seventy patients with metastatic hormone-refractory prostate cancer were randomized into 2 groups: One group (arm A) received 148 MBq 89Sr plus 50 mg/m(2) cisplatin, and the other group (arm B) received 148 MBq 89Sr plus placebo. After treatment, the patients were followed up until death to evaluate the outcome variables: grade and duration of pain palliation, onset of new painful sites, changes in bone disease, global survival, serum prostate-specific antigen and alkaline phosphatase changes, and hematologic toxicity.. Overall pain relief occurred in 91% of patients in arm A and 63% of patients in arm B (P < 0.01), with a median duration of 120 d in arm A and 60 d in arm B (P = 0.002). New painful sites on previously asymptomatic bone metastases appeared in 14% of patients in arm A and in 30% of patients in arm B (P = 0.18). The median survival without new painful sites was 4 mo in arm A and 2 mo in arm B (P = 0.04). Bone disease progression was observed in 27% of patients in arm A and in 64% of patients in arm B (P = 0.01). Median global survival after therapy was 9 mo in arm A and 6 mo in arm B (P = 0.30). Transient and moderate hematologic toxicity, as determined by World Health Organization criteria, was apparent in both arms without significant differences.. The addition of a low dose of cisplatin enhances the effect of a standard dose of 89Sr without significant side effects, producing a significant improvement in pain palliation and a cytostatic effect on bone disease.

Topics: Aged; Antineoplastic Agents; Bone Neoplasms; Cisplatin; Combined Modality Therapy; Humans; Male; Palliative Care; Prospective Studies; Prostatic Neoplasms; Strontium Radioisotopes; Survival Rate

Estramustine phosphate (EMP) and vinblastine have radiosensitizing properties and significant activity against hormone refractory prostate carcinoma. Strontium-89 is a palliative agent that acts as a selective radiation source for bone metastasis. The combination of EMP, vinblastine, and strontium-89 was developed to exploit the potential for radiosynergy. PATIENTS AND METHODS Forty-four patients at the Brown Oncology Group affiliated hospitals were treated with oral EMP 600 mg/m2 daily on Weeks 1-4 and 7-10, vinblastine 4 mg/m2 intravenously once each week on Weeks 1-4 and 7-10, and strontium-89 2.2 MBq/kg on Day 1. Courses were repeated every 12 weeks. Response assessment was based on a change in the serum prostate specific antigen (PSA) levels, correlated with change in measurable disease and bone scan appearance.. A greater than or equal to 50% decline in PSA for at least 6 weeks was observed in 21 patients (48%, 95% confidence interval, 33-62%). Median duration of response was 23 weeks (range, 6-70.8 weeks). The median survival was 13 months with 1- and 2-year survival rates of 55% and 25%, respectively. After completion of protocol therapy, a retrospective review showed that only nine patients received subsequent palliative external beam radiation after progression.. The addition of strontium-89 to the regimen of EMP and vinblastine can be delivered safely and in repeated doses, provides effective palliation, and may decrease the need for future radiation therapy. A randomized trial is necessary to quantify these effects.

Topics: Administration, Oral; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Antineoplastic Agents, Phytogenic; Carcinoma; Combined Modality Therapy; Estramustine; Humans; Infusions, Intravenous; Male; Middle Aged; Palliative Care; Prostate-Specific Antigen; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome; Vinblastine

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

Prostate carcinoma is linked to osteoblastic metastasis. We therefore investigated the value of bone-targeted consolidation therapy in selected patients with advanced androgen-independent carcinoma of the prostate.. 103 patients received induction chemotherapy, consisting of ketoconazole and doxorubicin alternating with estramustine and vinblastine. After two or three cycles of induction chemotherapy, we randomly assigned 72 patients who were clinically stable or responders to receive doxorubicin with or without strontium-89 (Sr-89) every week for 6 weeks.. Overall 62 of the 103 (60%, 95% CI 50-70) patients had a 50% or greater reduction in serum prostate-specific antigen concentration that was maintained for at least 8 weeks, and 43 (42%, 32-52) had an 80% or greater reduction. 49 (52%) patients with bone pain at registration had complete resolution of pain. After follow-up of 67 patients until death, the estimated median survival for all 103 patients was 17.5 months (range 0.5-37.7). For the 36 patients randomly assigned to receive Sr-89 and doxorubicin, the median survival time was 27.7 months (4.9-37.7), and for the 36 who received doxorubicin alone it was 16.8 months (4.4-34.2) (p=0.0014). The hazard ratio was 2.76 (95% CI 1.44-5.29).. Bone-targeted consolidation therapy consisting of one dose of Sr-89 plus doxorubicin once a week for 6 weeks, when given to patients with stable or responding advanced androgen-independent carcinoma of the prostate after induction chemotherapy, improved overall survival.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Bone Neoplasms; Carcinoma; Doxorubicin; Humans; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Strontium Radioisotopes; Survival Analysis; Texas

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

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

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

A review was performed of all patients who received strontium-89 chloride or samarium-153 ethylenediamine-tetramethylenephosphonate for prostate cancer metastatic to bone at the Royal Brisbane Hospital between 1992 and 1997. There were 57 patients, 38 treated with strontium-89 and 19 with samarium-153. Forty patients had radionuclide therapy alone, and 28/40 (or 70%) responded in terms of experiencing a beneficial effect on pain. In the other 17 patients, the effect of the radionuclide on pain could not be assessed because they received external beam radiotherapy concomitant with a therapeutic radionuclide. There was no difference in response rates between the samarium and strontium groups as measured by the effect on pain or in the time to progression. The median time to progression for all patients was 2-3 months. The present study confirms that following administration of a therapeutic radionuclide, a high proportion of patients experienced improvement of pain, but the time to progression is not long, so that the overall degree of benefit is modest.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Radioisotopes; Retrospective Studies; Samarium; Strontium; Strontium Radioisotopes

The clinical management of skeletal metastatic disease is problematic because of the difficulty in treating and accurately monitoring therapy impact and disease progression. This investigation measured serum procollagen type I C-terminal peptide (PICP) concentrations as a semi-quantitative index of bone turnover in patients with metastatic prostatic adenocarcinoma before and following palliative 89Sr chloride therapy. 10 patients with early stage (stage A2, B1 and B2) biopsy-confirmed prostatic adenocarcinoma were investigated (n = 10). Two groups of 10 patients each (n = 10 per group) with advanced (stage D) metastatic prostatic adenocarcinoma who had previously undergone hormonal manipulation were also investigated. One group of patients with scintigraphically documented metastatic bone disease received additional irradiation for new symptomatic bone metastases, whereas the other group received 89Sr chloride therapy. A radioimmunoassay for PICP was used to measure serum concentrations of patients in each of these groups as well as positive and negative controls. The concentration of serum PICP rose from 649 +/- 279 before treatment with external beam radiotherapy to 927 +/- 157 ng ml-1 4 months after therapy (p < 0.05). However, the results demonstrated a four-fold decrease (p < 0.001) in serum PICP in clinical responders to 89Sr chloride therapy versus baseline 4 months after the completion of treatment. The clinical non-responders demonstrated no significant change in PICP concentrations during that interval. This may be due to an increase in untreated bony metastases in the non-89Sr treated group. Although a relatively small representative group of patients was studied, these data demonstrate that serum PICP concentration correlates with clinical response to 89Sr chloride therapy. This objective laboratory technique may be useful for monitoring and predicting the need for 89Sr chloride therapy and optimizing palliative care. It may also be extremely useful in predicting a therapeutic response to such intervention.

Topics: Adenocarcinoma; Aged; Analgesics, Opioid; Biomarkers, Tumor; Bone Neoplasms; Drug Administration Schedule; Humans; Male; Middle Aged; Morphine; Palliative Care; Peptide Fragments; Procollagen; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome

In a prospective randomized Canadian trial, addition of radionuclide strontium (89Sr) to external radiotherapy (ER) was found to prolong the time to further ER by 15 weeks (35 versus 20, P = 0.006) compared to ER alone in patients with hormone-refractory metastatic prostate cancer (HRMPC). The total direct lifetime costs within the Swedish health care system for the following two treatment strategies was estimated as follows: (a) ER initially and in the event of relapse and (b) ER + 89Sr initially and ER in the event of relapse.. Calculation of lifetime costs was based on the initial total treatment cost and the probability of future treatment costs. In a retrospective analysis, the average cost of a relapse treated with ER alone was calculated from the actual care consumption of 79 consecutive patients from the south of Sweden who received ER because of skeletal pain due to HRMPC. The costs related to ER included skeletal scintigraphy, ER, outpatient visits, inpatients days, and travel to the treatment center. When 89Sr was added, the cost also included the radionuclide and its administration. Costs in Swedish currency (SEK) were based on the regional tariff for 1993 (U.S. $1 = SEK 8.30).. The initial cost for one relapse treated with ER alone was estimated to be SEK 31,011 (U.S. $3736) per patient resident within county (close to hospital) and SEK 48,585 (U.S. $5854) per patient resident out of county (far from hospital). The corresponding figure for initial addition of 89Sr to ER was SEK 43,426 (U.S. $5232) and 61,000 (U.S. $7349), respectively. However, comparison between estimated lifetime cost for the two treatment strategies indicated potential cost savings with initial addition of 89Sr to 3% SEK 2720 (U.S. $328) and 7% SEK 11,290 (U.S. $1360), respectively.. Strontium-89 as initial supplement to ER for palliation of pain in HRMPC is beneficial both from the patient and lifetime health service costs perspectives.

