Efficacy and safety of strontium chloride for bone metastases from prostate cancer: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

PANG Xiao ¹ , ZHOU Li ¹ , NIU Shuli ² , SUN Ru ³ , CHEN Yong ¹ , XU Li ¹ ,  LI Suping ¹

1. Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R.China;
2. Department of Nuclear Medicine, Deyang People’s Hospital, Deyang, 618000, P.R.China;
3. Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R.China;

Corresponding author：

LI Suping, Email: suping7273@163.com

Keywords：

Strontium chloride; Radionuclide therapy; Prostate cancer; Bone metastases; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201702051

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Objective To systemically review the efficacy and safety of strontium chloride for bone metastases from prostate cancer. Methods PubMed, The Cochrane Library, EMbase, VIP, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) about strontium chloride for bone metastases from prostate cancer from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 7 RCTs involving 1 532 patients were included. The results of meta-analysis showed that strontium chloride was superior to placebo in the rate of pain relief (RR=1.79, 95%CI 1.35 to 2.37, P<0.000 1), but more likely to cause slight leucopenia (Peto OR=5.02, 95%CI 1.49 to 16.95,P=0.009). However, no significant difference was found in overall survival time between two groups (RR=0.87, 95%CI 0.58 to 1.30, P=0.49). In addition, strontium chloride was superior to radiotherapy in rate of bone pain relief (RR=1.28, 95%CI 1.12 to 1.47, P=0.0004), but it would cause thrombocy (Peto OR=2.61, 95%CI 1.04 to 6.57, P=0.04). Conclusion Current evidence shows that the strontium chloride is superior to placebo in the rate of pain relief, but it will cause slight leucopenia. The strontium chloride is superior to radiotherapy in rate of bone pain relief. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： PANG Xiao, ZHOU Li, NIU Shuli, SUN Ru, CHEN Yong, XU Li, LI Suping. Efficacy and safety of strontium chloride for bone metastases from prostate cancer: a systematic review. Chinese Journal of Evidence-Based Medicine, 2017, 17(11): 1305-1311. doi: 10.7507/1672-2531.201702051 Copy

