Systemic Metabolic Radiopharmaceutical Therapy in the Treatment of Metastatic Bone Pain

Fabio M. Paes, Aldo N Serafini

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed.

Original languageEnglish
Pages (from-to)89-104
Number of pages16
JournalSeminars in Nuclear Medicine
Volume40
Issue number2
DOIs
StatePublished - Mar 1 2010

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Radiopharmaceuticals
Diphosphonates
Bone and Bones
Pain
Rhenium
Neoplasm Metastasis
Radiation
Etidronic Acid
Therapeutics
Spontaneous Fractures
Spinal Cord Compression
Kidney Neoplasms
Hypercalcemia
Pain Management
Thyroid Neoplasms
Chronic Pain
Patient Selection
Analgesics
Comorbidity
Lung Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Systemic Metabolic Radiopharmaceutical Therapy in the Treatment of Metastatic Bone Pain. / Paes, Fabio M.; Serafini, Aldo N.

In: Seminars in Nuclear Medicine, Vol. 40, No. 2, 01.03.2010, p. 89-104.

Research output: Contribution to journalArticle

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