Recent Developments in Nuclear Medicine in the Management of Bone Metastases

Abstract

Bone pain palliation is critical for cancer patients afflicted with bone metastases, but radionuclides remain underutilized in such treatments. The authors propose that physician education regarding radionuclide therapy be improved and additional investigations to evaluate newer radionuclides and treatment paradigms (eg, higher activities, repetitive or cyclic administration, chemosensitization, or chemosupplementation) be strongly encouraged. A comprehensive and an interdisciplinary clinical approach toward increasing the use of radionuclides in alleviating metastatic bone pain is proposed. Data from clinical collaborations will help optimize radiopharmaceutical therapy for pain palliation, increase its awareness among oncologists, and contribute effectively to patient palliation and quality-of-life improvements.

Metastatic bone disease: A 36‐Year single centre trend‐analysis of patients admitted to a tertiary orthopaedic surgical department

“…Most importantly, a substantial number of patients referred to a tertiary referral centre are in far advanced stages of their disease and surgical intervention would not result in the anticipated improvement in quality of life. Second, the use of non-surgical treatment modalities, such as serial embolization [30], radiopharmaceutical therapy [31], bisphosphonates [32], dentritic cell vaccine therapy [33], radiation therapy, and others which have emerged over the 36-year study period, have become the preferred treatment modality for selected cases [34]. However, for those patients who underwent surgery, an increasingly aggressive approach was observed over time.…”

Radium 223 dichloride: a multidisciplinary approach to metastatic castration-resistant prostate cancer

“…In addition, the available drugs have induced considerable serious adverse events, mostly hematologic, and thus have prevented subsequent therapeutic approaches [2]. Therefore, radionuclide-based therapy for symptomatic bone metastases has remained underused and limited to the late phases of the disease [3].…”

“…In addition, the available drugs have induced considerable serious adverse events, mostly hematologic, and thus have prevented subsequent therapeutic approaches [2]. Therefore, radionuclide-based therapy for symptomatic bone metastases has remained underused and limited to the late phases of the disease [3].The lack of safe therapeutic approaches to extend survival in CRPC patients has been a challenge for nuclear medicine physicians accustomed to successfully treating other tumor types, such as thyroid tumors with radioiodine therapy, or treating hematologic malignancies with ibritumomab tiuxetan. The recent introduction of the radiopharmaceutical radium Ra 223 (Ra 223) dichloride represents a breakthrough because, for the first time, an impact of a radiopharmaceutical on survival of patients with bone metastases due to prostate cancer was demonstrated in a large Phase III trial [4].…”

“…In particular, thrombocytopenia is common, with platelet counts at nadir generally 40-60% of baseline; however, in most patients this event leads to only grade 1 or 2 toxicity [3]. This adverse effect may keep many patients with mCRPC from accessing the treatment.…”

“…A flare reaction is observed in approximately 5-10% of patients, with a transient and self-limited increase of bone pain. This event is more common in patients with a significant burden of bone metastases visualized by bone scan [3].…”