Role of radionuclide therapy as adjuvant to palliative external beamradiotherapy for painful multiple skeletal metastasis

摘要

Purpose: Aim of this study was to evaluate the palliative efficacy of localized external radiotherapycombined with systemic radionuclide therapy in patients who had multiple painful osseous metastases ofdifferent primary origins. 33 patients with painful multiple bone metastases from different primarily originswere eligible for this trial. Initially, local external radiotherapy was delivered to the most symptomatic region inall patients, followed by either Re186HEDP or Sm153EDTMP. The patients' mean age was 58.8 (min 35- max 82).The performance status was assessed acording to ECOG scale. Before treatment, at the end of the radiotherapyand after the 4 weeks of systemic radionuclide therapy, analgesic intake and pain status were recorded by theRTOG scoring system. In addition, the EORTC QLQ C30 (vesion 3.0 Turkish) questionnaire was performed toevaluate the quality of life at the start of treatment, at the end of the radiotherapy and after the 4 weeks ofsystemic radionuclide therapy. Improved performances of 33.3% for post radiation therapy and 50% for postradionuclide therapy in the ECOG scale were observed. Statistically significant correlations were found betweenthe primary origins and decreased pain and analgesic intake (p< 0.05), but no differences were observed on theself assesment quality of life questionnaire. Toxicity was acceptable. Overall median survival was 17 months,and progression free survival was 10 months. Patients with breast and prostate tumors had a higher overall andprogression free survival than those with other primary tumors (p=0.0062, p=0.0080). The results of this studydemonstrate that; both Re186HEDP and Sm153EDTMP are effective and safe in bone pain palliation as anadjuvant to local field radiation therapy of breast and prostate cancer patients, who also continued to receivechemotherapy and/or hormontherapy. This combined treatment may be an alternative to half body irradiation formultiple painful skeletal metastasis .