Radionuclide Therapy in Palliation of Bony Metastases

Therapeutic Approaches to Palliation of Bone Pain

NSAIDs

§        Aspirin, acetaminophen, ibuprofen

§        Effective when pain is mild

§        Effective for a short time early in disease

§        May be used with other modalities

Chemotherapy

§        Most effective when used early before severe pain

§        Better results in lytic disease

§        Not very effective in blastic disease

§        Toxic side-effects

Hormonal Therapy

§        Most effective when started prior to pain onset

§        Only effective in hormonally dependent tumors

§        Results in decreased libido & male impotency

§        Many patients resist castration

§        May have undesirable side-effects

§        Second-line therapy is much less effective
 

External Beam Radiation

•  Very effective for localized disease

•  Wide-field therapy (hemibody) may be quite effective

•  Unmasks new sites of pain

•  Limitation on repeat therapy

•  May have symptomatic side-effects

•  May have additive toxicity to chemotherapy

•  High-cost  therapy

Narcotic Therapy

•  Commonly used modality

•  Drug dependency may develop

•  Loss of appetite common

•  GI symptoms are common

•  Patients become depressed and immobile

•  Confusion and disorientation common

•  Doses escalate with time

•  Ultimate decreased quality of life