Serum hemoglobin levels predict response to strontium-89 and rhenium-186-HEDP radionuclide treatment for painful osseous metastases in prostate cancer.
OBJECTIVE
Retrospective comparative analysis of strontium-89 chloride (Sr89) and rhenium-186-hydroxyethylidene diphosphonate (Re186-HEDP) radionuclide treatment to find predictors of response in patients with painful metastases from hormone refractory prostate cancer.


METHODS
Clinical data from 60 hormone refractory PCA patients (i.e. rising PSA at castrate testosterone serum levels) was obtained. Twenty-nine were treated with Sr89, 31 were treated with Re186-HEDP for painful osseous metastasis. Response was defined as a patient-reported decrease in pain and/or reduction in pain medication with stable pain level. Hematological parameters and serum levels of PSA, alkaline phosphatase, and lactate dehydrogenase were assessed prior to and at 4-week intervals after treatment.


RESULTS
Median survival of all patients was 7 months (95% CI: 6-9 months). Overall, 33/60 (55%) patients reported a decrease in pain after the first radionuclide treatment. This percentage was similar for patients treated with Re168-HEDP and Sr89. Mean duration of reported pain response was 75 days (+/- 68 days) for Sr89 and 61 days (+/- 56 days) for Re186-HEDP, which was not significantly different. A lower blood hemoglobin concentration was associated with a lower pain response rate. In a multivariate Cox regression analysis, pain response to radionuclide treatment predicted longer survival after treatment.


CONCLUSIONS
Pain response was present in 55% of patients. Serum hemoglobin concentration prior to radionuclide treatment predicted pain response for both Re186-HEDP and Sr89. A reduction in pain upon radionuclide treatment was associated with a longer survival after treatment.
van der Poel
H G
HG
Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. h.vd.poel@nki.nl
Antonini
N
N
Hoefnagel
C A
CA
Horenblas
S
S
Valdes Olmos
R A
RA
D000368:Aged; D001859:Bone Neoplasms / Q000097:blood* / Q000532:radiotherapy* / Q000556:secondary; D012968:Etidronic Acid / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010146:Pain; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000556:secondary*; D011868:Radioisotopes / Q000627:therapeutic use*; D012189:Retrospective Studies; D013326:Strontium Radioisotopes / Q000627:therapeutic use*
D006454:Hemoglobins; D009942:Organometallic Compounds; D011868:Radioisotopes; D013326:Strontium Radioisotopes; C101598:rhenium-186 HEDP; D012968:Etidronic Acid