1.	Body JJ, Bartl R, Burchardt P, et al. Current use of bisphosphonates in oncology. J Clin Oncol, 1998, 16(12): 3890-3899.
2.	Fidler IJ. The pathogenesis of cancer metastases: the " seed and soil” hypothesis revisited. Nat Rev Cancer, 2003, 3(6): 453-458.
3.	Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev, 2001, 27(3): 165-176.
4.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. Ca Cancer J Clin, 2015, 65(2): 87-108.
5.	韩苏军, 张思维. 中国前列腺癌发病现状和流行趋势分析. 临床肿瘤学杂志, 2013, 4(18): 330-334.
6.	Rodman GD. Mechanisms of bone metastasis. Discov Med, 2004, 4(22): 144-148.
7.	Buchali K, Correns HJ, Schuerer M, et al. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma. Eur J Nucl Med, 1988, 14(7-8): 349-351.
8.	Lewington VJ, McEwan AJ, Ackery DM, et al. A prospective, randomized double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone. Eur J Cancer, 1991, 27(8): 954-958.
9.	Porter AT, McEwan AB, Powe JE, et al. Results of a randomized phase III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys, 1993, 25(5): 805-813.
10.	Quilty PM, Kirk D, Bolger JJ, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol, 1994, 31(1): 33-40.
11.	Osterhof GN, Roberts JT, de Reijke TM, et al. Strontium (89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: A phase III study of the European Organisation for Research and Treatment of Cancer Genitourinary Group. Eur Urol, 2003, 44(5): 519-526.
12.	Baczyk M, Czepczyński R, Milecki P, et al. ⁸⁹Sr versus ¹⁵³Sm-EDTMP: Comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma. Nucl Med Commun, 2007, 28(4): 245-250.
13.	James ND, Pirrie SJ, Pope AM, et al. Clinical outcomes and survival following treatment of metastatic castrate-refractory prostate cancer with docetaxel alone or with strontium-89, zoledronic acid, or both the TRAPEZE randomized clinical trial. JAMA Oncol, 2016, 20(53): 1-288.
14.	World Health Organization. Cancer pain relief and palliative care. Report of a WHO committee. World Health Organ Technical Report Series. Geneva: World Health Organization, 1990.
15.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
16.	Blake GM, Zivanovic MA, McEwan AJ, et al. Sr-89 therapy: strontium kinetics in disseminated carcinoma of the prostate. Eur J Nucl Med, 1986, 12(9): 447-454.
17.	Ben JE, Lucas DR, Vasan S, et al. Selective accumulation of strontium-89 in metastatic deposits in bone: radio histological correlation. Nucl Med Commun, 1995, 16(6): 457-463.
18.	Breen SL, Powe JE, Porter AT. Dose estimation in strontium-89 radiotherapy in metastatic prostatic carcinoma. J Nucl Med, 1992, 33(7): 1316-1323.
19.	马安康, 汤青松. ⁸⁹Sr 内照射治疗恶性肿瘤多发性骨转移止痛疗效的评价. 广西医药, 2008, 30(12): 1909-1910.
20.	刘志军, 杨秀蓉, 陈玉石, 等. 89 锶内照射治疗转移性骨肿瘤骨痛的临床观察. 中国药师, 2005, 8(5): 408-409.
21.	刘康龙, 莫逸. ⁸⁹Sr 治疗前列腺癌、乳腺癌、肺癌骨转移的临床疗效. 现代肿瘤医学, 2006, 14(4): 475-476.
22.	沈伟华, 徐庆康, 于永涛, 等. 唑来膦酸联合放射性核素⁸⁹Sr 治疗晚期前列腺癌骨转移疼痛. 中国男科学杂志, 2008, 22(1): 28-30.
23.	Sciuto R, Festa A, Rea S, et al. Effects of low-dose cisplatin on ⁸⁹Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med, 2002, 43(1): 79-86.
24.	Kraeber-Bodéré F, Campion L, Rousseau C, et al. Treatment of bone metastases of prostate cancer with strontium-89chloride: efficacy in relation to the degree of bone involvement. Eur J Nucl Med, 2000, 27(10): 1487-1493.
25.	楼岑, 张大平, 余林良, 等. ⁸⁹ 锶内照射治疗转移性骨肿瘤的临床研究. 中华肿瘤杂志, 2001, 23(6): 507-509.
26.	Kuroda I. Effective use of strontium-89 in osseous metastases. Ann Nucl Med, 2012, 26(3): 197-206.
27.	Zyskowski A, Lamb D, Morum P, et al. Strontium-89 treatment for prostate cancer bone metastases: doesa prostate-specific antigen response predict for improved survival? Australas Radiol, 2001, 45(1): 39-42.
28.	Amato RJ, Hernandez-McClain J, Henary H. Bone-targeted therapy: phase II study of strontium-89 in combination with alternating weekly chemohormonal therapies for patients with advanced androgen-independent prostate cancer. Am J Clin Oncol, 2008, 31(6): 532-538.
29.	张王峰, 叶常青, 袁梦晖, 等. ⁸⁹ 氯化锶放疗辐射对肿瘤骨转移患者血象的影响. 华南国防医学杂志, 2010, 24(3): 193-195.

