Baziotis et al. (1998)

Baziotis et al. (1998)
Design: Prospective case series (therapy), evidence level: 3
Country: Greece
Inclusion criteria:
Metastatic breast cancer
Suffering extreme pain (10 on pain scale - see below)
Multiple (≥ 5) bone metastases
WBC ≥ 3,000 per mm3
Platelets ≥ 100,000 per mm3
Ht > 30%
Hb > 10 g per dl
Exclusion criteria:
None stated
Number of patients = 64.
Single i.v. injection of Sr-89 at a dose of 150 MBq (4 mCi)

10 patients received a second, and 5 a third, dose but the outcomes reported in this document only relate to the first treatment.
Pain reduction as measured on a scale of 0 (no pain)-10 (most severe) scale compared with an baseline score of 10.

Patients moved from 10 to the following:
(2.5–0) - dramatic response: sleep all night without analgesia
(5–2.5) - satisfactory response: sleep all night with analgesia
(7.5–5) - moderate response: sleep half night
(10–7.5) - no response: no sleep at all
Follow up:
Baseline laboratory tests were repeated every week for 8 weeks. Pain intensity was evaluated before treatment and every 10 days thereafter.

Bone scintigraphy (99 mTcMDP) images were obtained at baseline and 3 months after treatment. Sr-89 bremsstrahlung images were obtained to show localization to tumour sites.

Follow-up period was 6 months.
81% patients experienced pain palliation with reduction in analgesia requirement. These 52 patients reported:

Dramatic response (35%)
Satisfactory response (40%)
Moderate response (25%)

These improvements were generally recorded between 10–20 days after the injection.

78% patients had a decrease in peripheral blood cell counts which returned to pre-treatment levels after 4–6 weeks with full recovery in the following 3–5 weeks but 5 patients required colony- stimulating factor.

Most (not quantified) patients showed no improvement in bone scintigraphy. 3 patients showed improvement.
General comments:
This paper describes a small prospective case series of 64 MBC patients who received a single dose of Sr-89 for pain palliation.

Analgesia was standardised for all patients throughout the study.

Follow-up was sufficiently long to measure the outcome and included all patients.

The study is very weak evidence as there is no control, such as an analgesic or placebo, with which to compare the effects of strontium.

From: Chapter 6, Management of specific problems

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Advanced Breast Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 81.
National Collaborating Centre for Cancer (UK).
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