Metastatic bone pain is prevalent in advanced cancer, and, despite a plethora of available therapies, effective palliation remains a clinical challenge. Bone-seeking radiopharmaceuticals are an often-overlooked but valuable analgesic option for select patients. These agents work by binding to hydroxyapatite at the tumor-bone interface of osteoblastic lesions, delivering therapeutic doses of radiation to closely circumscribed tissue regions. They have been shown to reduce pain and improve quality of life. Their safety, simplicity, convenience of administration, and cost-effectiveness make them suitable for hospice and palliative care settings.
Foley KM:The treatment of cancer pain. N Engl J Med. 1985; 313(2): 84-94.
2.
Hortobagyi GN:Novel approaches to the management of bone metastases. Semin Oncol. 2003; 30(5 Suppl 16): 161-166.
3.
Data Evaluation & Publication Committee of the North America Association of Cancer Registries, based on cases included in the combined rates of cancer in the United States, 1995-1999.
4.
McEwan AJ:Use of radionuclides for the palliation of bone metastases. Semin Radiat Oncol. 2000; 10(2): 103-114.
5.
Lewington VJ:A practical guide to targeted therapy for bone pain palliation. Nucl Med Commun. 2002; 23(9): 833-836.
Falkmer U, Jarhult J, Wersall P, et al.: A systematic overview of radiation therapy effects in skeletal metastases. Acta Oncol. 2003; 42(5-6): 620-633.
10.
Ben-Josef E, Shamsa F, Williams AO, et al.: Radiotherapeutic management of osseous metastases: A survey of current patterns of care. Int J Radiat Oncol Biol Phys. 1998; 40(4): 915-921.
11.
Janjan NA:Radiation for bone metastases: Conventional techniques and the role of systemic radiopharmaceuticals. Cancer. 1997; 80(8 Suppl): 1628-1645.
12.
Li EC, Davis LE:Zoledronic acid: A new parenteral bisphosphonate. Clin Ther. 2003; 25(11): 2669-2708.
13.
Kelly WK, Steineck G:Bisphosphonates for men with prostate cancer: Sifting through the rubble. J Clin Oncol. 2003; 21(23): 4261-4262.
14.
Small EJ, Smith MR, Seaman JJ, et al.: Combined analysis of two multicenter, randomized, placebo-controlled studies of pamidronate disodium for the palliation of bone pain in men with metastatic prostate cancer. J Clin Oncol. 2003; 21(23): 4277-4284.
15.
Papatheofanis FJ:Variation in oncologic opinion regarding management of metastatic bone pain with systemic radionuclide therapy. J Nucl Med. 1999; 40(9): 1420-1423.
16.
Pons F, Fuster D:Under-utilization of radionuclide therapy in metastatic bone pain palliation. Nucl Med Commun. 2002; 23(4): 301-302.
17.
Serafini AN:Therapy of metastatic bone pain. J Nucl Med. 2001; 42(6): 895-906.
Nair N:Relative efficacy of 32P and 89Sr in palliation in skeletal metastases. J Nucl Med. 1999; 40(2): 256-261.
20.
Silberstein EB, Eugene L, Saenger SR:Painful osteoblastic metastases: The role of nuclear medicine. Oncology (Huntingt). 2001; 15(2): 157-163; discussion 167-70, 174.
21.
Goddu SM, Bishayee A, Bouchet LG, et al.: Marrow toxicity of 33P-versus 32P-orthophosphate: Implications for therapy of bone pain and bone metastases. J Nucl Med. 2000; 41(5): 941-951.
22.
Mertens WC, Filipczak LA, Ben-Josef E, et al.: Systemic bone-seeking radionuclides for palliation of painful osseous metastases: Current concepts. CA Cancer J Clin. 1998; 48(6): 361-374.
23.
Silberstein EB:The treatment of painful osseous metastases with phosphorus-32-labeled phosphates. Semin Oncol. 1993; 20(3 Suppl 2): 10-21. Review.
24.
Dickie GJ, MacFarlane D:Strontium and samarium therapy for bone metastases from prostate carcinoma. Australas Radiol. 1999; 43(4): 476-479.
25.
Pons F, Herranz R, Garcia A, et al.: Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer. Eur J Nucl Med. 1997; 24(10): 1210-1214.
26.
Turner SL, Gruenewald S, Spry N, et al.: Metastron Users Group: Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer. Br J Cancer. 2001; 84(3): 297-302.