Topics: Bone Neoplasms; Cost of Illness; Costs and Cost Analysis; Humans; Male; Neoplasm Recurrence, Local; Pain; Prostatic Neoplasms; Strontium Radioisotopes

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

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

From 1988 to 1991, 284 patients with prostatic cancer and painful bone metastases were treated with either radiotherapy or strontium-89 (200 MBq). Patients were first stratified according to suitability for local or hemibody radiotherapy, then randomly allocated that form of treatment or strontium-89 (i.v. injection). After 4, 8 and 12 weeks pain sites were mapped, toxicity monitored, and all additional palliative treatments recorded. There was no significant difference in median survival (after > 80% had died); 33 weeks following strontium-89 and 28 weeks following radiotherapy (p = 0.1). All treatments provided effective pain relief; improvement was sustained to 3 months in 63.6% after hemibody radiotherapy compared with 66.1% after strontium-89, and in 61% after local radiotherapy compared with 65.9% in the comparable strontium-89 group. Fewer patients reported new pain sites after strontium-89 than after local or hemibody radiotherapy (p < 0.05). Radiotherapy to a new site was required by 12 patients in the local radiotherapy group compared with 2 after strontium-89 (p < 0.01), although there was no significant difference between hemibody radiotherapy (6 patients) and strontium-89 (9 patients) in this respect. Platelets and leukocytes fell by an average 30-40% after strontium-89 but sequelae were uncommon, and other symptoms rare.

Topics: Aged; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Radiotherapy; Radiotherapy Dosage; Strontium Radioisotopes; Survival Analysis; Time Factors

A retrospective study was performed on the cost-effectiveness of treatment for advanced prostate cancer metastatic to bone. Patients (n = 29) recruited into the trans Canada trial at the Cross Cancer Institute, Edmonton and randomized to treatment with Metastron (strontium-89 chloride) (n = 14) or placebo (n = 15) after local field irradiation therapy for pain palliation were studied over their entire survival time. Estimates were made of the direct costs of treatment, i.e. drugs (analgesics and hormonal agents) and external radiotherapy, and the indirect costs (investigations, outpatient visits and inpatient days, either total or for tertiary care) based on records from the referring hospital, the cancer clinic and any hospitals to which the patients may subsequently have been referred. Meaningful differences were apparent between the two groups in direct costs with the group receiving Metastron showing a reduction over the entire survival time of Can$ 1,720/person compared with placebo; it should be noted that in this analysis neither the costs of the Metastron, nor of the initial radiotherapy, have been included. The Metastron group also showed a reduction in costs of hospitalization for tertiary care of Can$ 5,696/person, though the total cost of hospitalization was similar in the two groups. These results suggest that treatment with Metastron can bring about reductions in management costs for patients with advanced prostate cancer and, coupled with the findings of the Trans Canada trial on the improvement in quality of life for patients given Metastron, they add financial support to the clinical rationale for the use of Metastron for the palliative treatment of patients with bone metastases resulting from prostate cancer.

Topics: Aged; Antineoplastic Agents; Bone Neoplasms; Cost-Benefit Analysis; Hospital Costs; Humans; Male; Palliative Care; Prostatic Neoplasms; Retrospective Studies; Strontium; Strontium Radioisotopes

Radiation therapy plays a major role in the management of patients with either locally recurrent or metastatic carcinoma of the prostate.. In 23 patients with isolated postprostatectomy local recurrences treated with doses of 60-65 Gy, 17 (74%) had tumor control, and 45% survived relapse-free for 5 years after treatment of the recurrence. Pelvic irradiation has been used to treat patients with elevated prostate-specific antigen (PSA) levels after radical prostatectomy. This was tried, and 17 of 24 patients (70%) showed a significant decrease in PSA levels after irradiation, in five without subsequent elevation. Two of the seven patients with elevated PSA levels later had distant metastases. Local irradiation has been reported to yield excellent relief of symptoms in 100% of patients with hematuria, 80% with urinary outflow obstruction, and 50-70% with ureteral obstruction or pelvic pain secondary to locally advanced prostatic carcinoma. Reirradiation, particularly with brachytherapy (in preliminary studies combined with hyperthermia) has been used in the management of postirradiation prostatic recurrences with satisfactory tumor regression in approximately 75% of patients. The Radiation Therapy Oncology Group (RTOG) reported on the palliative effects of external irradiation on patients with bony metastasis. Approximately 54% of such patients had complete relief, and 29% had partial relief of bone pain. However, the retreatment rate of the bony metastasis was lower in the patients receiving higher doses. In a RTOG protocol in which all patients received local irradiation for osseous metastases, 77 were randomized to receive elective hemibody irradiation and 69, local treatment only. The frequency of additional treatment at 1 year was lower in the hemibody irradiation group (54% versus 78%). Occasionally, brain, mediastinal, or liver metastasis can be treated with irradiation. Radioactive phosphorus-32 or strontium-89 has been administered for disseminated bony metastasis with improvement of bone pain in approximately 70-80% of treated patients.. The role of irradiation in the treatment of spinal cord compression is discussed. Significant improvement of neurologic function has been reported in 36-60% of the patients, depending on severity of deficit and promptness in instituting emergency treatment.

Topics: Bone Neoplasms; Brachytherapy; Brain Neoplasms; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Phosphorus Radioisotopes; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radioisotopes; Radiotherapy Dosage; Rhenium; Spinal Cord Compression; Strontium Radioisotopes

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Radiotherapy; Strontium Radioisotopes; Survival Analysis

In a multicenter, randomized controlled trial involving 126 patients with endocrine-resistant advanced prostate cancer, all of whom received external beam radiotherapy, additional treatment with a single injected dose of 400 MBq strontium-89 (Metastron) significantly improved overall pain control. Adjuvant therapy with strontium-89 also significantly reduced analgesia requirements compared with placebo and delayed disease progression, as indicated by the requirement for further external beam radiotherapy. On certain measures, patients receiving strontium-89 also showed enhanced quality of life. Accompanying these changes, levels of prostate tumor markers were significantly reduced by strontium-89 treatment. The benefits resulting from adjuvant strontium therapy were associated with tolerable hematologic toxicity. The addition of strontium-89 to external beam radiation had no effect on survival. However, it has clear implications for improved palliation in advanced prostate cancer and may also impact positively on treatment costs.

Topics: Aged; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Radiotherapy; Strontium Radioisotopes; Survival Analysis

A large proportion of the practice of radiotherapy in the management of metastatic adenocarcinoma of the prostate is associated with palliation of pain from osseous metastases and improving quality of life. Radiation therapy is well known to be effective in treating painful sites and may also be effective in reducing the propensity for adjuvantly treated disease to become symptomatic. Strontium-89 is a systemic radionuclide that has clinical efficacy in the palliation of pain from bony metastases.. The study was a Phase-III randomized placebo control trial performed in eight Canadian Cancer Centers to evaluate the effectiveness of strontium-89 as an adjunct to local field radiotherapy. Patients with endocrine refractory metastatic prostate cancer received local field radiotherapy and either strontium-89 as a single injection of 10.8 mCi or placebo.. One hundred twenty-six patients were recruited. No significant differences in survival or in relief of pain at the index site where noted. Intake of analgesics over time demonstrated a significant reduction in the arm treated with strontium-89. Progression of pain as measured by sites of new pain or the requirement for radiotherapy showed statistically significant differences between the arms in favor of strontium-89. Tumor makers including prostate specific antigen, acid phosphatase, and alkaline phosphatase were also reduced in patients receiving strontium-89. A Quality-of-Life analysis was performed as a multivariate data set and demonstrated an overall superiority of strontium-89 with alleviation of pain and improvement in physical activity being statistically significant. Toxicity was evaluated and demonstrated increased hematological toxicity in the group receiving strontium-89.. It is concluded that the addition of strontium-89 is an effective adjuvant therapy to local field radiotherapy reducing progression of disease as evidenced by new sites of pain and the requirement of further radiotherapy and improving quality-of-life and need for analgesic support in this group of patients.

Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Quality of Life; Strontium Radioisotopes; Survival Rate

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

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

Since 1976 200 patients with multiple skeletal metastases from prostatic cancer were treated with 89Sr. In the present study the results were evaluated in order to confirm the efficacy of this therapy. Following the application of 3 injections each of 0 (n = 21), 37 (n = 65), 75 (n = 72), 100 (n = 25) or 150 (n = 17) MBq 89Sr subjective pain relief, scintigraphic follow-up observations, survival times and haematological complications were recorded. In comparison to the results of placebo administration the effects of 89Sr on pain were: in the placebo group deterioration 11%, no change 55%, improvement 17% and full pain relief 17% whereas in the Sr groups combined the corresponding figures were 3, 38, 26 and 33%. Pain relief correlated with the activity administered. A dose relationship to scintigraphic regression is probable, the latter correlating with pain relief. Due to a decrease of early deaths the survival rate increased during the first months after start of treatment but later on returned to the level observed in untreated patients. Pain relief and regressive scintigraphic findings were combined with increased marrow involvement which, however, did not by itself influence survival rates. 89Sr therapy is an effective additional treatment of patients with multiple skeletal metastases from prostatic cancer.

Topics: Berlin; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Retrospective Studies; Strontium Radioisotopes; Survival Rate

The palliative efficacy of strontium-89 chloride has been evaluated in a prospective double-blind crossover study comparing it with stable strontium as placebo in 32 patients with prostate cancer metastatic to bone. Response was assessed 5 weeks after each treatment. 26 patients were evaluable. Complete pain relief was only reported following strontium-89 injection. Statistical comparison between placebo and strontium-89 showed clear evidence of a therapeutic response to strontium-89 compared with only a limited placebo effect (P less than 0.01).

Topics: Aged; Bone Neoplasms; Double-Blind Method; Humans; Male; Middle Aged; Pain; Palliative Care; Platelet Count; Prospective Studies; Prostatic Neoplasms; Strontium Radioisotopes

In a multi-centre study strontium-89 was shown to be effective in relieving bone pain from prostatic carcinoma in patients who had failed conventional therapies. Of 83 patients assessed at 3 months, following the administration of a dose of at least 1.5 MBq/kg, 75% derived benefit and 22% became pain free. Symptomatic improvement usually occurred within 6 weeks and continued for between 4 and 15 months (mean 6 months). Based on the dose estimation part of this study the recommended dose of strontium-89 is 150 MBq. Toxicity was low, provided platelet levels were above 100 x 10(9) l-1 at the time of treatment. Repeat treatments with strontium-89 may be given at intervals of not less than 3 months. Strontium-89 is administered intravenously on an out-patient basis with no special radiological protection precautions.

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Platelet Count; Prostatic Neoplasms; Radiotherapy Dosage; Strontium; Strontium Radioisotopes

Forty-nine patients were treated with either 3 x 75 MBq 89Sr or saline as placebo. Analysis of results 1 to 3 years after therapy revealed the ineffectiveness of 89Sr to relieve pain from metastases. Unexpectedly, a higher survival rate was found after Sr application (46% vs 4% after 2 years). Covariate analysis underlines the effect of 89Sr therapy on life expectation.

Topics: Aged; Bone Neoplasms; Clinical Trials as Topic; Double-Blind Method; Humans; Male; Middle Aged; Palliative Care; Prognosis; Prostatic Neoplasms; Random Allocation; Strontium Radioisotopes

The skeleton is the most common metastatic site in patients with advanced cancer. Pain is a major healthcare problem in patients with bone metastases. Bone-seeking radionuclides that selectively accumulate in the bone are used to treat cancer-induced bone pain and to prolong survival in selected groups of cancer patients. The goals of these guidelines are to assist nuclear medicine practitioners in: (a) evaluating patients who might be candidates for radionuclide treatment of bone metastases using beta-emitting radionuclides such as strontium-89 (

Topics: Bone Neoplasms; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Prostatic Neoplasms; Quality of Life; Radioisotopes; Samarium; Strontium Radioisotopes

To relieve pain associated with multiple bone metastases radiopharmaceutical method of treatment is of great importance--the use of beta-emission isotope of strontium chloride-89 (metastron). Passing through the human skeletal system, strontium-89 accumulates in areas of high mineral density, which is it typical for osteoblastic metastases. In our institution in the frames of a randomized trial in 90 patients with metastatic hormone-resistant prostate cancer it was carried out systemic radiotherapy with strontium-89 chloride as a stage of complex treatment. Stabilization of pain syndrome during treatment was 72,7% and its progression was noted in 27,3% cases. Radiopharmaceutical therapy is well tolerated and can be used as a stage in complex treatment of patients with hormone-resistant prostate cancer.

Topics: Aged; Androgen Antagonists; Antineoplastic Agents, Hormonal; Bone Neoplasms; Drug Resistance, Neoplasm; Humans; Male; Middle Aged; Pain; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium; Strontium Radioisotopes; Treatment Outcome

Strontium-89 (Sr-89) has been considered to have a tumoricidal effect with minimal adverse events. However, few reports have investigated these effects in detail. In this study, we examined the tumoricidal and pain-relief effects of Sr-89 on prostate cancer with bone metastasis as well as survival.. A retrospective study was performed involving 31 prostate cancer patients with bone metastasis treated with Sr-89. Using PSA as an evaluation criterion of cancer control, patients were divided into PSA responder and non-responder groups, and the survival rates of these groups were compared. In addition, using the total amount of painkillers administered as an evaluation criterion of pain relief, patients were divided into pain responder and non-responder groups, and the survival rates of these groups were also compared. As secondary investigation items, age, PSA (ng/ml), pain site, extent of the disease, the presence or absence of castration-resistant prostatic cancer (CRPC), the presence or absence of a past medical history of treatment with docetaxel in CRPC cases, Gleason Score, hemoglobin (g/dl), platelet (Plt) (/μl), serum carboxyterminal telopeptide of type I collagen (ng/ml), and bone-alkaline phosphatase (BAP) (U/l) were investigated.. Longer survival was expected for the PSA responder group than for the PSA non-responder group, and whether the spine was the pain site and the presence or absence of CRPC were useful as predictors of this. Plt was suggested to be a useful indicator. Furthermore, the survival time was significantly longer in the pain responder group than in the pain non-responder group, and whether the pain site was present in the spine was considered to be a predictor; however, no significant difference was noted in any of the items assumed to be biomarkers.. Sr-89 has the potential to control PSA and prolong survival. A large-scale prospective study of the therapeutic effect of Sr-89 is expected.

Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Bone Neoplasms; Humans; Male; Middle Aged; Pain Management; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies; Strontium Radioisotopes; Survival Rate; Treatment Outcome

Randomized clinical trials of palliative radiation therapy and radiopharmaceuticals are emphasized, and new concepts in targeted alpha-emitter therapy are introduced.. Radiation therapy has a proven palliative role in the treatment of patients with advanced prostate cancer. Findings from 223radium clinical trials emphasize the importance of alpha particles as a new therapeutic modality in patients with bone metastatic castrate-resistant prostate cancer. We introduce the concept of alpha-emitting particles from both a basic and clinical perspective in the realm of bone-targeted radiopharmaceuticals and discuss how these agents compare and contrast with conventional beta-emitting radioisotopes. The physics, radiobiology, and survival data with 223radium are unique compared with previously used radiopharmaceuticals.. Targeted alpha-emitting therapies such as 223radium have the capacity to change the way we treat patients with bone-metastatic prostate cancer.

Topics: Alpha Particles; Bone Neoplasms; Dose Fractionation, Radiation; Evidence-Based Medicine; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Radium; Randomized Controlled Trials as Topic; Strontium Radioisotopes; Treatment Outcome

A 67-year old man was diagnosed with advanced prostate cancer with multiple pelvic lymph nodes and multiple bone metastases (cT2N1M1b), with an initial prostate specific antigen of 1,300 ng/ml. Prostate biopsy specimens revealed poorly differentiated adenocarcinoma, Gleason's score 5＋3. He was treated with maximal androgen blockade (MAB) from 2001, but showed resistance to hormone therapy and docetaxel in 2007. External radiation therapy for bone pain was difficult due to multiple lesions. 89Sr therapy was started in 2009. The therapy could be performed 5 times without any side effects. Good pain control and decreasing PSA was obtained at each dose.

