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Am J Health Syst Pharm 1995 Oct 15;52(20):2189-95
Strontium chloride Sr 89 for treating pain from metastatic bone disease.Nightengale. The agent selectively irradiates metastatic sites while generally sparing normal soft-bone tissue. In clinical studies, a majority of patients with prostate or breast cancer obtained substantial relief from bone pain after receiving strontium chloride Sr 89 alone or in combination with external-beam irradiation. Adverse effects tend to be mild, but patients should be monitored for possible hematologic toxicity. Patients should discontinue any calcium-containing products before receiving the agent. The typical dose is 4 mCi (148 MBq) administered by slow i.v. push over one to two minutes; doses can be repeated at three-month intervals. Pain relief usually begins in 10-20 days and lasts up to six months. Eur J Nucl Med 1997 Oct;24(10):1210-4 Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer.Pons. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. Semin Oncol 1993 Jun;20(3 Suppl 2):44-8 Clinical experience with strontium-89 in prostatic and breast cancer patients.Robinson Data accumulated over the last 15 years demonstrates that 89Sr provides pain relief in up to 80% of patients with bony metastases arising from breast or prostatic malignancies. Pain palliation is maintained for several months, along with improvements in functional status and quality of life. As many as one fifth of 89Sr-treated patients become pain free and require no further pain medication. The adverse effects of intravenous 89Sr are minimal. Bone marrow toxicity is observed in many patients, resulting in some reduction of platelet and white blood cell counts. Despite reductions of 20% to 30%, these hematologic effects are generally reversible and the majority of patients maintain platelet counts that are within normal limits. Radiother Oncol 1994 Apr;31(1):33-40 A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer.Quilty. 284 patients with prostatic cancer and painful bone metastases were treated with either radiotherapy or strontium-89 (200 MBq). There was no significant difference in median survival (after > 80% had died); 33 weeks following strontium-89 and 28 weeks following radiotherapy (p = 0.1). All treatments provided effective pain relief; improvement was sustained to 3 months in 63.6% after hemibody radiotherapy compared with 66.1% after strontium-89, and in 61% after local radiotherapy compared with 65.9% in the comparable strontium-89 group. Fewer patients reported new pain sites after strontium-89 than after local or hemibody radiotherapy (p < 0.05). Radiotherapy to a new site was required by 12 patients in the local radiotherapy group compared with 2 after strontium-89 (p < 0.01), although there was no significant difference between hemibody radiotherapy (6 patients) and strontium-89 (9 patients) in this respect. Platelets and leukocytes fell by an average 30-40% after strontium-89 but sequelae were uncommon, and other symptoms rare. Oncology 1998 Sep-Oct;55(5):377-81 Strontium-89 chloride in the treatment of bone metastases from breast cancer.Baziotis. Sixty-four patients with painful metastatic breast cancer in bone were treated with 2 MBq/kg of strontium-89 chloride as a single intravenous injection. Fifty-two of 64 patients (81%) showed at least a moderate improvement. Eighteen out of the 52 responders showed a dramatic decrease in bone pain (35%), 21 (40%) presented a satisfactory response and in 13 cases (25%) the response was moderate. Only 12 patients (19%) from the whole group did not feel any improvement on pain palliation. A statistically significant decrease of pretreatment levels of platelets and leukocyte counts was observed after 4-6 weeks of therapy in 50 (70%) patients. Prostate Suppl 1994;5:23-6 An overview of current clinical experience with strontium-89 (Metastron).Bos. Diffuse painful metastases can be treated with half-body irradiation with a response rate of up to 70%, but there is considerable toxicity. Strontium-89 (Metastron) is a calcium analog radionuclide that is selectively absorbed at bone locations with increased osteoblastic activity. It is a pure beta-emitter with bone penetration of 0.8 cm, and it has been used in multiple trials with response rates of up to 80%. Results are reported with Metastron in 28 patients with diffuse painful bone metastases, in whom a response rate of 82% was seen. Clin Oncol (R Coll Radiol) 1992 Mar;4(2):101-7 Palliation of bone metastases in prostate cancer. Hemibody irradiation or strontium-89?Dearnaley. study compares the results of treatment using hemibody irradiation (HBI) at the Royal Marsden Hospital (27 cases) with isotope therapy using the bone-seeking isotope strontium-89 (89Sr) Pain control assessed at 3 months was similar for HBI and matched 89Sr cases, with 63% and 52% respectively showing some benefit. Median survival was similar for these groups at 20 and 21 weeks respectively. The unmatched 89Sr group, which had more favourable prognostic factors, had a better outcome with 96% showing improvement in pain and with a median survival of 59 weeks. Cancer Nurs 1995 Aug;18(4):286-91 Palliation of bone pain in patients with metastatic cancer using strontium-89 (Metastron).Kan. Bony metastasis is the most common cause of cancer pain. Strontium-89 (Sr-89), or Metastron, therapy has been shown to be effective for the palliation of pain due to skeletal metastases. By reducing opioid analgesics intake and restoring mobility, Sr-89 improves the patient's quality of life. Sr-89 is given conveniently as an outpatient procedure, and when necessary it can be repeated at 3-month intervals. Sr-89 is useful as an adjunct to local external beam radiation (EBR) because Sr-89 will target all skeletal metastases, including those not included in the EBR field. Because Sr-89 is a beta-emitting radionuclide with a long physical half-life (50.5 days), precautions should be taken by the caretaker(s) against Sr-89 contamination from the patient's blood or excretions, particularly if the patient is incontinent. Am J Clin Oncol 1996 Apr;19(2):102-7 Strontium-89 chloride (Metastron) for palliative treatment of bony metastases. The University of Minnesota experience.Lee. We evaluated blood count changes and pain relief in 28 patients with widespread painful bony metastasis treated with strontium-89 .The median time (range) to nadir was about 6 weeks. The percentage reductions relative to baseline were 32% (range 0-72%) for WBC; 14% (range 0-50%) for Hgb; 15% (range 0-47%) for the red blood cell (RBC) count; and 40% (range 0-85%)for Plts. The median time of survival was 23 weeks (range 2-66 weeks). At 12 weeks, 29% of patients had moderate to dramatic improvement of pain, 32% had some relief of pain, and 50% had no improvement in pain. Urology 1997 Nov;50(5):747-53 Painful bone metastases in hormone-refractory prostate cancer: economic costs of strontium-89 and/or external radiotherapy.Malmberg. In a prospective randomized Canadian trial, addition of radionuclide strontium (89Sr) to external radiotherapy (ER) was found to prolong the time to further ER by 15 weeks (35 versus 20, P = 0.006) compared to ER alone in patients with hormone-refractory metastatic prostate cancer (HRMPC). Strontium-89 as initial supplement to ER for palliation of pain in HRMPC is beneficial both from the patient and lifetime health service costs perspectives. |