Treatment of metastatic bone pain

Full text: Bone metastases are distressingly common in patients with progressive cancers, and the pain caused by these is a significant burden on health care resources. Up to 50% of patients receiving radiation in most large cancer centers receive radiation for palliation of pain. There are a number of strategies available for managing this population of patients, including the use of narcotic analgesics, external beam radiotherapy, hormone therapy, bisphosphonates and radioisotope therapy. Radioisotope therapy is a very effective mechanism of treating this population of patients, particularly if careful patient selection occurs. A number of radiopharmaceuticals have been described as being effective-these include Strontium-89, Phosphorus-32, Samarium-153 EDTMP and Rhenium-186 HEDP. Data have now been developed which support the use of these radiopharmaceuticals in carefully selected patient populations, and support the use of these radiopharmaceuticals on multiple occasions. Inclusion and exclusion criteria for accepting patients for therapy have been developed and will be discussed, together with dosing strategies and relative effectiveness of the 4 radiopharmaceuticals. Cost is a significant issue with these radiopharmaceuticals, although these treatments are not significantly more expensive than current chemotherapy protocols. The framework will be reviewed for introducing these radiopharmaceuticals into clinical practice and there will be an attempt at reviewing the cost effectiveness of Phosphorus-32, which was used extensively in the 1960's and 1970's but has lately fallen out of favour. (author)