1. Body JJ, Bartl R, Burchardt P, et al. Current use of bisphosphonates in oncology. J Clin Oncol, 1998, 16(12): 3890-3899.
2. Fidler IJ. The pathogenesis of cancer metastases: the " seed and soil” hypothesis revisited. Nat Rev Cancer, 2003, 3(6): 453-458.
3. Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev, 2001, 27(3): 165-176.
4. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. Ca Cancer J Clin, 2015, 65(2): 87-108.
5. 韩苏军, 张思维. 中国前列腺癌发病现状和流行趋势分析. 临床肿瘤学杂志, 2013, 4(18): 330-334.
6. Rodman GD. Mechanisms of bone metastasis. Discov Med, 2004, 4(22): 144-148.
7. Buchali K, Correns HJ, Schuerer M, et al. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma. Eur J Nucl Med, 1988, 14(7-8): 349-351.
8. Lewington VJ, McEwan AJ, Ackery DM, et al. A prospective, randomized double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone. Eur J Cancer, 1991, 27(8): 954-958.
9. Porter AT, McEwan AB, Powe JE, et al. Results of a randomized phase III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys, 1993, 25(5): 805-813.
10. Quilty PM, Kirk D, Bolger JJ, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol, 1994, 31(1): 33-40.
11. Osterhof GN, Roberts JT, de Reijke TM, et al. Strontium (89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: A phase III study of the European Organisation for Research and Treatment of Cancer Genitourinary Group. Eur Urol, 2003, 44(5): 519-526.
12. Baczyk M, Czepczyński R, Milecki P, et al. ⁸⁹Sr versus ¹⁵³Sm-EDTMP: Comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma. Nucl Med Commun, 2007, 28(4): 245-250.
13. James ND, Pirrie SJ, Pope AM, et al. Clinical outcomes and survival following treatment of metastatic castrate-refractory prostate cancer with docetaxel alone or with strontium-89, zoledronic acid, or both the TRAPEZE randomized clinical trial. JAMA Oncol, 2016, 20(53): 1-288.
14. World Health Organization. Cancer pain relief and palliative care. Report of a WHO committee. World Health Organ Technical Report Series. Geneva: World Health Organization, 1990.
15. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
16. Blake GM, Zivanovic MA, McEwan AJ, et al. Sr-89 therapy: strontium kinetics in disseminated carcinoma of the prostate. Eur J Nucl Med, 1986, 12(9): 447-454.
17. Ben JE, Lucas DR, Vasan S, et al. Selective accumulation of strontium-89 in metastatic deposits in bone: radio histological correlation. Nucl Med Commun, 1995, 16(6): 457-463.
18. Breen SL, Powe JE, Porter AT. Dose estimation in strontium-89 radiotherapy in metastatic prostatic carcinoma. J Nucl Med, 1992, 33(7): 1316-1323.
19. 马安康, 汤青松. ⁸⁹Sr 内照射治疗恶性肿瘤多发性骨转移止痛疗效的评价. 广西医药, 2008, 30(12): 1909-1910.
20. 刘志军, 杨秀蓉, 陈玉石, 等. 89 锶内照射治疗转移性骨肿瘤骨痛的临床观察. 中国药师, 2005, 8(5): 408-409.
21. 刘康龙, 莫逸. ⁸⁹Sr 治疗前列腺癌、乳腺癌、肺癌骨转移的临床疗效. 现代肿瘤医学, 2006, 14(4): 475-476.
22. 沈伟华, 徐庆康, 于永涛, 等. 唑来膦酸联合放射性核素⁸⁹Sr 治疗晚期前列腺癌骨转移疼痛. 中国男科学杂志, 2008, 22(1): 28-30.
23. Sciuto R, Festa A, Rea S, et al. Effects of low-dose cisplatin on ⁸⁹Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med, 2002, 43(1): 79-86.
24. Kraeber-Bodéré F, Campion L, Rousseau C, et al. Treatment of bone metastases of prostate cancer with strontium-89chloride: efficacy in relation to the degree of bone involvement. Eur J Nucl Med, 2000, 27(10): 1487-1493.
25. 楼岑, 张大平, 余林良, 等. ⁸⁹ 锶内照射治疗转移性骨肿瘤的临床研究. 中华肿瘤杂志, 2001, 23(6): 507-509.
26. Kuroda I. Effective use of strontium-89 in osseous metastases. Ann Nucl Med, 2012, 26(3): 197-206.
27. Zyskowski A, Lamb D, Morum P, et al. Strontium-89 treatment for prostate cancer bone metastases: doesa prostate-specific antigen response predict for improved survival? Australas Radiol, 2001, 45(1): 39-42.
28. Amato RJ, Hernandez-McClain J, Henary H. Bone-targeted therapy: phase II study of strontium-89 in combination with alternating weekly chemohormonal therapies for patients with advanced androgen-independent prostate cancer. Am J Clin Oncol, 2008, 31(6): 532-538.
29. 张王峰, 叶常青, 袁梦晖, 等. ⁸⁹ 氯化锶放疗辐射对肿瘤骨转移患者血象的影响. 华南国防医学杂志, 2010, 24(3): 193-195.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of strontium chloride for bone metastases from prostate cancer: a systematic review

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