Berna et al. (1995)

Berna et al. (1995)
Design: Prospective case series (therapy), evidence level: 3
Country: Spain
Inclusion criteria:
Breast cancer with skeletal metastases refractory to opioid analgesia and/or RT
WBC ≥ 3,500 per mm3
Platelets ≥ 100,000 per mm3
Exclusion criteria:
None stated
Number of patients = 15, age range 47 to 83 years, mean age = 61 years.
Single i.v. injection of Sr-89 at doses between 118–148 MBq
Primary outcome: pain relief.

Pain severity was scored from a combination of clinical status, mobility, sleeping pattern, number of painful sites, pain intensity and analgesia requirement.
Follow up:
Baseline evaluations of clinical status, sleeping pattern, pain severity and analgesia dependency were repeated at 4, 8 and 12 weeks after treatment.
Overall pain relief and reduction of analgesia = 47%

Substantial improvement with reduction of pain > 50% (range: 55–71) = 20%
Mild to moderate improvement with reduction of pain severity < 50% (range: 34–47) = 27%
No response = 53%

Response duration ranged from 3–7 months

Decreased peripheral blood cell count = 73%
General comments:
This is a very small case series of patients receiving Sr-89 for pain palliation. All had multiple bone metastases diagnosed between 2 and 10 years previously.

Authors point out that all patients continued to take analgesics throughout the follow-up period which confounds the assessment of efficacy of the treatment alone.

This observational study offers only a very weak level evidence in favour of the strontium-89 for pain palliation.

From: Chapter 6, Management of specific problems

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