• Therapeutic Radiopharmaceutical Guidelines Group. Radiopharmaceuticals for the palliation of painful bone metastases [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jun 15. 36 p. (Practice guideline report; no. 14-1). [74 references]

• Use of radiopharmaceuticals (strontium-89 and samarium-153) may be considered as an option for the palliation of multiple sites of bone pain from metastatic prostate cancer as these patients represented the majority (80%) of patients experiencing benefit in clinical trials where histology was specified.
• Use of radiopharmaceuticals (strontium-89 and samarium-153) may also be considered for patients with lung and breast cancers. These patients represented a substantial minority (20%) in the clinical trials where histology was specified.
• The selection of patients for radiopharmaceutical therapy should consider the patient’s marrow function, performance status, recent use of other marrow suppression agents (chemotherapy or radiotherapy), unsuitability for alternate palliative interventions (wide field or local field radiotherapy, hormone therapy, chemotherapy, bisphosphonates), and anticipated life expectancy.
• Ideally the decision for radiopharmaceutical use should be based on a multidisciplinary (radiation oncology, nuclear medicine, medical oncology, palliative care) patient assessment.
• Patients with a partial response or complete response following radiopharmaceutical therapy may be considered for repeat administration for persistent or recurrent bone pain if the following is ruled out: rapid systemic disease progression, mechanical component to bone pain, underlying other bone pathology, impending or established fracture, or spinal cord compression.
• The recommended dose for strontium-89 is 148 mBq (4mCi) by slow intravenous injection (1 to 2 minutes), accompanied by intravenous or oral hydration (at least 500 mL). The recommended dose for samarium-153 is 37 mBq/kg (1 mCi/kg) by slow intravenous injection (1 to 2 minutes), accompanied by intravenous or oral hydration (at least 500 mL).

None provided

The recommendations are supported by randomized controlled trials.

• Therapeutic Radiopharmaceutical Guidelines Group. Radiopharmaceuticals for the palliation of painful bone metastases [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jun 15. 36 p. (Practice guideline report; no. 14-1). [74 references]

Not applicable: The guideline was not adapted from another source.

2004 Jun 15

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Therapeutic Radiopharmaceuticals Guidelines Group

Members of the Therapeutic Radiopharmaceutical Guidelines Group disclosed potential conflict of interest information. No conflicts were declared.

None available

This summary was completed by ECRI on September 24, 2004. The information was verified by the guideline developer on October 20, 2004.