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Annals of Nuclear Medicine

, Volume 26, Issue 3, pp 197–206 | Cite as

Effective use of strontium-89 in osseous metastases

  • Isao KurodaEmail author
Invited review article

Abstract

Bone is one of the organs to which cancer metastasizes most frequently. However, it is not a vital organ, therefore, survival after the occurrence of osseous metastasis is relatively favorable. Improvements of medical treatment bring prolonged survival to patients with osseous metastases. But this makes us to recognize the importance of quality of life (QOL) due to several factors, including pain. It is important for oncologists to know how to deal with such painful osseous metastases, as pain relief may enable patients to live their remaining lives to the fullest. Strontium-89 (89Sr) has been used worldwide as in Japan, while being reported to have positive effects on pain relief and QOL improvement in patients with osseous metastases. This review paper is aimed to present not only the history, roles, and medical characters of 89Sr, but also new aspects, such as how to use bone turnover markers, which location of osseous metastases is suitable for effective use of 89Sr.

Keywords

Strontium-89 Pain Osseous metastases 

References

  1. 1.
    Coleman AE. Skeletal complications of malignancy. Cancer. 1997;80:1588–94.PubMedCrossRefGoogle Scholar
  2. 2.
    Craig KD. Emotions and psychobiology. In: Wall Pd, Reds Melzack, editors. Pain. 4th ed. London: Churchill Livingstone; 1999. p. 331–43.Google Scholar
  3. 3.
    Mantyh PW, Clohisy DR, Koltzenburg M, Hunt SP. Molecular mechanism of cancer pain. Nat Rev Cancer. 2002;2:201–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Grond S, Zech D, Diefenbach C, Radbruch L, Lehmann KA. Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain. 1996;64:107–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. Pain. 1999;82:263–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Hoskin PJ. Scientific and clinical aspects of radiotherapy in the relief of bone pain. Cancer Surv. 1988;7:69–86.PubMedGoogle Scholar
  7. 7.
    De Vita Jr, Hellman S, Rosenberg SA. Cancer principles and practice of oncology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 2720.Google Scholar
  8. 8.
    Robinson RG, Peston DF, Schiefelbein M, Bater KG. Strontium-89 therapy for the palliation of pain due to osseous metastases. JAMA. 1995;274:420–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Lewington VJ, McEwan AJ, Ackery DM, Bayley RJ, Keeling DH, Macleod P, et al. A prospective randomized double-blind crossover study to examine the efficacy of 89Sr in pain palliation in patients with advanced prostate cancer metastatic to bone. Eur J Cancer. 1991;27:954–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Pecher C. Biological investigation with radioactive calcium and strontium: preliminary report on the use of radioactive strontium in treatment of metastatic bone cancer. Pharmacology. 1942;11:117–49.Google Scholar
  11. 11.
    Robinson RG, Sicer JA, Preson DF, Wegst AV, Martin NL. Treatment of metastatic bone pain with strontium-89. Nucl Med Biol. 1987;14:219–22.Google Scholar
  12. 12.
    Porter AT, Davis LP. Systemic radionuclide therapy of bone metastases with strontium-89. Oncology. 1994;893–96.Google Scholar
  13. 13.
    Robinson RG, Preston DF, Baxter KG, Dusing RW, Spicer JA. Clinical experience with strontium-89 in prostatic and breast cancer patients. Semin Oncol. 1993;20(Suppl 2):44–8.PubMedGoogle Scholar
