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THERAPY AND DOSIMETRY IN NUCLEAR MEDICINE - AN UPDATE
D’angelo G. 1, Sciuto R. 2, Salvatori M. 1, Sperduti I. 3, Mantini G. 4, Maini C. L. 2, Mariani G. 5
1 Nuclear Medicine, Catholic University, Rome, Italy;
2 Nuclear Medicine, “Regina Elena” National Cancer Institute, Rome, Italy;
3 Biostatistics Unit, “Regina Elena” National Cancer Institute, Rome, Italy;
4 Radiation Oncology, Catholic University, Rome, Italy;
5 Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
AIM: The aim of the study was to assess the state of the art of the use of bone-seeking radiopharmaceuticals for palliation therapy of pain from bone metastases.
METHODS: A systematic literature search was conducted about therapy with 89Sr-chloride and 153Sm-EDTMP between 2001-2011. The primary outcomes were efficacy and toxicity. Descriptive and quantitative data were extracted from each study, calculating event rates and odds ratio (OR) with 95% confidence intervals (CI) for pooled analysis. Subgroup analyses were performed.
RESULTS: Fifty-seven studies contributed to the systematic review. Forty-six studies used radiopharmaceuticals as a single agent, 15 investigated therapeutic combinations. Most of the studies included patients with prostate cancer. The overall efficacy of bone-seeking radiopharmaceuticals as single agents was 70%, whereas it was 74% when used in combination with other therapies. Complete response was reported in 27% of patients. Efficacy resulted to be 70% for prostate cancer and 79% for breast cancer. The overall toxicity of radiopharmaceuticals was 15%: the toxicity was 11% selecting only studies reporting on the use of radiopharmaceuticals as a single agent. No significant difference was found between bone-seeking radiopharmaceuticals and other oncological treatments regarding efficacy or toxicity. Reports of objective response outcomes suggest that bone-seeking radiopharmaceuticals have some cytotoxic activity, either alone or combination with chemotherapy.
CONCLUSION: This literature analysis emphasizes multiple evidences of high efficacy and low toxicity of bone seeking radiopharmaceuticals; moreover, this therapy may have a therapeutic potential beyond simple palliation of bone pain.