Targeted "bone-seeking" radiopharmaceuticals for palliative treatment of bone metastases: a systematic review and meta-analysis.
OBJECTIVE
The aim of the study was to assess the state of the art of the use of bone-seeking radiopharmaceuticals for palliation therapy of pain from bone metastases.


METHODS
A systematic literature search was conducted about therapy with 89Sr-chloride and 153Sm-EDTMP between 2001-2011. The primary outcomes were efficacy and toxicity. Descriptive and quantitative data were extracted from each study, calculating event rates and odds ratio (OR) with 95% confidence intervals (CI) for pooled analysis. Subgroup analyses were performed.


RESULTS
Fifty-seven studies contributed to the systematic review. Forty-six studies used radiopharmaceuticals as a single agent, 15 investigated therapeutic combinations. Most of the studies included patients with prostate cancer. The overall efficacy of bone-seeking radiopharmaceuticals as single agents was 70%, whereas it was 74% when used in combination with other therapies. Complete response was reported in 27% of patients. Efficacy resulted to be 70% for prostate cancer and 79% for breast cancer. The overall toxicity of radiopharmaceuticals was 15%: the toxicity was 11% selecting only studies reporting on the use of radiopharmaceuticals as a single agent. No significant difference was found between bone-seeking radiopharmaceuticals and other oncological treatments regarding efficacy or toxicity. Reports of objective response outcomes suggest that bone-seeking radiopharmaceuticals have some cytotoxic activity, either alone or combination with chemotherapy.


CONCLUSIONS
This literature analysis emphasizes multiple evidences of high efficacy and low toxicity of bone seeking radiopharmaceuticals; moreover, this therapy may have a therapeutic potential beyond simple palliation of bone pain.
Nuclear Medicine, Catholic University, Rome, Italy. giorgiadangelo80@yahoo.it
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D'angelo
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Sciuto
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Salvatori
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Sperduti
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Mantini
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Maini
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Mariani
D001859:Bone Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000556:secondary*; D015897:Comorbidity; D006801:Humans; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011832:Radiation Injuries / Q000453:epidemiology; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012307:Risk Factors; D012493:Samarium / Q000627:therapeutic use*; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D013326:Strontium Radioisotopes; D012493:Samarium