27.
Kraeber-Bodere F, Campion L, Rousseau C, et al.: Treatment of bone metastases of prostate cancer with strontium-89 chloride: Efficacy in relation to the degree of bone involvement. Eur J Nucl Med. 2000; 27(10): 1487-1493.
28.
Lee CK, Aeppli DM, Unger J, et al.: Strontium-89 chloride (Metastron) for palliative treatment of bony metastases. The University of Minnesota experience. Am J Clin Oncol. 1996; 19(2): 102-107.
29.
Kasalicky J, Krajska V:The effect of repeated strontium-89 chloride therapy on bone pain palliation in patients with skeletal cancer metastases. Eur J Nucl Med. 1998; 25(10): 1362-1367.
30.
Quilty PM, Kirk D, Bolger JJ:A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol. 1994; 31(1): 33-40.
31.
Porter AT, McEwan AJ, Powe JE, et al: Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys. 1993; 25(5): 805-813.
32.
McEwan AJ, Amyotte GA, McGowan DG, et al.: A retrospective analysis of the cost-effectiveness of treatment with Metastron (89Sr-chloride) in patients with prostate cancer metastatic to bone. Nucl Med Commun. 1994; 15(7): 499-504.
33.
Malmberg I, Persson U, Ask A, et al.: Painful bone metastases in hormone-refractory prostate cancer: Economic costs of strontium-89 and/or external radiotherapy. Urology. 1997; 50(5): 747-753.
34.
Atkins HL:Therapy of bone pain. In Harbert JC, Eckelman WC, Newman RD (eds.): Nuclear Medicine: Diagnosis and Therapy. New York: Thieme Medical Publishers, 1996.
35.
Shah Syed GM, Maken RN, Muzzaffar N, et al.: Effective and economical option for pain palliation in prostate cancer with skeletal metastases: 32P therapy revisited. Nucl Med Commun. 1999; 20(8): 697-702.
36.
Silberstein EB, Elgazzar AH, Kapilivsky A:Phosphorus-32 radiopharmaceuticals for the treatment of painful osseous metastases. Semin Nucl Med. 1992; 22(1): 17-27.
37.
Burnet NG, Williams G, Howard N:Phosphorus-32 for intractable bony pain from carcinoma of the prostate. Clin Oncol (R Coll Radiol). 1990; 2(4): 220-223.
38.
Hellman RS, Krasnow AZ:Radionuclide therapy for palliation of pain due to osteoblastic metastases. J Palliat Med. 1998; 1(3): 277-283.
39.
Anderson PM, Wiseman GA, Dispenzieri A, et al.: High-dose samarium-153 ethylene diamine tetramethylene phosphonate: Low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases. J Clin Oncol. 2002; 20(1): 189-196.
40.
Laing AH, Ackery DM, Bayly RJ, et al.: Strontium-89 chloride for pain palliation in prostatic skeletal malignancy. Br J Radiol. 1991; 64(765): 816-822.
41.
Dafermou A, Colamussi P, Giganti M, et al.: A multicentre observational study of radionuclide therapy in patients with painful bone metastases of prostate cancer. Eur J Nucl Med. 2001; 28(7): 788-798.
42.
Windsor PM:Predictors of response to strontium-89 (Metastron) in skeletal metastases from prostate cancer: Report of a single centre’s 10-year experience. Clin Oncol (R Coll Radiol). 2001; 13(3): 219-227.
43.
Piffanelli A, Dafermou A, Giganti M, et al.: Radionuclide therapy for painful bone metastases. An Italian multicentre observational study. Writing Committee of an Ad Hoc Study Group. Q J Nucl Med. 2001; 45(1): 100-107.
44.
Schmeler K, Bastin K:Strontium-89 for symptomatic metastatic prostate cancer to bone: Recommendations for hospice patients. Hosp J. 1996; 11(2): 1-10.
45.
Silberstein EB, Williams C:Strontium-89 therapy for the pain of osseous metastases. J Nucl Med. 1985; 26(4): 345-348.
46.
Roque M, Martinez MJ, Alonso P, et al.: Radioisotopes for metastatic bone pain. Cochrane Database Syst Rev. 2003; (4): CD003347.
47.
Blake GM, Zivanovic MA, McEwan AJ, et al.: Sr-89 therapy: Strontium kinetics in disseminated carcinoma of the prostate. Eur J Nucl Med. 1986; 12(9): 447-454.