  14. 14.
    Medi-Physics Inc., Amersham UK, Metastron (Strontium[89Sr] Chloride SMS.2P) Technical Information, 2001.Google Scholar
  15. 15.
    Siegel HJ, Luck JV Jr, Siegel ME. Advances in radionuclide therapeutics in orthopaedics. J Am Acad Orthop Surg. 2004;12:55–64.PubMedGoogle Scholar
  16. 16.
    Lanki LM, Haynie TP, Dexeus F. Strontium-89 in the palliative therapy of painful bone metastases: a phase II clinical study. J Nucl Med. 1989;30:836. (abstract).Google Scholar
  17. 17.
    Robinson RG, Preston DF, Spicer JA. Strontium-89: improved clinical response with increasing dose in patients with painful metastatic prostate and breast cancer in bone. J Nucl Med. 1989;30:843. (abstract).Google Scholar
  18. 18.
    Laing AH, Ackery DM, Bayly RJ, Buchanan RB, Lewington VJ, McEwan AJ, et al. Strontium-89 chloride for pain palliation in prostatic skeletal malignancy. Br J Radiol. 1991;l64:816–22.CrossRefGoogle Scholar
  19. 19.
    Ackery D, Yardley J. Radionuclide-targeted therapy for the management of metastatic bone pain. Semin Oncol. 1993;20(Suppl 2):27–31.PubMedGoogle Scholar
  20. 20.
    Society of Nuclear Medicine Procedure Guideline for Palliative Treatment of Painful Bone Metastases ver. 3.0. Society of Nuclear Medicine, USA. 2003.Google Scholar
  21. 21.
    Kan Michael K. Palliation of bone pain in patients with metastatic cancer using strontium-89 (Metastron). Cancer Nurs. 1995;18:286–91.Google Scholar
  22. 22.
    Finlay IG, Mason MD, Shelley M. Radioisotopes for the palliation of metastatic bone cancer: a systematic review. Lancet Oncol. 2005;6:40–392.CrossRefGoogle Scholar
  23. 23.
    Nishio M, Sano M, Tamaki Y, Fujii H, Shima Y, Fujimoto H, et al. A multicenter study to determine the efficacy and safety of strontium (89Sr) chloride for palliation of painful body metastases in cancer patients. Nippon Acta Radiol. 2005;65:399–410.PubMedGoogle Scholar
  24. 24.
    Kimura Y, Hamamoto K, Furudate M, Fukuda H, Shishido F, et al. Effectiveness of the radioactive strontium (89Sr) chloride agent, SMS.2P for pain palliation in patients with metastatic bone tumor in phase III multicenter clinical trial. Kaku Igaku. 1996;33:1347–58.PubMedGoogle Scholar
  25. 25.
    Baranauskas Z, Valuckas K, Aleknavicius E, Jankevicius F, Burneckis A. Use of strontium-89 in the analgesic treatment of cancer patients with bone metastases. Medicina. 2006;42:11–4.PubMedGoogle Scholar
  26. 26.
    Robinson RG, Preston DF, Spicer JA, Baxter KG. Radionuclide therapy of intractable bone pain. Semin Nucl Med. 1992;22:28–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Robinson RG, Blake GM, Preston DF, McEwan AJ, Spicer JA, Martin NL, et al. Strontium-89: treatment results and kinetics inn patients with painful metastatic prostate and breast cancer in bone. Radiographics. 1989;9:271–81.PubMedGoogle Scholar
  28. 28.
    Robinson RG. Strontium-89 precursor targeted therapy for pain relief of blastic metastatic disease. Cancer. 1993;72:3433–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Kimura Y, Hamamoto K, Suzuki K, Yokoyama K, Hisada K, Kaagi K, et al. Phase II clinical trial of the radioactive strontium (89Sr) chloride agent, SMS.2P for pain palliation in patient with prostatic cancer with bone metastases. Kaku Igaku. 1995;32:311–21.PubMedGoogle Scholar
  30. 30.