Topics: Adenocarcinoma; Aged; Docetaxel; Drug Resistance, Neoplasm; Humans; Male; Orchiectomy; Prostatic Neoplasms; Strontium Radioisotopes; Taxoids

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

Bone metastases are a major problem in the clinical management of patients with prostate cancer. Despite the use of analgesic for the relief of such pain, the outcomes are not often satisfactory. Strontium-89 (89Sr) is a pure beta-emitting radioisotope to be avidly concentrated in the areas of high osteoblastic activity. The aim of this study was to evaluate the efficacy of 89Sr in the therapy for bone metastases of prostate carcinoma. 116 patients received intravenous injection of 89Sr at the dose of 3mCi (111MBq). All patients underwent physical examination and Karnofsky's Performance Score (KPS) evaluation before and after administration; the analgesic effects were evaluated by scores of pain. The complete response (CR) was defined as scores of pain > 75%; no response (NR) was defined as scores of pain < 25% the remaining was partial response (PR). The changes of bone metastases were screened by CT, MRI and 99mTc-MDP bone scintigraphy according to the standards of WHO. After the treatment with 89Sr, the total response rate was 80.2%. In the 116 cases, 21 cases (18.1%) displayed complete response and 72 cases (62.1%) displayed partial response, but 23 cases (19.2%) showed no response. The mean score on Karnfsky's performance status (KPS) was 20.0% higher. About 1/3 cases exhibited an obvious decrease in the number of metastases, and some foci disappeared. Thirteen cases (12%) showed a greater decrease in prostate-specific antigen (PSA) value. 89Sr chloride is an effective and safe therapy of the bone metastases from prostate cancer.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; 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

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 safety and efficacy of strontium-89-chloride for management of bone metastases in patients without bone pain.. Fifty-four patients without painful bone metastases were given a single intravenous dose (1.48-2.22 MBq/kg) of strontium-89-chloride, which was repeated once or twice at the interval between 3 and 6 months.. The total response rate was 74.0% in these, and the response rate was significantly lower in patients with focal size>2 cm than in those with focal size

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Prostatic Neoplasms; Strontium Radioisotopes; Treatment Outcome

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

Retrospective comparative analysis of strontium-89 chloride (Sr89) and rhenium-186-hydroxyethylidene diphosphonate (Re186-HEDP) radionuclide treatment to find predictors of response in patients with painful metastases from hormone refractory prostate cancer.. Clinical data from 60 hormone refractory PCA patients (i.e. rising PSA at castrate testosterone serum levels) was obtained. Twenty-nine were treated with Sr89, 31 were treated with Re186-HEDP for painful osseous metastasis. Response was defined as a patient-reported decrease in pain and/or reduction in pain medication with stable pain level. Hematological parameters and serum levels of PSA, alkaline phosphatase, and lactate dehydrogenase were assessed prior to and at 4-week intervals after treatment.. Median survival of all patients was 7 months (95% CI: 6-9 months). Overall, 33/60 (55%) patients reported a decrease in pain after the first radionuclide treatment. This percentage was similar for patients treated with Re168-HEDP and Sr89. Mean duration of reported pain response was 75 days (+/- 68 days) for Sr89 and 61 days (+/- 56 days) for Re186-HEDP, which was not significantly different. A lower blood hemoglobin concentration was associated with a lower pain response rate. In a multivariate Cox regression analysis, pain response to radionuclide treatment predicted longer survival after treatment.. Pain response was present in 55% of patients. Serum hemoglobin concentration prior to radionuclide treatment predicted pain response for both Re186-HEDP and Sr89. A reduction in pain upon radionuclide treatment was associated with a longer survival after treatment.

Topics: Aged; Bone Neoplasms; Etidronic Acid; Hemoglobins; Humans; Male; Organometallic Compounds; Pain; Predictive Value of Tests; Prostatic Neoplasms; Radioisotopes; Retrospective Studies; Strontium Radioisotopes

Strontium-89 (Sr-89) alone or with concurrent chemotherapy has a role in the treatment of patients with prostate cancer (PCP). The schedules for repeated doses of Sr-89 or for concurrent chemotherapy is undetermined. The objective of this study was to measure the effective half-life (Te) of Sr-89 using a detector available in a nuclear research facility. Blood and urine samples obtained from PCP treated with Sr-89 (Metastron, Amersham, U.K.) were measured for radioactivity with a High Pure Germanium (HPGe) detector in a gamma spectrometry system (Eurisys, France). Twenty-five urine and 22 blood samples were obtained from 8 patients during a period of 160 days after Metastron injection. Sr-89 radioactivity levels in blood and urine were quite low (<8.2 x 10(-3) microCi/mL) in all patients after 21 days, whereas Sr-85 (available in 0.5% of Metastron) urine and, to a lesser extent, blood radioactivity levels were moderately high and could be detected up to 160 days. Based on Sr-85 urine levels, the calculated Sr-89 Te ranged from 9.6 to 20.7 days. Sr-89 Te can be routinely calculated in PCP based on HPGe detection of Sr-85 radioactivity levels in urine. This measurement can establish schedules for either repeated doses of Sr-89 or concurrent chemotherapy.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Drug Administration Schedule; Half-Life; Humans; Male; Middle Aged; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Strontium Radioisotopes

Clinicians may have reservations about using strontium-89 for the treatment of bone metastases because of concerns that it may limit future use of chemotherapy. We assessed the rate of bone marrow failure in patients with prostate cancer who had received a dose of strontium-89.. This subgroup analysis involved 34 patients with androgen-independent prostate cancer who had been given a dose of strontium-89 and six weekly doses of doxorubicin after response to induction chemotherapy. We assessed subsequent hematotoxicity in terms of bone marrow failure and the ability to tolerate additional treatments during a median of 25 months (range, 7 to 76 months) after the strontium-89 was administered.. No patients developed bone marrow failure within 6 months of receiving strontium-89. Five (15%) of 34 patients developed bone marrow failure at a median 23 months (range, 6 to 53 months) after the strontium-89 treatment. Bone marrow biopsy performed in two of these five patients showed complete replacement of the marrow by tumor. Thirty-one patients (91%) received subsequent cytotoxic treatments at a median 11 months (range, 1 to 33 months) after the strontium-89 treatment.. This analysis demonstrated that a single dose of strontium-89 combined with chemotherapy did not affect the delivery of subsequent courses of chemotherapy in a select group of patients. However, a majority of these therapies were given off protocol and were administered at a dose schedule that might be considered inappropriate or inadequate. The clinical role and safety profile of radiopharmaceuticals combined with chemotherapy in prostate cancer therapy deserve further exploration.

Topics: Aged; Aged, 80 and over; Antibiotics, Antineoplastic; Bone Marrow; Bone Neoplasms; Combined Modality Therapy; Doxorubicin; Humans; Male; Maximum Tolerated Dose; Middle Aged; Neoplasms, Hormone-Dependent; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes; Survival Rate; Treatment Outcome

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

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

Examination of 127 patients with generalized prostate cancer established a low prophylactic effect of systematic treatment with strontium-39 chloride: it failed to alleviate pain in metastatic cancer, nor was it followed by longer mean survival. Repeat systematic radiotherapy is not indicated when palliative measures such as hormonal therapy, local radiotherapy and chemotherapy are still effective.

Topics: Aged; Bone Neoplasms; Humans; Male; Middle Aged; Neoplasm Staging; Pain; Palliative Care; Prostatic Neoplasms; Quality of Life; Retreatment; Strontium; Strontium Radioisotopes; Treatment Failure; Whole-Body Irradiation

Strontium-89 (Sr-89) chloride is an effective palliative treatment of the bone metastases of prostate cancer. Chemotherapy has also been shown to have a palliative benefit in this disease. We aimed to determine the benefits and complications of Sr-89 therapy in patients with prostate cancer who had become refractory to chemotherapy. We conducted a retrospective review of 14 treatments administered to 13 patients with chemotherapy-resistant and hormone-resistant prostate cancer.. Of the 14 administered treatments, 8 (57%) resulted in improved pain control, with 2 patients able to stop analgesia. The median duration of response was 56 days. No prostate-specific antigen response was seen in the 8 patients tested. There was significant and prolonged bone marrow toxicity, with 6 patients requiring red blood cell transfusion. Prolonged thrombocytopenia was seen, with platelet counts remaining below baseline levels after treatment in all but one patient. Leukopenia was generally mild and not associated with infection.. Sr-89 is an effective treatment of patients with chemotherapy-refractory prostate cancer, but careful and prolonged monitoring of hematologic parameters after therapy is required.

