PTU - Polskie Towarzystwo Urologiczne
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CODE: 7.4 - Comparison of results of bone metastases treatment with monotherapy of strontium 89 (Sr89) or samar 153 (Sm153) and combined therapy (Sr89 or Sm153 + radiotherapy) in prostate cancer patients
Article published in Urologia Polska 2006/59/Suplement 1.


Maciej B±czyk 1, Piotr Milecki 2, Jan Sowiński 3
1 Zakład Medycyny Nuklearnej AM w Poznaniu
2 Wielkopolskie Centrum Onkologii w Poznaniu
3 Zakład Medycyny Nuklearnej AM w Poznaniu


Introduction. Metastases to bone in case of advanced stage of prostate cancer are responsible for pain in 60% to 80% of patients.
Objectives. The purpose of this study is to compare the influence of monotherapy with Sr89 or Sm153 isotope and combined therapy (Sr89 or Sm 153 plus local radiotherapy) on pain intensity in prostate cancer patients with bone metastases.
Materials an methods. One hundred patients aged from 53 to 84 years with bone metastases due to prostate cancer were included into retrospective analysis. All patients had confirmed in bone scintygraphy metastases and any pathological fracture in radiology assessment (X-ray, CT/MRI) were excluded. In addition for all patients the nature of bone metastases was evaluated as follows: in 75 cases classic osteoblastic and in 25 cases the mixed (osteoblastic-osteolitic) nature was established. The most frequent site of metastases was lumbar-sacral and thoracic part of spine, bone of pelvis, and costae. Fifty patients were treated with standard dose of 150 MBq Sr89 and another group of patients (n=50) were treated with dose of Sm 153 calculated proportionally to the body weight. Additionally, 40 patients (20 patients from each treated groups with isotopes) were irradiated to the largest single bone metastases. Pain intensity measured using the VAS scoring system before treatment ranged from 5 to 10 (median; 7), performance score evaluated by Karnofsky scale ranged from 40 to 80 (median; 50), and activity according ECOG scale ranged from 4 to 2 (median; 3). Efficacy of treatment was based on the change of patients' status in mentioned scales (VAS, ECOG, Karnofsky) and the quantity of pain killers used in each case. Complete response was defined as drop of pain intensity to the level of less than 2 according to VAS scale, partial response when VAS points were between 2 and 5, and no response when VAS was higher than 5.
Results. After 12 weeks stable pain control effect was maintained for 75% of treated patients, especially with osteoblastic metastases. Drop of pain intensity and drug intake, improvement of ECOG and Karnofsky indicators were statistically significant (p<0.05). In 3 cases severe pancytopenia was observed and additionally in 21 cases drop of leucocytes and platelets were noted, too. In nine cases hypercalcemia was observed but successfully treated with biphosphonates.
Conclusions. Isotop Sr89 and Sm153 are efficient drugs for therapy of osteoblastic bone metastases and in case of mixed metastases combined therapy (isotop Sm 153 plus radiotherapy) gave better pain control. Treatment toxicity for both strategies was acceptable.