    Serafini AN. Therapy of metastatic bone pain. J Nucl Med. 2001;42:895–906.PubMedGoogle Scholar
  31. 31.
    Dafermou A, Colamussi P, Giganti M, Cittanti C, Bestagno M, Piffanelli A. A multicenter observational study of radionuclide therapy in patients with painful bone metastases of prostate cancer. Eur J Nucl Med. 2001;28:788–98.PubMedCrossRefGoogle Scholar
  32. 32.
    Hung JC, Wilson ME, Valley TB. Regulations for releasing patients who receive radiopharmaceuticals. Health Phys. 1992;63:467–8.PubMedGoogle Scholar
  33. 33.
    Schraml FV, Parr LF, Ghurani S, Silverman ED. Autopsy of a cadaver containing strontium-89-chloride. J Nucl Med. 1997;38:380–2.PubMedGoogle Scholar
  34. 34.
    Torizuka K. Japanese archives of internal medicine. 1959;6:4.Google Scholar
  35. 35.
    EANM procedure guidelines for treatment of refractory metastatic bone Pain. Eur. J. Nucl. Med. 2003;30:BP7–11.Google Scholar
  36. 36.
    Twycross RG, Fairfield S. Pain in far-advanced cancer. Pain. 1982;14:303–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Fields HL. Pain. New York: McGraw Hill; 1987. p. 1–78.Google Scholar
  38. 38.
    Mach DB, Rogers SD, Sabino MC, Luger NM, Schwei MJ, Pomonis JD, et al. Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience. 2002;113:155–66.PubMedCrossRefGoogle Scholar
  39. 39.
    Yoneda T, Hiraga T. Crosstalk between cancer cells and bone microenvironment in bone metastasis. Biochem Biophys Res Commun. 2005;328:679–87.PubMedCrossRefGoogle Scholar
  40. 40.
    Sennoune SR, Bakunts K, Martinez GM, Chua-Tuan JL, Kebir Y, Attaya MN, et al. Vacuolar H+-ATPase in human breast cancer cells with distinct metastatic potential: distribution and functional activity. Am J Physiol Cell Physiol. 2004;286:1443–52.CrossRefGoogle Scholar
  41. 41.
    Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain. 1997;69:1–18.PubMedCrossRefGoogle Scholar
  42. 42.
    Ghilardi JR, Röhrich H, Lindsay TH, Sevcik MA, Schwei MJ, Kubota K, et al. Selective blockade of the capsaicin receptor TRPV1 attenuates bone cancer pain. J Neurosci. 2005;25:3126–31.PubMedCrossRefGoogle Scholar
  43. 43.
    Sevcik MA, Luger NM, Mach DB, Sabino MA, Peters CM, Ghilardi JR, et al. Bone cancer pain: the effects of the bisphosphonate alendronate on pain, skeletal remodeling, tumor growth and tumor necrosis. Pain. 2004;11:169–80.CrossRefGoogle Scholar
  44. 44.
    Amaya F, Oh-hashi K, Naruse Y, Iijima N, Ueda M, Shimosato G, et al. Local inflammation increases vanilloid receptor 1 expression within distinct subgroups of DRG neurons. Brain Res. 2003;963:190–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Chen CC, Zimmer A, Sun WH, Hall J, Brownstein MJ, Zimmer A. A role for ASIC3 in the modulation of high-intensity pain stimuli. PNAS. 2002;25:8992–7.Google Scholar
  46. 46.
    Pandit-Taskar N, Batraki M, Divgi CR. Radiopharmaceutical therapy for palliation of bone pain from osseous metastases. J Nucl Med. 2004;45:1358–65.PubMedGoogle Scholar
  47. 47.
    Clarke SEM. Isotope therapy for bone metastases. In: Rubens D, Fogelman I, editors. Bone metastases: diagnosis and treatment. Berlin: Springer; 1991. p. 187–205.Google Scholar
  48. 48.
    Mertens WC, Reid RH, Porter AT, Powe JE. Recent advances in radionuclide therapy of bone metastases. In: Freeman LM, editor. Nuclear medicine annual. New York: Raven; 1992. p. 69–89.Google Scholar
  49. 49.
