Medknow Publications on behalf of Indian Cancer Society
Abstract
BACKGROUND: Systemic therapy with radionuclides may be used for the
treatment of patients with painful skeletal metastases owing to its
efficacy, low cost and low toxicity. Imported radionuclides for pain
palliation, like Strontium-89 are expensive; particularly for
developing countries. In the Indian scenario, Samarium-153 (Sm-153) is
produced in our own reactors and as a result, it is readily available
and economical. AIM: We undertook this study to determine the
efficacy and toxicity of single-dose Sm-153 ethylenediamine
tetramethylene phosphonate as a palliative treatment for painful
skeletal metastases. MATERIALS AND METHODS: Eightysix patients with
painful skeletal metastases from various primaries, were treated with
Sm-153 EDTMP at a dose of 37 MBq/kg. The effects were evaluated
according to change in visual analogue pain score, analgesic
consumption, Karnofsky performance score, mobility score and blood
count tests, conducted regularly for 16 weeks. STATISTICS: Repeated
measures analysis. RESULTS: The overall response rates were 73%, while
complete response was seen in 12.4%. Reduction in analgesic consumption
with improvement in Karnofsky performance score and mobility score, was
seen in all responders. Response rates were 80.3 and 80.5% in breast
and prostate cancer, respectively. One case, each of Wilms tumor,
ovarian cancer, germ cell tumor testis, multiple myeloma, primitive
neuroectodermal tumor and oesophageal cancer, did not respond to
therapy. No serious side-effects were noted, except for fall in white
blood cell, platelet and haemoglobin counts, which gradually returned
to normal levels by six-eight weeks. CONCLUSION: Sm-153 EDTMP
provided effective palliation in 73% patients with painful bone
metastases: the major toxicity was temporary myelosuppression