Radioisotopes for Tumor Metastatic Bone Pain: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Xinling ¹ , LIAO Yi ² , WU Tai xiang ³

1.Department of Nuclear Medicine; Kelamayi City Central Hospital; Kelamayi 834000; China2.Department of Orthopaedics; Kelamayi City Central Hospital; Kelamayi 834000; China3.Chinese Evidence-Based Medicine Center/ Clinical Epidemiology Resource and Training Center （Chengdu）; West China Hospital; Sichuan University; Chengdu 610041;

Corresponding author：

Keywords：

Tumor metastases; Metastasis bone pain; Radioisotopes; Systematic review

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Objective 　To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed.
Methods 　MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis.
Results 　Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively.
Conclusions 　There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.

Citation： WANG Xinling,LIAO Yi,WU Tai xiang. Radioisotopes for Tumor Metastatic Bone Pain: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(6): 455-460. doi: Copy

1.	Portenoy RK. Cancer Pain. Epidemiology and pain syndromes[J]. Cancer, 1989; 63(11 Suppl): 2298-2307.
2.	Nelson OS, Munro AJ, Tannock IF. Bone metastatic: pathophysiology and management policy[J]. J Clin Oncol, 1991; 9(3):509-524.
3.	Scully SP, Ghert MA, Zurakowski D, Thompson RC, Gebhardt MC. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications[J]. J Bone Joint Surg Am, 2002; 84-A(1):49-57.
4.	Mertens WC, Filipczack LA, Ben-Josef Edgar, Davis LP, Portes AT. Systemic bone-seeking Radionuclides for palliation of painful osseous metastases: Current Concepts[J]. CA Cancer J Clin, 1998; 48(6):361-374.
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9.	Buchali K, Correns HJ, Schuerer M, Schnorr D, Lips H, Sydow K. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma[J]. European Journal of Nuclear Medicine, 1988; 14(7-8):349-351.
10.	Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, Reed NS, Russell JM, Yardley J. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer[J]. Radiotherapy & Oncology, 1994; 31(1): 33-40.
11.	Liepe K, Franke WG, Kropp J, Koch R, Runge R, Hliscs R. Vergleich von Rhenium-188-HEDP, Rhenium-186-HEDP und Strontium-89 fur die palliative Schmerztherapie von Skelettmetastasen[J]. Nuklearmedizin, 2000; 39(6): 146-151.
12.	Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.
13.	Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.

1. Portenoy RK. Cancer Pain. Epidemiology and pain syndromes[J]. Cancer, 1989; 63(11 Suppl): 2298-2307.
2. Nelson OS, Munro AJ, Tannock IF. Bone metastatic: pathophysiology and management policy[J]. J Clin Oncol, 1991; 9(3):509-524.
3. Scully SP, Ghert MA, Zurakowski D, Thompson RC, Gebhardt MC. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications[J]. J Bone Joint Surg Am, 2002; 84-A(1):49-57.
4. Mertens WC, Filipczack LA, Ben-Josef Edgar, Davis LP, Portes AT. Systemic bone-seeking Radionuclides for palliation of painful osseous metastases: Current Concepts[J]. CA Cancer J Clin, 1998; 48(6):361-374.
5. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003]. Section 6. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
6. Lewington VJ, McEwan AJ, Ackery DM, Bayly RJ, Keeling DH, Macleod PM, Porter AT, Zivanovic MA. A prospective, randomised double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone[J]. European Journal of Cancer, 1991; 27(8):954-958.
7. Porter AT, McEwan AJB, Powe JE, Reid R, McGowan DG, Lukka H, Sathyanarayana JR, Yakemchuk VN, Thomas GM, Erlich LE. 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[J]. INT-J-RADIAT-ONCOL-BIOL-PHYS, 1993; 25(5): 805-813.
8. Serafini AN, Houston SJ, Resche I, Quick DP, Grund FM, Ell PJ, Bertrand A, Ahmann FR, Orihuela E, Reid RH, Lerski RA, Collier BD, McKillop JH, Purnell GL, Pecking AP, Thomas FD, Harrison KA. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: A double-blind placebo-controlled clinical trial[J]. Journal of Clinical Oncology, 1998; 16(4):1574-1581.
9. Buchali K, Correns HJ, Schuerer M, Schnorr D, Lips H, Sydow K. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma[J]. European Journal of Nuclear Medicine, 1988; 14(7-8):349-351.
10. Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, Reed NS, Russell JM, Yardley J. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer[J]. Radiotherapy & Oncology, 1994; 31(1): 33-40.
11. Liepe K, Franke WG, Kropp J, Koch R, Runge R, Hliscs R. Vergleich von Rhenium-188-HEDP, Rhenium-186-HEDP und Strontium-89 fur die palliative Schmerztherapie von Skelettmetastasen[J]. Nuklearmedizin, 2000; 39(6): 146-151.
12. Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.
13. Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.

Chinese Journal of Evidence-Based Medicine

Radioisotopes for Tumor Metastatic Bone Pain: A Systematic Review

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