    Blake GM, Zivanovic MA, Blaquiere RM, Fine DR, McEwan AJ, Ackery DM. Strontium-89 therapy: measurement of absorbed dose to skeletal metastases. J Nucl Med. 1988;29:549–57.PubMedGoogle Scholar
  50. 50.
    Blake GM, Zivanovic MA, McEwan AJ, Ackery DM. Strontium-89 therapy: strontium kinetics in disseminated carcinoma of the prostate. Eur J Nucl Med. 1986;12:447–54.PubMedGoogle Scholar
  51. 51.
    ICRP. Radiation dose to patients from radiopharmaceuticals. ICRP53. vol. 18, p. 171. Oxford: Pergamon Press; 1988.Google Scholar
  52. 52.
    Davis J, Pither RJ. Biochemical responses in cultured cells following exposure to 89SrCl2: potential relevance to the mechanism of action in pain palliation. Eur J Cancer. 2001;37:2464–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Sato N. Strontium ranelate. Bone. 2005;19:71–4.Google Scholar
  54. 54.
    Canalis E, Hott M, Deloffre P, Tsouderos Y, Marie PJ. The divalent strontium salt S12911 enhances bone cell replication and bone formation in vitro. Bone. 1996;18:517–23.PubMedCrossRefGoogle Scholar
  55. 55.
    Takahashi N, Sasaki T, Tsouderos Y, Suda T. S 12911-2 inhibits osteoclastic bone resorption in vitro. J Bone Miner Res. 2003;18:1082–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Baron R, Tsuouderos Y. In vitro effect of S12911-2 on osteoclast function and bone marrow macrophage differentiation. Eur J Pharmacol. 2002;450:11–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Ammann P, Shen V, Robin B, Mauras Y, Bonjour JP, Rizzoli R. Strontium ranelate improves bone resistance by increasing bone mass and improving architecture in intact female rats. J Bone Miner Res. 2004;19:2012–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Buehler J, Chappuis P, Saffar JL, Tsouderos Y, Vignery A. Strontium ranelate inhibits bone resorption while maintaining bone formation in alveolar bone in monkeys (Macaca fascicularis). Bone. 2001;29:176–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Reginster JY, Malaise O, Neuprez A, Bruyere O. Strontium ranelate in prevention of osteoporotic fractures. Int J Clin Pract. 2007;61:324–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: treatment of peripheral osteoporosis (TROPOS) study. J Clin Endocrinol Metab. 2005;2816–2822.Google Scholar
  61. 61.
    Marie PJ, Ammann P, Boivin G, Rey C. Mechanisms action and therapeutic potential of strontium in bone. Calcif Tissue Int. 2001;69:121–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Boivin G, Meunier PJ. The mineralization of bone tissue: a forgotten dimension in osteoporosis research. Osteoporos Int. 2003;14(Suppl 3):S19–24.PubMedGoogle Scholar
  63. 63.
    Kraeber-Bodéré F, Campion L, Rousseau C, Bourdin S, Chatal JF, Resche I, et al. Treatment of bone metastases of prostate cancer with strontium-89 chloride: efficacy in relation to the degree of bone involvement. Eur J Nucl Med. 2000;27:1487–93.PubMedCrossRefGoogle Scholar
  64. 64.
    Lee CK, Aeppli DM, Unger J, Boudreau RJ, Levitt SH. Strontium-89 chloride (Metastron) for palliative treatment of bony metastases. The University of Minnesota experience. Am J Clin Oncol. 1996;19:102–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Levy MH. Pharmacologic treatment of cancer pain. In: American Society of Clinical Oncology educational book 33rd annual meeting; 1997. pp. 284–294.Google Scholar
  66. 66.
    Ron IG, Stav O, Vishne T, Evan-Sapir E, Soyfer V, Agai R, et al. The correlation between palliation of bone pain by intravenous strontium-89 and external beam radiation to linked field in patients with osteoblastic bone metastases. Am J Clin Oncol. 2004;27:500–4.PubMedCrossRefGoogle Scholar
