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

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Jong J.M.V.D.D., Oprea-Lager D.E., Hooft L., de Klerk J.M.H., Bloemendal H.J., Verheul H.M.W., Hoekstra O.S., van den Eertwegh A.J.M.


European Urology 2015

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 (<sup>89</sup>Sr), 153-samarium-EDTMP (<sup>153</sup>Sm), 186-rhenium-HEDP (<sup>186</sup>Re), 188-rhenium-HEDP (<sup>188</sup>Re), and 223-radium-chloride (<sup>223</sup>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 <sup>89</sup>Sr, 7 <sup>153</sup>Sm, 12 <sup>186</sup>Re, 2 <sup>188</sup>Re, and 2 <sup>223</sup>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%. Treatment with a bone-seeking radiopharmaceutical is an effective therapeutic option for patients with castration-resistant prostate cancer suffering from malignant bone pain.


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