title: Palliative treatment of metastatic bone pain with radiopharmaceuticals: A perspective beyond Strontium-89 and Samarium-153.
abstract: OBJECTIVE
  The present review article aims to provide an overview of the available radionuclides for palliative treatment of bone metastases beyond (89)Sr and (153)Sm. In addition, it aims to review and summarize the clinical outcomes associated with the palliative treatment of bone metastases using different radiopharmaceuticals.
  
  
  METHODS
  A literature search was conducted on Science Direct and PubMed databases (1990 - 2015). The following search terms were combined in order to obtain relevant results: "bone", "metastases", "palliative", "care", "therapy", "treatment", "radiotherapy", "review", "radiopharmaceutical", "phosphorus-32", "strontium-89", "yttrium-90", "tin-117m", "samarium-153", "holmium-166", "thulium-170", "lutetium-177", "rhenium-186", "rhenium-188" and "radium-223". Studies were included if they provided information regarding the clinical outcomes.
  
  
  CONCLUSIONS
  A comparative analysis of the measured therapeutic response of different radiopharmaceuticals, based on previously published data, suggests that there is a lack of substantial differences in palliative efficacy among radiopharmaceuticals. However, when the comparative analysis adds factors such as patient's life expectancy, radionuclides' physical characteristics (e.g. tissue penetration range and half-life) and health economics to guide the rational selection of a radiopharmaceutical for palliative treatment of bone metastases, (177)Lu and (188)Re-labeled radiopharmaceuticals appear to be the most suitable radiopharmaceuticals for treatment of small and medium/large size bone lesions, respectively.
authors.affiliation: Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias s/n, 4200-465 Porto, Portugal. Electronic address: meb12020@fe.up.pt.
authors.forename: Francisco D C
authors.initials: FDC
authors.lastname: Guerra Liberal
authors.affiliation: Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias s/n, 4200-465 Porto, Portugal. Electronic address: adriana_tavares@msn.com.
authors.forename: Adriana Alexandre S
authors.initials: AAS
authors.lastname: Tavares
authors.affiliation: Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias s/n, 4200-465 Porto, Portugal. Electronic address: tavares@fe.up.pt.
authors.forename: João Manuel R S
authors.initials: JMRS
authors.lastname: Tavares
mesh_terms: D001859:Bone Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D010166:Palliative Care; D011868:Radioisotopes / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012493:Samarium / Q000627:therapeutic use; D013326:Strontium Radioisotopes / Q000627:therapeutic use
chemical_list: D011868:Radioisotopes; D019275:Radiopharmaceuticals; D013326:Strontium Radioisotopes; D012493:Samarium
keywords: Alpha particles; Auger electrons; Beta particles; Bone metastases; Radiopharmaceutical; Systematic review