Topics: Adult; Aged; Antineoplastic Agents; Bone Marrow Diseases; Cohort Studies; Drug Resistance, Neoplasm; Hormones; Humans; Male; Middle Aged; Pain; Palliative Care; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Retrospective Studies; Strontium Radioisotopes; Survival Rate; Thrombocytopenia; Treatment Outcome

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

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

Topics: Anthracyclines; Bone Neoplasms; Disease Progression; Humans; Male; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Strontium Radioisotopes; Survival Analysis

Topics: Adenocarcinoma; Aged; Humans; Leukemia, Myeloid; Male; Neoplasms, Radiation-Induced; Prostatic Neoplasms; Strontium Radioisotopes

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

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

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

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

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: Antineoplastic Agents; Bone Neoplasms; Doxorubicin; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes; Survival Rate

A review of 50 patients treated with strontium-89 for prostate cancer bone metastases from January 1993-1997 at the Wellington Cancer Centre was undertaken to determine if there was any correlation between changes in prostate-specific antigen (PSA) following treatment and subsequent survival. Thirty cases were evaluable for PSA response. Of these, 14 had a fall in PSA following strontium-89 treatment, and their mean survival was 641 days. The remaining 16 patients did not demonstrate a post-treatment fall in PSA and their mean survival was 275 days. A difference between these two groups in the time to development of new bone symptoms following treatment was also observed. No significant correlation between pretreatment PSA and PSA response was observed. In conclusion, a PSA response following strontium-89 treatment appears to predict for improved survival in patients with bone metastases from carcinoma of the prostate. Further prospective studies are indicated.

Topics: Aged; Bone Neoplasms; Humans; Male; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies; Strontium Radioisotopes; Survival Analysis; Treatment Outcome

A multicentre observational study was conducted by the Italian Association of Nuclear Medicine between 1996 and 1998. Twenty-nine Nuclear Medicine Departments participated. The aims of the study were to systematically evaluate the efficacy, toxicity and repeatability of radionuclide therapy of painful bone metastases (RTBM) in a large number of patients and to assess its incidence in patients with prostate cancer. Out of 818 treatments performed with a single i.v. dose of 148 MBq of strontium-89 chloride or 1,295 MBq of rhenium-186 hydroxyethylidene diphosphonate (HEDP), 610 could be evaluated (527 with 89Sr and 83 with 186Re-HEDP). Eighty-one patients received multiple (up to five) RTBM. The total number of retreatments was 100. Patients were followed up for a period of 3-24 months. Results, assessed according to pain relief and consumption of analgesic drugs, were expressed at four levels: 1, no response; 2, mild response; 3, good response; 4, excellent response. Responses were: level 1 in 19%, level 2 in 21.3%, level 3 in 33.3% and level 4 in 26.4% of cases. Retreatments showed significantly (P<0.01) worse responses (48% levels 3+4), in comparison to first RTBM. Duration of palliation was 5.0+/-3.5 months, and was longer in cases of excellent response, in first RTBM, in patients with limited metastases and when 89Sr was used. Better responses were found in cases of limited skeletal disease, under good clinical conditions, when life expectancy exceeded 3 months, and in radiologically osteoblastic or mixed bone lesions. The only statistically significant predictive factor was life expectancy (P<0.001). Flare phenomenon (14.1% of cases) did not correlate with the response. Haematological toxicity (mild to moderate in most cases) mainly affected platelets, and was observed in 25.5% of cases overall and in 38.9% of retreatments. RTBM did not seem to prolong life, though in some cases scintigraphic regression of bone metastases was observed. The two radiopharmaceuticals did not show any statistically significant differences in palliative efficacy and toxicity, either in first RTBM or in retreatments.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Etidronic Acid; Humans; Injections, Intravenous; Male; Middle Aged; Organometallic Compounds; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Strontium; Strontium Radioisotopes

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

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

89SrCl2 is currently used as a palliative treatment for painful osseous metastases associated with an osteoblastic reaction in bone. However, the underlying biologic mechanism by which 89SrCl2 accumulates at these lesions and mediates palliation remains unclear. The aim of this study was therefore to elucidate this mechanism.. An in vitro cell biologic model, incorporating the MC3T3-E1 murine osteoblast cell line, was established to replicate the process of collagen production and mineralization. Experiments were performed to investigate the cellular association of 89SrCl2 and 45CaCl2 with both MC3T3-E1 cells and the PC-3 human prostate adenocarcinoma cell line.. No evidence of intracellular localization of 89SrCl2 or 45CaCl2 was found for either cell line. Localization of radiolabel was seen to be associated with MC3T3-E1 cells but only in cultures that had undergone both differentiation and mineralization. The association of 89SrCl2 was inhibited by the alkaline phosphatase inhibitor levamisole, and extracellular localization of 89SrCl2 was confirmed by microautoradiography.. 89SrCl2 acts as a calcium mimic and, as such, becomes associated with the collagen matrix produced by the MC3T3-E1 cells during collagen mineralization.

Topics: Animals; Bone and Bones; Bone Neoplasms; Calcification, Physiologic; Calcium Chloride; Calcium Radioisotopes; Cell Line; Collagen; Humans; Male; Mice; Palliative Care; Prostatic Neoplasms; Strontium; Strontium Radioisotopes; Time Factors; Tumor Cells, Cultured

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma; Humans; Leukemia, Myeloid, Acute; Leukemia, Radiation-Induced; Male; Neoadjuvant Therapy; Neoplasms, Second Primary; Prostatic Neoplasms; Radiopharmaceuticals; Risk Factors; Strontium Radioisotopes

Palliative systemic radionuclide therapy with 89Sr-chloride is a useful intervention for patients with bone pain from metastatic prostatic cancer. Although this radionuclide is highly effective, its mechanism of action remains unresolved. This investigation sought to determine whether systemic radionuclide therapy decreases the production of cell adhesion molecules (E-selectins) that participate in the metastatic process.. Sera were collected from 25 men with metastatic (stage IV) prostate carcinoma who received 89Sr-chloride palliative therapy and from 10 age-matched healthy volunteers. The serum concentration of E-selectin was quantified by an enzyme-linked immunosorbent assay. Sera from 5 patients who received 2 courses of radionuclide therapy were also included in the analysis.. A 2.8-fold decrease in serum E-selectin concentration occurred within 2 mo of radionuclide therapy (P < 0.0001). At 10 mo, however, the concentration increased to a mean (+/- SD) of 151.2 +/- 51.3 ng/mL, surpassing the baseline concentration. This pattern coincided with symptomatic improvement and subsequent health status deterioration. For patients who received 2 courses of radionuclide therapy, a second fall in serum E-selectin concentration followed the second radionuclide treatment.. A significant decrease in serum E-selectin concentration was observed after systemic radionuclide therapy. This finding suggests that expression of cell adhesion molecules, an important determinant of metastatic progression, may be inhibited by 89Sr-chloride.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; E-Selectin; Enzyme-Linked Immunosorbent Assay; Humans; Male; Pain; Pain Management; Pain Measurement; Palliative Care; Prostate-Specific Antigen; Prostatic Neoplasms; Strontium; Strontium Radioisotopes

Topics: Adenocarcinoma; Brachytherapy; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Palliative Care; Prostatic Neoplasms; Risk Factors; Strontium Radioisotopes; Time Factors

This retrospective study evaluated the toxicity and efficacy of strontium-89 chloride (Metastron, Amersham) in 94 patients with painful bone metastases of prostate cancer (117 injections of 150 MBq) and compared the efficacy of treatment in patients with moderate and extensive bone involvement. The predictive value of flare response with regard to analgesic response was also studied. High-grade leukothrombopenias were observed after only 5% of injections. An improvement in quality of life was obtained in 65% of cases, a decrease in pain in 78% (31% complete response) and a reduction of analgesics in 60%. Efficacy was significantly better for pain decrease (P=0.005) and reduction of analgesics (P=0.018), and response was significantly longer (P<0.0035) in patients with moderate than in patients with extensive bone involvement. The flare response observed in 23% of cases was not predictive of pain response (P=0.919) or reduction of analgesics (P=0.353). A second dose prolonged analgesia in three-quarters of cases without any apparent increase in toxicity. These results confirm the benefit of 89Sr chloride for the treatment of metastatic bone pain and suggest that internal radiotherapy should be started earlier. A bone scan could be proposed at the time of hormonal escape resulting in bone pain, and internal radiotherapy could be initiated when several metastatic foci exist, even if only one is painful. In this way, pain-free follow-up could be prolonged, and the transition to other therapeutic approaches, particularly opioids, delayed.

