PAIN PALLIATION FOR BONE METASTASES

Abstract

This refers to the symposium report ‘Palliative care in your hospital’ (Buchanan D.J R Coll Physicians Edin 2009; 39:252-6). In his discussion of new interventions Dr Edwards makes no reference to an important strategy for pain palliation due to skeletal metastases. I am referring to systemic radiotracer therapy. It may not be considered a ‘new’ way as the first therapy was performed in l941.¹ There has been significant progress in systemic radiotracer therapy since then with the focus on developing specific and less toxic compounds. While phosphorus-32 has been in use for many decades and revisited,² newer compounds such as Sr89,³ Sm153 EDTMP,⁴ Rel86 HEDP and Sn117m pentetate⁵ have been successfully employed for pain palliation.

Targeted radiotracer therapies can ameliorate pain in 40-80% patients. Therapy is done on an outpatient basis. Onset of relief may take five days. The patient can be pain-free for about three months. Repeat therapies are indicated in patients who benefit from the first dose. Improved performance and quality of life has been reported in several studies. Patients with osteoblastic lesions show good response. Bone marrow suppression is a known toxicity but is usually mild and reversible in the majority. The cost of newer compounds limits frequent use. However, it is worthwhile when one takes into consideration the cost of alternate intervention and the potential benefit to the patient.