Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer

Abstract

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.

A prospective randomized trial: A comparison of the analgesic effect and toxicity of 153Sm radioisotope treatment in monotherapy and combined therapy including local external beam radiotherapy (EBRT) among metastatic Castrate Resistance prostate cancer (m

“…The proportion of patients obtaining a 50% reduction or more of baseline pain defined as partial response after therapy was 70% in 77 -84 days. The overall results from our study are analogous to data presented in other randomized controlled trials and in large observational studies [8,9,11,12]. There were not clear differences in clinical efficacy among available radionuclides, which induce clinical relevant pain relief and complete pain relief in range from 50% to 95% and from 20% to 30% of patients, respectively.…”

Radionuclide Therapy of Bone Metastases

“…Pain relief typically occurs within 1 week of intravenous 153 Sm-EDTMP administration and usually lasts for about 8-12 weeks, although prolonged responses of up to 12 months have been reported [23]. The advantage of 89 Sr is a longer mean response duration of approximately 4 to 6 months, but this benefit must be weighed against the delayed onset of symptom palliation of 14-28 days after radiopharmaceutical administration [30] and the increased risk of myelosuppression. …”

The role of radiation therapy in the treatment of metastatic castrate-resistant prostate cancer

“…The physical half life of 46.3 h is shorter than Sr 89, resulting in a faster delivery and response [Resche et al 1997]. After a single injection, overall response rates for pain are Other common toxicity Nausea and vomiting Pain flare 13% (⩾grade 3 = 4%) 10% [Pons et al 1997;KraeberBodere et al 2000;Turner et al 2001;Sciuto et al 2002;Oosterhof et al 2003] 65-74% with onset at 1 week, and duration 2-3 months Resche et al 1997;Serafini et al 1998;Tian et al 1999;Sartor et al 2004]. Grade 3 myelosuppression is significant, occurring in 3-12%, with blood counts reaching nadir by week 3-5 [Resche et al 1997;Serafini et al 1998;Tian et al 1999;Sartor et al 2004 [Maxon et al 1990;Palmedo et al 2003;Liepe et al 2003].…”