title: Therapy tolerance in selected patients with androgen-independent prostate cancer following strontium-89 combined with chemotherapy.
abstract: OBJECTIVE
  Clinicians may have reservations about using strontium-89 for the treatment of bone metastases because of concerns that it may limit future use of chemotherapy. We assessed the rate of bone marrow failure in patients with prostate cancer who had received a dose of strontium-89.
  
  
  METHODS
  This subgroup analysis involved 34 patients with androgen-independent prostate cancer who had been given a dose of strontium-89 and six weekly doses of doxorubicin after response to induction chemotherapy. We assessed subsequent hematotoxicity in terms of bone marrow failure and the ability to tolerate additional treatments during a median of 25 months (range, 7 to 76 months) after the strontium-89 was administered.
  
  
  RESULTS
  No patients developed bone marrow failure within 6 months of receiving strontium-89. Five (15%) of 34 patients developed bone marrow failure at a median 23 months (range, 6 to 53 months) after the strontium-89 treatment. Bone marrow biopsy performed in two of these five patients showed complete replacement of the marrow by tumor. Thirty-one patients (91%) received subsequent cytotoxic treatments at a median 11 months (range, 1 to 33 months) after the strontium-89 treatment.
  
  
  CONCLUSIONS
  This analysis demonstrated that a single dose of strontium-89 combined with chemotherapy did not affect the delivery of subsequent courses of chemotherapy in a select group of patients. However, a majority of these therapies were given off protocol and were administered at a dose schedule that might be considered inappropriate or inadequate. The clinical role and safety profile of radiopharmaceuticals combined with chemotherapy in prostate cancer therapy deserve further exploration.
authors.affiliation: Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA. stu@mdanderson.org
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Tu
authors.forename: Jeri
authors.initials: J
authors.lastname: Kim
authors.forename: Lance C
authors.initials: LC
authors.lastname: Pagliaro
authors.forename: Funda
authors.initials: F
authors.lastname: Vakar-Lopez
authors.forename: Frankin C
authors.initials: FC
authors.lastname: Wong
authors.forename: Sijin
authors.initials: S
authors.lastname: Wen
authors.forename: Rosales
authors.initials: R
authors.lastname: General
authors.forename: Donald A
authors.initials: DA
authors.lastname: Podoloff
authors.forename: Sue-Hwa
authors.initials: SH
authors.lastname: Lin
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Logothetis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects / Q000528:radiation effects; D001859:Bone Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy / Q000532:radiotherapy; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D013326:Strontium Radioisotopes; D004317:Doxorubicin