Topics: Aged; Aged, 80 and over; Analgesia; Analgesics; Bone Neoplasms; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Pain Management; Palliative Care; Prostatic Neoplasms; Quality of Life; Radiopharmaceuticals; Retrospective Studies; 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

What is the role of strontium-89 in effective palliative care of patients with stage D endocrine-refractory prostate cancer and multiple sites of painful bone metastases?. To make recommendations about the routine use of 89Sr in this clinical setting.. Effective palliation is the primary outcome of interest. Patient survival and toxic effects of treatment are also considered.. Evidence was selected and reviewed by 3 members of the Genitourinary Cancer Disease Site Group (Genitourinary Cancer DSG) of the Cancer Care Ontario Practice Guidelines Initiative. Earlier drafts of the guideline were circulated and reviewed by members of the DSG. The Genitourinary Cancer DSG comprises medical oncologists, radiation oncologists, urologists, a pathologist and a community representative. Guideline approval requires input from community representatives.. Three randomized controlled trials (RCTs) were available for evaluation. Two compared 89Sr with placebo, and one RCT compared 89Sr with conventional radiation (either hemibody or involved-field radiotherapy, as determined before randomization).. One of the 2 studies comparing 89Sr with placebo demonstrated the palliative efficacy of the intervention (p < 0.01); the other showed no benefit. The third study, comparing 89Sr with conventional radiation, concluded that all treatments provided equally effective pain relief and that improvement was sustained for at least 3 months in similar proportions of patients. The difference in the median duration of patient survival between groups in this study was neither clinically nor statistically significant.. The use of 89Sr may cause bone marrow suppression, but clinically significant sequelae are uncommon. The use of 89Sr may preclude further systemic chemotherapy or eligibility for clinical trials of systemic therapy. Symptoms other than those due to bone marrow suppression are rare.. 89Sr is recommended for use in patients with endocrine-refractory prostate cancer who have multiple uncontrolled painful sites of bone metastases on both sides of the diaphragm not adequately controlled with conventional analgesic therapy, and in whom the use of multiple single fields of external beam radiation is not possible. 89Sr has proven to be efficacious in the palliation of hormone-refractory painful bone metastases from prostate cancer. It has not been shown to lengthen the average duration of patient survival. There is limited evidence on the relative efficacy of 89Sr compared with wide-field radiotherapy. 89Sr is the treatment of choice given all the following specific indications: Established diagnosis of prostate cancer metastatic to bone. Metastatic disease refractory to hormone therapy. Progressive sites of pain poorly controlled with conventional narcotics. Painful sites of disease on both sides of the diaphragm (otherwise, hemibody radiotherapy is equally efficacious). Patient or tumour factors (number of involved sites, location of involved sites or level of pain control) that are relative contraindications to the use of multiple single fields of radiation as an alternative. No evidence of impending spinal cord compression. Adequate bone marrow reserve. Evidence from a diagnostic bone scan of radionuclide concentration in painful bone lesions. PRACTICE GUIDELINE DATE: Nov. 23, 1997. Part 2.. What is the role of 89Sr in effective palliative care of patients with stage D hormone-refractory prostate cancer receiving involved-field radiotherapy for isolated painful bone metastases?. As described in preceding abstract (Part 1).. One RCT was available for evaluati

Topics: Bone Marrow; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Strontium Radioisotopes

An autopsy was performed on a patient who died after receiving 89Sr-chloride for treatment of bone pain from metastatic prostate carcinoma. Coordination between nuclear medicine physicians, radiation safety division personnel and pathologists resulted in minimal radiation exposure and the acquisition of dosimetry data.

Topics: Aged; Aged, 80 and over; Autopsy; Bone Neoplasms; Environmental Monitoring; Fatal Outcome; Humans; Male; Occupational Exposure; Prostatic Neoplasms; Protective Clothing; Strontium; Strontium Radioisotopes; Whole-Body Counting

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

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

The urinary production of pyridinium collagen cross-links, pyridinoline (PYD) and deoxypyridinoline (DPD), has been correlated to increased bone resorption in patients with neoplasms. This study investigated the production of these compounds in patients with metastatic prostate carcinoma who received palliative treatment that did and did not include 89Sr-chloride therapy.. Urinary production of PYD and DPD was measured by high-performance liquid chromatography and natural flucrescence detection methods. The urine from several age-matched groups of patients was examined for these compounds including healthy controls (n = 20), patients with early-stage (Stage A-B) prostate carcinoma (n = 8), patients with metastatic prostate carcinoma treated with conventional analgesic and radiotherapeutic palliation (n = 20), patients with metastatic disease who underwent 89Sr-chloride therapy (n = 20) and patients with mild Paget's disease (n = 5). Patients were also monitored for urinary PYD and DPD production for a 6-mo interval after a palliative intervention.. Elevated PYD and DPD (p < 0.05) concentrations were measured in patients with metastatic and nonmetastatic prostate cancer and Paget's disease. The urinary production of these compounds remained unchanged for 6 mo after 89Sr-chloride therapy for symptomatic osseous metastases. However, the patients who did not undergo 89Sr-chloride therapy exhibited a two-fold increase in PYD and a four-fold increase in DPD above controls during the interval.. PYD and DPD are sensitive and specific bone resorption markers which demonstrate a slowing of bone resorption after palliative 89Sr-chloride therapy in patients with bone metastases.

Topics: Aged; Amino Acids; Bone Neoplasms; Bone Resorption; Case-Control Studies; Humans; Male; Osteitis Deformans; Palliative Care; Prostatic Neoplasms; Strontium; Strontium Radioisotopes; Time Factors

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

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

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

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

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

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

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

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

Topics: Bone Neoplasms; Disseminated Intravascular Coagulation; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

In our institution, 4 mCi doses of the radiopharmaceutical strontium-89 (Sr89) have been given to 101 prostate cancer patients suffering from symptomatic bone metastases. Patients were prospectively analyzed for pain response, treatment-related hematologic toxicity, and survival. Pre-treatment clinical factors were correlated with outcome. Karnofsky Performance Scores (KPS) predicted for survival and pain response. Myelosuppression from the Sr89 treatment was minimal. Twenty-eight of the treated patients had a KPS of 60 or less. This group of patients had a median actuarial survival of 17.5 weeks, and collectively, met Hospice admission survival criteria. In a subset analysis of this group, patients with a KPS of 50 or less demonstrated a low pain response (40%) and average survival (12.5 weeks), both of which did not appear to justify the significant cost and risk of toxicity associated with Sr89 treatment. In these patients, opioids appeared to offer more cost-effective pain control. Patients with a pre-treatment KPS score of 60 had a mean survival of 20.5 weeks following Sr89 therapy, with 42 percent of patients experiencing a reduction in pain. We conclude that patients with a pretreatment KPS of 50 or less should not be treated with Sr89 and patients with a pretreatment KPS of 60 should be evaluated on a case-by-case basis to determine whether or not Sr89 represents the most reasonable treatment option for palliation of their bone pain.

Topics: Bone Neoplasms; Cost-Benefit Analysis; Hospice Care; Humans; Male; Pain Measurement; Palliative Care; Prospective Studies; Prostatic Neoplasms; Strontium Radioisotopes; Survival Analysis

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

Topics: Bone Neoplasms; Humans; Male; Pain; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

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

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

Topics: Aged; Bone Neoplasms; Fatal Outcome; Humans; Male; Occupational Exposure; Prostatic Neoplasms; Strontium Radioisotopes

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

No systemic therapy has led to prolongation of life in patients with hormone resistant prostate cancer though secondary hormone treatment and chemotherapy have resulted in an about 30% response rate. The main goal of treatment is palliation and improvement of quality of life, the former aim obtained in 50-70% of the patients by radiotherapy of skeletal metastases. The evaluation of response, today assisted by the use of prostate specific antigen, and the understanding of hormone resistance remain principal topics of clinical research in hormone resistant prostate cancer.

Topics: Androgen Antagonists; Antineoplastic Agents; Humans; Male; Palliative Care; Prostate-Specific Antigen; Prostatic Neoplasms; Quality of Life; Strontium Radioisotopes

A patient with metastatic prostate cancer was found to have low-grade disseminated intravascular coagulation (DIC). He had significant bone pain despite external-beam radiotherapy and was given 89Sr with subsequent thrombocytopenia and epistaxis. The patient died from generalized hemorrhage 36 days postinjection. Although it is not possible to establish a causal relationship between the 89Sr and DIC, practitioners should be alert to complications associated with the primary disorder which might occur at a time to raise concern about the intervention.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Disseminated Intravascular Coagulation; Epistaxis; Fatal Outcome; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes; Thrombocytopenia

Bone metastases can have a devastating effect on a patient's quality of life due to pain and pathologic fractures. Local external beam radiotherapy is very effective for patients with only a few involved areas. Systemic therapy consisting of chemotherapy and hormonal therapy is extremely useful until the patient becomes refractory to treatment. Systemic radionuclide therapy using Strontium-89 has been shown to be very valuable, specifically in patients with bone metastases from hormonally-resistant prostate cancer. Studies have shown a significant improvement in analgesic requirement, time to further radiotherapy, and a reduction in tumor markers with this treatment. The use of Strontium-89 in the treatment of other bone neoplasms and the use of other radionuclides, such as Rhenium-186 HEDP and Samarium-153 EDT-MP, are still investigational.

