Targeted "bone-seeking" radiopharmaceuticals for palliative treatment of bone metastases: a systematic review and meta-analysis.
Source
Nuclear Medicine, Catholic University, Rome, Italy. giorgiadangelo80@yahoo.it
Abstract
AIM:
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.
CONCLUSION:
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.
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