A comparative study of 188Re-HEDP, 186Re-HEDP, 153SM-EDTMP and 89Sr in the treatment of painful skeletal metastases

Aim The surface bone-seeking radiopharmaceuticals Re-188-HEDP, Re-186-HEDP and Sm-153-EDTMP, and the volume seeker Sr-89 were investigated to determine the efficacy and toxicity in pain palliation of bone metastases. Method The effect of treatment with Re-188-HEDP, (ReHEDP)-Re-186, Sm-153-EDTMP and Sr-89 on pain symptoms, quality of life, and bone marrow function were studied. In total, 79 patients (18 with breast cancer and 61 with prostate cancer) were treated (31 patients with Re-188-HEDP, 15 patients each with Re-186-HEDP and Sm-153-EDTMP and 18 patients with Sr-89). All patients were interviewed using standardized sets of questions before and after therapy weekly for 12 weeks. Results In total, 73% of patients reported pain relief (77% after 188Re-HEDP, 67% after 186Re-HEDP 73% after 153Sm- EDTMP, and 72% after 89Sr). Fifteen percent of patients could discontinue their analgesics and were pain-free. Pain showed a decrease from 3.6 +/- 1.7 to a maximum of 2.2 +/- 1.8 at visual analogue scale in 10 steps (P < 0.01). Patients described an improvement on the Karnofsky performance scale from 70 +/- 10% to 78 +/- 14% 12 weeks after treatment (P= 0.15). There were eight patients with a thrombocytopenia grade 1, two patients with grade 11 Blood counts were taken weekly for 6 weeks and after 12 weeks. and one with grade III. The maximum nadir of platelet and leukocyte counts were observed between the 2(nd) to 5(th) week after treatment and was reversible within 12 weeks. There were no significant differences in pain palliation, Karnofsky performance status (KPS) and bone marrow toxicity between the different radionuclides (P= 0.087-0.449). Conclusion All radiopharmaceuticals were effective in pain palliation, without induction of severe side effects or significant differences in therapeutic efficacy or toxicity. Nucl Med Commun 28:623-630 (2007 Lippincott Williams & Wilkins.