Role of radionuclide therapy as adjuvant to palliative external beam radiotherapy for painful multiple skeletal metastasis

The aim of this study was to evaluate the palliative efficacy of localized external radiotherapy (RT) with sistemic radionuclide (RN) therapy in patients with multiple painful osseos metastases of different primary origins. Thirty-three patients with a refferal to the Ankara University School of Medicine Department of Radiation Oncology with painful multiple skeletal metastases from different primarily origins (breast 8, prostate 6, lung 10, GIS 3, others 6) were eligible for this trial. Local external radiotherapy was delivered to the most symptomatic region initially in all patients, and then they received either Re-186-HEDA= Rhenium 186 hidroxyethylydene disphosphonate or SM-153 EDTMP= Samarium-153 ethylene daimine tetramethylene phosphate. The mean age was 58.8 (min 35- max 82). The performance status was assessed acording to ECOG scale. At the start of treatment, end of the radiotherapy and after the 4 weeks sistemic radionuclide therapy analgesic intake and pain status were recorded by RTOG scoring system. EORTC QLQ C30 (vesion 3.0 Turkish) questionnaire was performed to evaluate the quality of life at the start of treatment, end of the radiotherapy and after the 4 week systemic radionuclide therapy. Overall median survival was 17 months, and progression free survival was 10 months. Patients with breast and prostate tumours had a higher overall and progression free survival than that of other primary tumours (p=0.0062, p=0.0080). An improved performance of 33.3% for post radiation therapy and 50% for post radionuclide therapy in ECOG scale were observed. Statistically significant correlations were found between the primary origins and decreased pain and analgesic intake (p< 0.05). But no differences were observed on the self assesment quality of life questionnaire. Toxicity was acceptable. Sistemic radionuclide therapy, as adjuvant to local external RT, is found to be reducing pain and analgesic intake particularly patients with multiple bone metastases of breast and prostate cancer with expectation of long survival. This combined treatment may be an alternative to total body or half body irradiation for multiple painful skeletal metastasis with acceptable toxicity and faster palliative response