Radionuclide therapy with bone seeking radionuclides in palliation of painful bone metastases.

Radionuclide therapy with bone seeking radiopharmaceuticals is one of the oldest interventions in nuclear medicine and has been now in use for many years as an effective method of palliating painful bone metastases. Clinical indications have slowly but progressively increased starting from end-stage prostate cancer with diffuse painful bone metastases to earlier stages of several cancers with only microinvolvement of the skeleton. Several newer bone seeking agents for therapeutic applications have been developed during the last 10 years. A large body of specific literature is now available, but only a few well designed clinical trials can be selected to obtain evidence-based guidelines. This study summarizes the therapeutic effects of the three commercially available radiopharmaceuticals, the current indication for their use as supported by the most rigorous literature studies and the original contributions of the "Regina Elena" ten-year experience. Innovative strategies and future research questions are also breafly addressed.