Format

Send to

Choose Destination
Eur Urol. 2016 Sep;70(3):416-26. doi: 10.1016/j.eururo.2015.09.005. Epub 2015 Sep 19.

Radiopharmaceuticals for Palliation of Bone Pain in Patients with Castration-resistant Prostate Cancer Metastatic to Bone: A Systematic Review.

Author information

1
Department of Medical Oncology, VU University Medical Centre, Amsterdam, The Netherlands.
2
Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
3
Dutch Cochrane Centre Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
4
Department of Nuclear Medicine, Meander Medical Centre, Amersfoort, The Netherlands.
5
Department of Medical Oncology, Meander Medical Centre, Amersfoort, The Netherlands.
6
Department of Medical Oncology, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: vandeneertwegh@vumc.nl.

Abstract

CONTEXT:

The majority of patients with castration-resistant prostate cancer develop bone metastatic disease. It is often challenging to optimally palliate malignant bone pain. In case of multifocal pain due to diffuse osteoblastic metastases, treatment with bone-seeking radiopharmaceuticals can be considered.

OBJECTIVE:

This systematic review evaluates the efficacy of different bone-seeking radiopharmaceuticals for palliation of malignant bone pain from prostate cancer.

EVIDENCE ACQUISITION:

The PubMed (Medline) and Embase databases were searched for publications on 89-strontium-chloride ((89)Sr), 153-samarium-EDTMP ((153)Sm), 186-rhenium-HEDP ((186)Re), 188-rhenium-HEDP ((188)Re), and 223-radium-chloride ((223)Ra). Randomised controlled trials and prospective cohort studies were included. Metastatic bone pain had to be registered as outcome measure for prostate cancer patients separately.

EVIDENCE SYNTHESIS:

This review included 36 articles of which 13 randomised trials and 23 prospective studies. Of all trials, 10 studies used (89)Sr, 7 (153)Sm, 12 (186)Re, 2 (188)Re, and 2 (223)Ra; three reported on a combination of different radionuclides. Only a few trials contained a blinding procedure and several studies contained incomplete follow-up or lack of intention-to-treat analysis. It was not possible to calculate a pooled estimate of pain response to treatment with any of the radionuclides because different definitions of pain response were used.

CONCLUSIONS:

Overall, pain response percentages greater than 50-60% were seen with each radionuclide. Haematological toxicity was reported in 26 of the 36 studies and more than half of these trials stated no grade 3/4 leukopenia or thrombocytopenia occurred.

PATIENT SUMMARY:

In this report we reviewed the efficacy of bone-seeking radionuclides for treating bone pain from metastatic prostate cancer. Overall, treatment with bone-seeking radionuclides resulted in pain responses greater than 50-60%.

KEYWORDS:

Bone metastases; Bone pain; Bone seeking radiopharmaceutical; Prostate cancer

Comment in

PMID:
26391636
DOI:
10.1016/j.eururo.2015.09.005
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center