Treatment of Painful Osseous Metastases

Painful Osseous Metastases

Radionuclide therapy has proven to be effective in the management of painful osseous metastases refractory to conventional analgesic treatments. Radionuclide treatment mediated by high-energy beta particles does not reduce the risk for pathologic fracture in these patients. There are two radiopharmaceuticals that are commercially available for this use:

Samarium-153

Sm-153 decays by emissions of both beta and gamma particles, allowing diagnostic imaging. It provides prompt relief of pain usually within five to 10 days with a mean duration of two to four months. Following therapy, mild transient myelosupression can occur. Patients can be retreated for recurrent pain.

Strontium-89

Sr-89 is a pure beta emitter and, as such, has no gamma emissions. Pain relief onset can take a few days longer than with Sm-153, but mean duration of relief is about six months because of its longer half-life. Patients can be retreated at intervals of not less than 90 days. Many, but not all, patients are responsive to therapy. Adding low-dose cisplatin can enhance the therapeutic effect of Sr-89 for pain. Mild myelosupression is a common adverse effect.