A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer

Quilty, P.M.; Kirk, D.; Bolger, J. J.; Dearnaley, David P.; Lewington, Val; Masone, M.; Reed, Nicholas; Russell, John M.; Yardley, John H.

doi:10.1016/0167-8140(94)90411-1

Cited by 304 publications

(126 citation statements)

References 12 publications

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“…The response rates to Sr-89 therapy of 62.5% (including 17.5% complete responses) in this group of patients were typical of those reported in phase III Porter et al, 1993a;Quilty et al, 1994) and large phase II studies (Robinson et al, 1989;Laing et al, 1991) in the literature. This is despite the relative 'late' use of this agent in this study as judged by the high median baseline PSA (96 ng ml -1 ), high proportion of patients with extensive skeletal disease (63% of 92 evaluable patients had more than 20 bone scan hot spots).…”

Section: Discussionsupporting

confidence: 79%

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

et al. 2001

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Several phase III studies (Quilty et al, 1982;Lewington et al, 1991;McEwan et al, 1994;Malmberg et al, 1997) now support the usefulness and cost effectiveness of Sr-89 either as an alternative or an adjunct to external beam radiotherapy (EBRT) in men with bone pain due to metastatic prostate cancer. Primary study end points have included pain response presented in terms of reduction in severity and/or frequency of pain and/or analgesic use, delayed onset of new painful sites and/or decrease in EBRT requirement over the patient's remaining lifetime.It is recognized that the effects of palliative treatment extend beyond simply reducing the severity of a reference symptom, such as pain. Health-related QoL describes a multidimensional view of a patient's psychological and social, as well as physical wellbeing. Despite the frequent citing of the importance of overall QoL in men with metastatic prostate cancer and the potential impact that Sr-89 might have on QoL, there has been little attention paid to formal evaluation of QoL as a primary end-point in the study of Sr-89 to date.The Trans Canada Study Group (Porter et al, 1993) undertook a limited QoL evaluation and found that in the areas of physical mobility and pain control, Sr-89 produced a significant beneficial effect for men with metastatic prostate cancer. This assessment, as the authors acknowledge, was not ideal in that a standardized instrument was not used and conclusions were based on data pooled from a number of non-validated instruments including linear analogue self assessment scales, questionnaires and patient diaries.Following the establishment of a Government reimbursement in early 1995, Sr-89 therapy for the relief of bone pain due to prostate cancer became widely available in Australia. A group of interested Radiation Oncologists (the Australian Metastron User's Group) took this opportunity to initiate a prospective study to (1) confirm that treatment efficacy and toxicity were consistent with the world literature and to (2) simultaneously assess the nature and time course of any possible QoL benefits using a validated instrument. Secondary end-points included toxicity, (specifically bone marrow depression, pain 'flare' and/or other unexpected morbidity), and PSA 'response' following Sr-89. MATERIALS AND METHODSThis was a prospective multicentre study involving 13 oncology centres in 5 states and territories of Australia. Accrual took place over a two-year period from mid 1995 to mid 1997. There was a minimum 8-month interval from the date of Sr-89 injection in the last study patient to analysis, with a median follow up overall of 6.8 months (censoring patients at death).Eligible patients were those who had histologically proven prostate cancer with bone scan evidence of metastatic disease and who had progressed either clinically, biochemically or both following 'standard' first-line hormone therapy (with or without further hormonal manoeuvres), and who had one or more sites of bony pain. 7 patients had previously been treated with various chemot...

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Section: Discussionsupporting

confidence: 79%

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

et al. 2001

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“…The majority of patients who participated in this study had a life expectancy of only a few months (Hoskin, 1988;Quilty et al, 1994) and the main objective of therapy was lo provide pain relief while sparing them the extra burden of ineffective treatment. For the definition of a complete response to radiotherapy, it is necessary to apply strict criteria.…”

Section: Discussionmentioning

confidence: 99%

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

Rutten

Crul

Toorn

et al. 1997

Pain

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It is recognised that radiotherapy provides relief for intractable pain in approximately 50% of patients with cancer pain. Unfortunately, traditional explanatory variables, such as age, gender, histology or radiation dose, do not help to predict which individuals w ill benefit from palliative radiotherapy. A non-randomised prospective clinical trial was conducted on 51 patients to evaluate the value of pain characteristics as new explanatory variables for predicting the efficacy of palliative radiotherapy for providing cancer pain relief. Two new explanatory variables were identified: the presence of radiating pain and the pain score before radiotherapy.

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“…The work of Firusian et al (1976) suggested again that strontium-89 would be useful for relief of pain secondary to osseous metastases. Robinson and others further explored the utility of strontium-89 (Robinson, 1986;Quilty et al, 1994;Lewington et al, 1991;Robinson et al, 1987) resulting in the FDA approval for its routine application in 1993. This work has also stimulated clinical research in order to find other radionuclides, which may have improved physical properties that permit treatment with fewer side effects on the myeloproliferative cells in the bone marrow.…”

Section: Bone Pain Palliationmentioning

confidence: 99%

The role of electron-emitting radiopharmaceuticals in the palliative treatment of metastatic bone pain and for radiosynovectomy: applications of conversion electron emitter Tin-117m

Srivastava¹

2007

Braz. arch. biol. technol.

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A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer

Cited by 304 publications

References 12 publications

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain

The role of electron-emitting radiopharmaceuticals in the palliative treatment of metastatic bone pain and for radiosynovectomy: applications of conversion electron emitter Tin-117m

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