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A Journal on Nuclear Medicine and Molecular Imaging

A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413

Frequency: Quarterly

ISSN 1824-4785

Online ISSN 1827-1936


The Quarterly Journal of Nuclear Medicine and Molecular imaging 2011 August;55(4):431-47



Radionuclide therapy and integrated protocols for bone metastases

Chiacchio S. 1, Mazzarri S., 1 Lorenzoni A. 1, Nyakale N. E. 2, Boni G. 1, Borsò E. 1, Alsharif A. A. 3, Grosso M. 1, Manca G. 1, Greco C. 4, Volterrani D. 1, Mariani G. 1

1 Regional Center of Nuclear Medicine, University of Pisa Medical School and University Hospital, Pisa, Italy;
2 Nuclear Medicine Service, “Steve Biko” Pretoria Academic Hospital, Pretoria, Republic of South Africa;
3 Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan;
4 Division of Radiotherapy, Department of Oncology, Transplants, and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy

Bone metastases are responsible for most of the morbidity and mortality associated with solid malignant tumors, occurring in about 65-70% of the patients with advanced breast or prostate cancer. The pathophysiology of skeletal metastasis is a complex process that involves several biologic process leading to cellular invasion, adhesions and stimulation of osteoclasts and osteoblasts with the mediation of several factors including cytokines, serine proteases and tumor-derived factors. The clinical management of pain from bone metastasis, which is mostly due to indirect stimulation of sensory nerve endings by cytokines and other biologically-active compounds released locally in response to the presence of tumor cells in the bone marrow, includes several options that can be used either alone or in varying combinations, such as analgesic drugs, chemo- or hormonal therapy, bisphosponates, external beam radiation therapy, and surgery. Bone-seeking radiopharmaceuticals play an important role in the treatment of pain caused by multiple blastic or mixed-type skeletal lesions; they have in general a favorable toxicity profile and a high rate of overall clinical benefit, although they may differ in terms of duration of pain palliation and suitability for repeat treatments. The palliative effect can be attributed to the radiation targeted to the bone marrow space, and the overall average response ranges between about 45-80%, with complete response in 10-30% of the cases. In selected clinical conditions, radionuclide therapy can also constitute an effective systemic treatment beyond bone pain palliation, and a synergistic anti-tumour effect can be expected by the combination with other agents, such as chemotherapy or bisphosphonates. This review summarizes the current experience with bone-seeking radiopharmaceuticals used for bone pain palliation, focusing on indications, patients’ selection, efficacy and toxicity. Finally, the available data on combination therapies showing encouraging results as to potential anti-tumor efficacy are also reviewed.

language: English


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