An evaluation of strontium-89 chloride for palliative treatment of 449 cases in bony metastases

Objective: To evaluate the palliative treatment effect of strontium-89 chloride for bony metastases. Methods: In 449 cases with bone pain of multiple and diffuse metastases, 394 cases were identified as primary cancer (120 lung carcinoma, 109 prostate carcinoma, 57 breast carcinoma, 24 intestinal carcinoma, 21 gastric carcinoma, 13 nasopharyngeal carcinoma, 10 renal carcinoma, 7 liver carcinoma, 6 esophagus carcinoma and 27 other carcinoma), 55 cases were unknown primary cancer. The therapy dosage of strontium-89 chloride was 148 MBq (4 mCi) for every single injection. In 449 cases, 318 cases were injected with single injection, 57 cases with two times, 32 cases with three times, 16 cases with four times, 11 cases with five times, 5 cases with six times, 4 cases with seven times, and 3 cases with eight times and ninth times of injections respectively. The repeated interval was 3-11 months. Serial blood counts were checked monthly postinjection. Results: During the period of 2 months to 6 years follow-up in 449 patients, 84 cases presented dramatic decreased in bone pain (18.7%), 277 cases showed some relief of bone pain (61.7%), and 88 cases had no improvement in bone pain (19.6%). The number and the size of metastatic cancer nests decreased or vanished in 210 cases (75/210, 35.7%). The ratios of counts of ROIs in the metastatic lesions, compared to counts of ROIs in normal counterparts after treatment, decreased significantly (P < 0.05). Pain relief usually began in 14 days and lasted up to 3 ∼ 9 months. In few cases, white blood count and platelets were decreased after injection, but all were among the normal range. Conclusion: In this group of 449 cases of painful bony metastases treated by strontium-89 chloride, the effectiveness of pain relief was 80.4%. Most of patients showed decreased bony pain, and the quality of life was improved. This palliative treatment showed no relevant hematological toxicity. (authors)