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Systemic radionuclide therapy in pain palliation

University Hospital Dresden, Department of Nuclear Medicine, Dresden, Radeberg, Germany

Roswitha Runge, PhD

University Hospital Dresden, Department of Nuclear Medicine, Dresden, Radeberg, Germany

Jörg Kotzerke, MD

University Hospital Dresden, Department of Nuclear Medicine, Dresden, Radeberg, Germany

Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate (¹⁸⁸Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate (¹⁸⁶Re-HEDP), and strontium-89 (⁸⁹Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with ¹⁸⁸Re-HEDP (3194 ± 387 MBq), 15 patients with 186Re-HEDP (1358 ± 158 MBq), and 18 patients with⁸⁹Sr (152 ± 19 MBq). The 188Re-HEDP group included six breast cancer patients and 25 prostate cancer patients; the 186Re-HEDP group included three breast cancer patients and 12 prostate cancer patients; and the⁸⁹Sr group included three breast cancer patients and 15 prostate cancer patients. All subjects participated in an interview using a standardized sets of questions before and after the 12-week term of therapy. Blood counts were taken weekly for six weeks and after 12 weeks. Results showed that 77 percent of patients reported pain relief after treatment with¹⁸⁸Re-HEDP, 67 percent after treatment with 186Re-HEDP, and 72 percent after treatment with⁸⁹Sr. Sixteen percent of patients treated with¹⁸⁸Re-HEDP, 13 percent treated with¹⁸⁶Re-HEDP, and 17 percent treated with⁸⁹Sr were able to discontinue their analgesics and were pain-free. Patients described an improvement on Karnofsky performance status (KPS) from 73 ± 7 percent to 85 ± 8 percent 12 weeks after¹⁸⁸Re-HEDP (p < 0.05), from 72 ± 13 percent to 79 ± 12 percent after¹⁸⁶Re-HEDP (p = 0.251), and from 62 ± 14 percent to 69 ± 16 percent after⁸⁹Sr (p = 0.415). Only three patients undergoing 188Re-HEDP therapy, one undergoing¹⁸⁶Re-HEDP therapy, and three undergoing 89Sr therapy had thrombocytopenia (platelet count below 100 x 10(3)/µl) following treatment. The maximum nadir of platelet and leukocyte counts was observed between the second and fifth week after treatment for all radionuclides and was reversible within 12 weeks. The nadir was earlier for¹⁸⁸Re-HEDP with a shorter physical half-life compared with⁸⁹Sr. There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after¹⁸⁸Re-HEDP was the only statistically significant finding (p = 0.001).

Key Words: bone pain • bone metastases • radionuclide therapy • breast cancer • prostate cancer

American Journal of Hospice and Palliative Medicine®, Vol. 22, No. 6, 457-464 (2005)
DOI: 10.1177/104990910502200613


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