title: [Radionuclide therapy for the treatment of skeletal metastases of urological malignancies: a forgotten therapy?].
abstract: Many patients suffering from urological or non-urological malignancies develop bone metastases. One symptom often found is severe skeletal pain which siginificantly lowers the quality of life. Further symptoms are pathological fractures, spinal cord compression and hypercalcemia. The systemic radiopharmaceutical therapy represents an important systemic treatment option, in addition to chemotherapy, hormone therapy, external beam radiation, bisphosphonates and analgesics. The radionuclide therapy is rarely used and often used in a later phase of disease, mainly known for the bone pain palliation. This review article should help remind physicians to use this interesting therapy. It focuses on the common radionuclides Strontium-89-chloride, Samarium-153-EDTMP (ethylene-diamine-tetra-methylene-phosphonate) and Rhenium-186-HEDP (hydroxyethylidene-diphosphonate), their physical characteristics and differences, contraindications of the therapy like spinal cord compression and side effects. Additionally, potential tumoricidal activity and improvement of survival are discussed when using the radionuclides repetitively or in combination. The European and German guidelines are included. Furthermore, the combination of radionuclides and bisphosphonates or chemotherapy are briefly discussed, based on available clinical studies. Additionally, alpharadin (radium-223 chloride) is discussed, an experimental radiopharmaceutical under clinical evaluation, which emits alpha-radiation. In phase III clinical trials, it was shown to significantly increase the median overall survival in patients with bone metastases from advanced prostate cancer.
authors.affiliation: Klinik für Urologie, Med. Fakultät Mannheim der Universität Heidelberg, Mannheim.
authors.forename: J K
authors.initials: JK
authors.lastname: Badawi
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D009943:Organophosphorus Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D010166:Palliative Care; D011868:Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D011883:Radium / Q000009:adverse effects / Q000627:therapeutic use; D013117:Spinal Cord Compression / Q000532:radiotherapy; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary; D013324:Strontium / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000401:mortality / Q000532:radiotherapy*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D009943:Organophosphorus Compounds; D011868:Radioisotopes; C449682:rhenium ethylenediamine-N,N,N',N'-tetrakis(methylene phosphonic acid); C061972:samarium Sm-153 lexidronam; C025700:strontium chloride; D011883:Radium; D013324:Strontium