Division of Nuclear Medicine, Department of Radiology, University of Miami/Jackson Memorial Medical Center/Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
Semin Nucl Med. 2010 Mar;40(2):89-104. doi: 10.1053/j.semnuclmed.2009.10.003.
Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed.
骨骼转移引起的骨痛是癌症患者最常见的慢性疼痛类型。它显著降低了患者的生活质量，并与合并症相关，如高钙血症、病理性骨折和脊髓压迫。大约 65%的前列腺或乳腺癌患者以及 35%的晚期肺癌、甲状腺癌和肾癌患者将出现有症状的骨骼转移。骨痛的管理极其困难，需要多学科方法，通常包括镇痛药、激素治疗、双膦酸盐、外照射和全身放射性药物。对于广泛骨转移的患者，全身放射性药物应该是缓解疼痛的首选辅助治疗。在本文中，我们回顾了目前批准用于骨痛缓解的放射性药物武器库，重点讨论了锶-89 氯化物、钐-153 依替膦酸盐和铼-186 依替膦酸盐的适应证、患者选择、疗效以及不同的生化特性和毒性。简要讨论了关于铼-188 的现有数据，重点介绍了其主要优缺点。我们还简要评估了其他可用的治疗选择，包括药物和激素治疗、外照射和双膦酸盐。最后，讨论了放射性药物与双膦酸盐或化疗联合治疗的现有数据。