Topics: Bone Neoplasms; Combined Modality Therapy; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes

Prostate cancer is one of the most common tumors in men. At presentation, 50% of patients have advanced disease and 25% have bone metastases. Hormonal palliation is the treatment of choice for metastatic bone pain, with a pain-free response rate of 75% for a period of 16-18 months. Second-line treatment with chemotherapy has a moderate and short-term effect. Once endocrine therapy and chemotherapy cease to be effective, radiotherapy is a good option for recurrent painful bone metastases. Diffuse painful metastases can be treated with half-body irradiation with a response rate of up to 70%, but there is considerable toxicity. Strontium-89 (Metastron) is a calcium analog radionuclide that is selectively absorbed at bone locations with increased osteoblastic activity. It is a pure beta-emitter with bone penetration of 0.8 cm, and it has been used in multiple trials with response rates of up to 80%. Results are reported with Metastron in 28 patients with diffuse painful bone metastases, in whom a response rate of 82% was seen.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Strontium Radioisotopes

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life is very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all these possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-849 Chloride is a powerful new therapy. Sr-89 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results, hoping that a similar research will extend as a multicenter study.

Topics: Bone Neoplasms; Carcinoma; Humans; Male; Pain; Prostatic Neoplasms; Radiation Protection; Radiotherapy Dosage; Remission Induction; Strontium; Strontium Radioisotopes

Hematological and biochemical parameters were evaluated in 31 patients receiving 150 MBq 89Strontium (89Sr) intravenously due to painful skeletal metastases from hormone resistant prostate cancer. Two and 3 months after the injection prostate specific antigen (PSA) had increased by a median of 36% and 100%, respectively, as compared to the pretreatment value whereas alkaline phosphatase (APHOS) had decreased by about 20% (median). The leucocyte and platelet counts were reduced by about 20-35%, without reaching grade greater than or equal to 2 toxicity. Pain relief was reported in 14 of 29 evaluable patients at 2 months and in 11 of 23 patients at 3 months. It is concluded that 89Sr represents a worthwhile therapeutic modality in the palliation treatment of patients with hormone resistant prostate cancer, though the biological significance of frequently increasing PSA and decreasing APHOS is not yet completely understood.

Topics: Aged; Alkaline Phosphatase; Analgesics; Biomarkers, Tumor; Bone Neoplasms; Humans; Injections, Intravenous; Male; Pain Management; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all those possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-89 Chloride is a powerful new therapy. Sr-90 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results hoping that a similar research will extend as a multicenter study.

Topics: Bone Neoplasms; Evaluation Studies as Topic; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes

Strontium-89 radiotherapy is becoming an important treatment in the palliation of bone pain from osteoblastic metastases. The absorbed dose delivered to bone metastases during 89Sr radiotherapy has been estimated in four patients with metastatic prostatic carcinoma. Patients were injected with a tracer dose of 85Sr-chloride. Blood and urine samples were obtained during the week following injection. Strontium-85 scintigrams of metastases and normal bone were obtained up to 8 wk postinjection. Half of the patients showed elevated whole-body retention; plasma-strontium concentrations were decreased from normal values. Uptake of strontium in metastases was 2-25 times that in normal bone but rates of washout of strontium from metastases were similar to those from normal bone. Absorbed doses delivered in infinite time to the metastases by 89Sr ranged from 21 +/- 4 to 231 +/- 56 cGy/MBq with a median value of 68 cGy/MBq. Doses to red marrow were less by a factor of 2 to 50. These absorbed doses are sufficiently large to be expected to produce a therapeutic benefit.

Topics: Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radiotherapy Dosage; Strontium Radioisotopes

Strontium-89 has been used for the treatment of painful bony metastases in patients suffering from disseminated adenocarcinoma of the prostate, with a variable proportion of patients obtaining clinically significant reductions in analgesic requirements. Based on data revealing enhancement of continuous low-dose rate irradiation by low-dose cisplatin in murine models, a protocol using 148 MBq (4 mCi) of 89Sr and 35 mg/m2 of cisplatin infused over 2 days, 1 and 4 wk after administration of the radioisotope was undertaken. Preliminary data suggest good pain relief with 55% of 18 patients entered thus far obtaining at least a 50% reduction in analgesic requirements. Improvements in total alkaline phosphatase and serum lactate dehydrogenase have consistently been seen, with some patients exhibiting improvements in hemoglobin, tumor markers and bone scans. Toxicity appears to be mild, with no life-threatening complications. In particular, myelosuppression after one course of treatment was modest, but retreatments in two patients has resulted in grade 3 hematologic toxicity. Two patients developed a "pain flare" after administration of cisplatin. Further accrual to this study will allow more accurate determination of pain response rate, and improved evaluation of parameters of objective response.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Cisplatin; Combined Modality Therapy; Drug Evaluation; Humans; Male; Middle Aged; Pain; Prostatic Neoplasms; 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 total strontium plasma clearance rate due to excretion through the kidneys and gut has an important influence on the absorbed does delivered to skeletal metastases and red bone marrow in patients receiving 89Sr radionuclide therapy for disseminated prostatic carcinoma. Although a measurement of the renal strontium plasma clearance rate may readily be obtained through a 24-h urine collection, little information is available on the correlation between renal and total clearances. We describe a method of determining total strontium plasma clearance rate from whole body counter measurements of total body strontium retention and measurements of plasma strontium concentration following administration of a 85Sr tracer dose at the time of 89Sr therapy. Amongst the 26 patients whom we studied, the total clearance rate varied from 1.2-15.0 l/day, renal clearance rate from 0.1-11.5 l/day, and the mean gut clearance rate was 2.0 l/day. A close correlation was found between total and renal clearance, with the renal component accounting for 96% of the variance in total strontium plasma clearance. A weak collection may exist between gut and renal clearance.

Topics: Humans; Kidney; Male; Prostatic Neoplasms; Radiotherapy Dosage; Strontium Radioisotopes; Whole-Body Counting

Strontium plasma clearance is an important factor determining the absorbed dose to metastases and bone marrow in patients receiving 89Sr radionuclide therapy for metastatic bone disease. Amongst male patients with disseminated prostatic carcinoma, the renal component of strontium clearance is frequently greatly reduced compared with values reported for healthy middle aged men. We report a study of renal and gut strontium plasma clearance, renal function, calcium urinary excretion, parathyroid function and extent of skeletal osteoblastic metastatic disease in patients referred for radiostrontium therapy for metastasised prostatic malignancy. The wide variation in net strontium clearance was principally due to variation in the renal component. Low values of strontium renal clearance were found to correlate with the elevation of serum PTH and nephrogenous cyclic AMP, which in turn correlated with extent of skeletal metastatic disease. This suggests that the osteosclerotic metastases characteristic of prostatic carcinoma induce secondary hyperparathyroidism due to the high avidity of the skeleton for calcium. The resulting reduction in strontium excretion may be beneficial to the objectives of radiostrontium therapy.

Topics: Bone Neoplasms; Calcium; Cyclic AMP; Humans; Kidney; Male; Parathyroid Hormone; Prostatic Neoplasms; Strontium Radioisotopes

The efficacy of strontium-89 in relieving pain caused by disseminated bone metastases was studied in 11 patients with prostatic carcinoma. The therapy consisted either of 3 i.v. injections of 100 MBq strontium-89 chloride in intervals of 4 weeks in 8 patients or 200 MBq i.v. administered on one occasion in 3 patients. The study suggests that 1-3 i.v. injections of 100 MBq strontium-89 may be a worthwhile and fairly atoxic treatment for palliation of bone pain from metastatic prostatic carcinoma.

