title: Predictors of response to strontium-89 (Metastron) in skeletal metastases from prostate cancer: report of a single centre's 10-year experience.
abstract: An analysis of prospectively collected data from 75 patients with bone metastases secondary to prostate cancer who were treated with strontium-89 injection in a single centre over a 10-year period, is presented. The surrogate role of markers of disease progression (haemoglobin and prostate specific (PSA) antigen levels; number of bone scan-positive sites), symptomatic factors (analgesic intake; number of painful bone sites) and history of prior external radiotherapy, were analysed to determine whether any parameters had a predictive effect on the success of strontium-89 treatment. The success of strontium-89 injection was determined by calculating the change in number of sites of bone pain (pain sites) and analgesic intake. The outcome was classed as successful in 42 (56.0%) patients, unsuccessful in 13 (17.3%) and unchanged in 20 (26.7%). Proportionately more of the patients who had 'superscans' on bone scintigraphy at baseline had an unsuccessful outcome after a strontium-89 injection (5/7; 71.4%); for those with fewer bone scan-positive sites the majority had successful outcomes. Patients with a successful outcome had a significantly better survival rate after strontium-89 injection. Multivariate analysis showed haemoglobin level, PSA level and outcome after strontium-89 treatment to be significant independent prognostic variables; no change/unsuccessful outcome, a high PSA level prior to treatment, and a low haemoglobin level were associated with poor survival. It is suggested that early treatment with strontium-89 (Metastron) in patients with fewer bone metastases is more likely to be successful, with a longer time before further therapy required.
authors.affiliation: Department of Radiotherapy and Oncology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Windsor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary*; D003802:Dentifrices / Q000494:pharmacology* / Q000627:therapeutic use; D018450:Disease Progression; D005544:Forecasting; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D011877:Radionuclide Imaging; D013324:Strontium / Q000494:pharmacology* / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003802:Dentifrices; D006454:Hemoglobins; D017430:Prostate-Specific Antigen; C025700:strontium chloride; D013324:Strontium