title: Palliation of bone pain in prostate cancer using chemotherapy and strontium-89. A randomized phase II study.
abstract: Strontium-89 is an established alternative for the alleviation of bone pain in prostate cancer. There are few data evaluating the effect on pain of palliative chemotherapy. The aim of this randomized phase II study was to assess and compare the analgesic efficacy of strontium-89 and chemotherapy (FEM=5-FU, epirubicin, and mitomycin C) in 35 patients with disseminated, hormone-refractory prostate cancer suffering from persisting bone pain despite analgesic treatment. In order to minimize the risk for imbalances regarding the two patient groups, a double-blind randomization was performed. A significant reduction in pain intensity and pain frequency was registered in both patient groups (P < 0.01 in both groups after 3 weeks). Side effects were generally mild in the strontium-89 group and significantly more severe in the FEM group. The effect of FEM on pain is surprising as chemotherapy has generally only limited effect on tumor growth in bone metastases due to prostate cancer. A possible explanation is that FEM has an inhibitory activity on the inflammatory component of metastases.
authors.affiliation: Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Nilsson
authors.forename: Peter
authors.initials: P
authors.lastname: Strang
authors.forename: Claes
authors.initials: C
authors.lastname: Ginman
authors.forename: Rolf
authors.initials: R
authors.lastname: Zimmermann
authors.forename: Maliha
authors.initials: M
authors.lastname: Edgren
authors.forename: Britta
authors.initials: B
authors.lastname: Nordström
authors.forename: Marianne
authors.initials: M
authors.lastname: Ryberg
authors.forename: Karl-Mikael
authors.initials: KM
authors.lastname: Kälkner
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Westlin
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D004311:Double-Blind Method; D015251:Epirubicin / Q000008:administration & dosage*; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012720:Severity of Illness Index; D013324:Strontium / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D015251:Epirubicin; D016685:Mitomycin; C025700:strontium chloride; D005472:Fluorouracil; D013324:Strontium