Topics: Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

We report measurements of absorbed dose to vertebral metastases in ten patients referred for 89Sr therapy for disseminated prostatic carcinoma. Patients received a tracer dose of 85Sr at the time of 89Sr treatment and metastatic strontium retention was monitored scintigraphically for 6 mo. Metastatic 85Sr activity corrected for tissue attenuation was measured using the conjugate view principle, with special care taken to eliminate errors due to the selection of the metastatic region of interest. Metastatic volume was determined from high resolution CT images, and density inferred from Hounsfield number using the QCT bone mineral calibration of Genant and Cann. The mean absorbed dose was 850 rad/mCi (23 cGy/MBq) with a range from 220-2260 rad/mCi (6 to 61 cGy/MBq). The wide range found was consistent with the variation expected to arise due to differences in strontium renal plasma clearance (range 0.1-11.81/day) and extent of skeletal metastatic disease (varying from two small metastases to a superscan on [99mTc]MDP images) among the patients studied.

Topics: Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiotherapy Dosage; Spinal Neoplasms; Spine; Strontium Radioisotopes

We present dosimetry for spinal metastases and red bone marrow in two patients who received 89Sr therapy for disseminated prostatic carcinoma. Absorbed dose to metastases was estimated by combining 85Sr gamma camera studies with computed tomographic measurements of bone mass, and doses of 20 cGy/MBq and 24 cGy/MBq were found for vertebral metastases that uniformly involved the bodies of L3 and D12 respectively. Absorbed dose to red bone marrow was estimated from total body strontium retention studies using the ICRP model for bone dosimetry, and a ratio of metastatic to marrow dose of around 10 was found in each patient. Although they received comparable treatment activities of around 200 MBq, the patients showed markedly different haematological response, this difference being confirmed when each received a second 89Sr treatment 6 months after the first. As a result, clinically significant thrombocytopenia occurred in one patient which prevented further radiostrontium therapy being given.

Topics: Adenocarcinoma; Aged; Bone Marrow Diseases; Brachytherapy; Energy Transfer; Follow-Up Studies; Hematologic Diseases; Humans; Male; Prostatic Neoplasms; Radiotherapy Dosage; Spinal Neoplasms; Strontium Radioisotopes; Tomography, X-Ray Computed; Whole-Body Counting

Amongst patients referred for 89Sr palliation of disseminated prostatic carcinoma, we have found wide variations in extent of skeletal metastatic disease and in strontium renal plasma clearance. A numerical technique using impulse response function analysis is reviewed which enables the effect of such variations on the total body, plasma and metastatic strontium retention functions to be calculated. The prediction of the model are compared with kinetic data from patients presenting for radiostrontium therapy, and correlations that have important implications for 89Sr dosimetric studies are confirmed. The simplest kinetic data required to allow for these effects in studies of dose-response and haematological toxicity following radio-strontium treatment are discussed and attention is drawn to a small group of patients who may form a significant exception to the general model.

Topics: Bone Neoplasms; Humans; Lumbar Vertebrae; Male; Metabolic Clearance Rate; Prostatic Neoplasms; Radiation Dosage; Spinal Neoplasms; Strontium Radioisotopes

Ten patients with disseminated bone metastases, nine from prostatic and one from renal cell carcinoma, were treated with intravenous strontium-89. Half the patients experienced significant improvement in pain control and increased general well-being for an average of 14 weeks. Sequential radiophosphate bone scanning showed decreased activity in lesions present at the time of therapy, with subsequent remineralization of the metastases on radiographs. Some patients showed simultaneous reduction in alkaline and acid phosphatase levels. These objective findings prove a physiologic basis for the clinical improvement. Treatments, however, did not prevent progression at initially uninvolved sites, particularly in the extremities.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma; Follow-Up Studies; Humans; Male; Middle Aged; Prostatic Neoplasms; Radiography; Radionuclide Imaging; Strontium Radioisotopes

In a series of patients receiving 89Sr palliation for metastasised prostatic carcinoma, strontium renal plasma clearance was found to vary from 0.14 to 11.81 day-1, and the extent of skeletal metastatic disease seen on 99Tcm-MDP images varied from a few small metastases to a superscan. Using a numerical technique based on impulse response function (IRF) analysis, we have investigated the effect of such variation between patients on 89Sr dosimetry. The whole-body IRF, HWB(t), is defined by the deconvolution of the whole-body strontium retention function, RWB(t), with the plasma retention function, P(t). For patients with minimal metastatic bone disease we assumed HWB(t) = HO(t), where HO is the IRF derived from the International Commission on Radiological Protection model for normal strontium metabolism. The strontium plasma clearance, k, was allowed to vary, and the resulting variation of RWB(t), P(t) and absorbed dose to bone marrow calculated. By convoluting P(t,k) with the IRF measured for a discrete metastasis, the effect of varying k on tumour dose was investigated. Tumour and bone marrow dose were shown to change by a factor of three as k varied over the range observed in patients. For patients with extensive metastatic bone disease we assumed HWB(t) = (1-beta)HO(t) + beta HS(t), where HS was the IRF measured for a superscan patient and beta was a parameter reflecting the extent of skeletal metastatic disease. The effect of varying beta on tumour and bone marrow dose was investigated, and dose shown to decrease by a factor of five as beta increased from zero to unity. Impulse response function analysis was found to be a powerful and useful aid in clarifying the relationship between strontium kinetics and 89Sr dosimetry.

Topics: Bone Marrow; Bone Neoplasms; Humans; Kinetics; Male; Prostatic Neoplasms; Radiotherapy Dosage; Strontium Radioisotopes; Time Factors

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

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

Initial clinical trials using strontium-89 (Sr-89) chloride for the treatment of painful skeletal metastases have observed minimal or no hematological depression secondary to the radiostrontium. A patient with marked bone marrow depression temporally related to the administration of the Sr-89 is reported, and the need for close hematological monitoring is emphasized. Bone marrow tumor replacement may predispose patients to marrow depression from radiostrontium, and such patients should be treated with caution.

Topics: Aged; Bone Marrow; Bone Neoplasms; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium; Strontium Radioisotopes

Strontium kinetics were investigated in a group of 14 patients receiving 89Sr palliation for metastatic bone disease secondary to prostatic carcinoma. Using 85Sr as a tracer, total body strontium retention R(t) was monitored for a 3 month period following 89Sr administration, and at 90 days was found to vary from 11% to 88% and to correlate closely with the fraction of the skeleton showing scintigraphic evidence of osteoblastic metastatic involvement. Strontium renal plasma clearance varied from 1.6 l/day to 11.6 l/day, and in nine patients was significantly reduced compared with values found in healthy adult men, probably due to increased renal tubular reabsorption associated with the disturbance of calcium homoeostasis. Renal clearance rate was the principal factor determining R(t) for t less than 6 days, and was an important secondary factor at later times. Over the interval 30 days less than t less than 90 days, R(t) was closely fitted by the power law function R(t) = R30 (t/30)-b, with R30 and b showing the close correlation expected from the effect of R(t) on strontium recycling. The correction of the data for this effect to determine the true skeletal release rate is described. Measurement of localized strontium turnover in individual metastatic deposits from whole body profiles and scintigraphic images gave retention curves that typically rose to a plateau by 10 days after therapy, and then decreased very slowly. In contrast, retention curves for adjacent normal trabecular bone showed more rapid turnover, peaking at 1 day and subsequently decreasing following a t-0.2 power law function.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Metabolic Clearance Rate; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Whole-Body Counting

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes

The osteotropic radionuclides 89Sr and 32P are now mainly used in the treatment of bone metastases. This therapy is palliative and is mainly directed at alleviating pain. The indications, procedure, treatment result and side effects are described as discussed. Bone metastases of iodinophilous thyroid carcinomas represent a special case. These can be treated selectively with 131I. However, complete regression of the tumour by means of radioactive iodine is only rarely achieved in bone metastases. Nevertheless, the complaints and symptoms are definitely alleviated even with relatively small radiation doses, similar to the therapy employing strontium.

Topics: Adenocarcinoma; Bone Neoplasms; Female; Humans; Iodine Radioisotopes; Male; Prostatic Neoplasms; Rectal Neoplasms; Strontium Radioisotopes; Thyroid Neoplasms

In the urological department of the Wilhelminenspital altogether 22 patients with incurable bone pains in metastasizing carcinoma were treated with radioisotopes between 1976 and 1980. 32P and 89Sr were used in a dosage of 3 times 3 mCi and once 1 mCi. A reaction to the therapy could be proved in 46%, in 23% the success could be estimated as very good. Clinic and therapy were discussed with the help of own cases and literature.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Carcinoma; Female; Humans; Kidney Neoplasms; Male; Neoplasm Staging; Palliative Care; Phosphorus Radioisotopes; Prostatic Neoplasms; Strontium Radioisotopes

Topics: Bone and Bones; Estrogens; Humans; Immunotherapy; Lymph Nodes; Male; Orchitis; Progesterone; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging; Radiotherapy; Strontium Radioisotopes

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

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 Neoplasms; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes; Time Factors

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

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

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

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

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

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

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