  67. 67.
    Silberstein EB, Williams C. Strontium-89 therapy for the pain of osseous metastases. J Nucl Med. 1985;26:345–8.PubMedGoogle Scholar
  68. 68.
    Silberstein EB. Teletherapy and radiopharmaceutical therapy of painful bone metastases. Semin Nucl Med. 2005;35:152–8.PubMedCrossRefGoogle Scholar
  69. 69.
    McEwan AJ. Use of radionuclides for the palliation of bone metastases. Semin Radiat Oncol. 2000;10:103–14.PubMedCrossRefGoogle Scholar
  70. 70.
    Windsor PM. Predictors of response to strontium-89 (Metastron) in skeletal metastases from prostate cancer: report of a single centre’s 10-year experience. Clin Oncol (R Coll Radiol). 2001;13:219–27.Google Scholar
  71. 71.
    McEwan AJ. Radioisotope therapy and clinical trial design: the need for consensus and innovation. J Nucl Med. 2002;43:87–8.PubMedGoogle Scholar
  72. 72.
    Porter AT, McEwan AJ, Powe JE, Reid R, McGowan DG, Lukka H, et al. Results of a randomized phase III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys. 1993;25:805–13.PubMedCrossRefGoogle Scholar
  73. 73.
    Zyskowski A, Lamb D, Morum P, Hamilton D, Johnson C. Strontium-89 treatment for prostate cancer bone metastases: does a prostate-specific antigen response predict for improved survival? Australas Radiol. 2001;45:39–42.PubMedCrossRefGoogle Scholar
  74. 74.
    Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol. 1994;31:33–40.PubMedCrossRefGoogle Scholar
  75. 75.
    Suzawa N, Yamakado K, Takaki H, Nakatsuka A, Takeda K. Complete regression of multiple painful bone metastases from hepatocellular carcinoma after administration of strontium-89 chloride. Ann Nucl Med. 2010;24:617–20.PubMedCrossRefGoogle Scholar
  76. 76.
    Smeland S, Erikstein B, Aas M, Skovlund E, Hess SL, Fosså SD. Role of strontium-89 as adjuvant to palliative external beam radiotherapy is questionable: results of a double-blind randomized study. Int J Radiat Oncol Biol Phys. 2003;56:1397–404.PubMedCrossRefGoogle Scholar
  77. 77.
    Akerley W, Butera J, Wehbe T, Noto R, Stein B, Safran H, et al. A multiinstitutional, concurrent chemoradiation trial of strontium-89, estramustine, and vinblastine for hormone refractory prostate carcinoma involving bone. Cancer. 2002;94:1654–60.PubMedCrossRefGoogle Scholar
  78. 78.
    Tu SM, Millikan RE, Mengistu B, Delpassand ES, Amato RJ, Pagliaro LC, et al. Bone-targeted therapy for advanced androgen-independent carcinoma of the prostate: a randomized phase II trial. Lancet. 2001;357:336–41.PubMedCrossRefGoogle Scholar
  79. 79.
    Sciuto R, Festa A, Rea S, Pasqualoni R, Bergomi S, Petrilli G, et al. Effects of low-dose cisplatin on 89SR therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med. 2002;43:79–86.PubMedGoogle Scholar
  80. 80.
    Storto G, Klain M, Paone G, Liuzzi R, Molino L, Marinelli A, et al. Combined therapy of 89Sr and zoledronic acid in patients with painful bone metastases. Bone. 2006;39:35–41.PubMedCrossRefGoogle Scholar
  81. 81.
    Kuroda I. Knack to prescribe Strontium-89 effectively with clinical knowledge. Jpn J Clin Radiol. 2011;56:975–82.Google Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2011

Authors and Affiliations

  1. 1.Department of Urological-OncologyInternational Medical Centre, Saitama Medical UniversityHidakaJapan

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