Original Article World J Oncol • 2010;1(4):158-166 Press Elmer Articles © The authors | Journal compilation © World J Oncol and Elmer Press™ | www.wjon.org Role of Radionuclide Therapy as Adjuvant to Palliative External Beam Radiotherapy for Painful Multiple Skeletal Metastasis Ayse Hicsonmez a, d , Ozlem N. Kucuk b , Meltem Nalca Andrieu a , Yildiz Guney c , Erkan Ibis b Abstract Background: The aim of this study was to evaluate the palliative efficacy of localized external radiotherapy (RT) combined with sys- temic radionuclide (RN) therapy in patients who had multiple pain- ful osseous metastases of different primary origins. Methods: Thirty-three patients initially local external radiother- apy was delivered to the most symptomatic region in all patients. Then they received either Re 186 HEDP or Sm 153 EDTMP. The performance status was assessed according to ECOG scale. Before treatment, at the end of the radiotherapy and after the four weeks of systemic radionuclide therapy, analgesic intake and pain status were recorded by the RTOG scoring system, and EORTC QLQ C30 (Version 3.0 Turkish) questionnaire was performed to evaluate the quality of life. Results: Improved performances of 33.3% for post radiation ther- apy and 50% for post radionuclide therapy in the ECOG scale were observed. Statistically significant correlations were found between the primary origins and decreased pain and analgesic intake (p < 0.05), but no differences were observed on the self assessment qual- ity of life questionnaire. Conclusions: Both Re 186 HEDP, Sm 153 EDTMP are effective and safe in bone pain palliation as an adjuvant to local field radia- tion therapy of breast and prostate cancer patients, who also contin- ued to receive chemotherapy and/or hormontherapy. Keywords: Bone metastases; Radiotherapy; Radionuclide therapy Introduction Bone metastasis is a common, challenging problem in pa- tients with advanced cancer. Although they are often clini- cally silent, they may lead to serious complications such as pain, fractures and hypercalcemia, which result in reduce performance status and decrease the quality of life. The life expectancy of the patients with bone metastases varies widely, depending on tumor types [1]. Management of bone pain can be maintained with analgesia, radiation, hormones, chemotherapy and surgery. Localized sites of bone involve- ment can be treated with surgery, radiofrequency ablation or external beam radiotherapy, whereas radiopharmaceuticals, hormones and chemotherapy are used to treat more diffuse bone involvement. Radiation therapy and surgery are used for the treatment of localized bone metastases. The goal of localized irradia- tion is to relieve symptoms, restore function and prevent the sequelae of disease progression in the area treated [2- 6]. Despite the lack of a dose response relationship for lo- cal field radiation therapy, different dose fractionations have been recommended [7]. Some patients with extensive dis- ease are candidates for hemibody irradiation, however this treatment is associated with a high incidence of side effects [8]. Response rates are reported to be higher than 70%, and complete relief of pain has been achieved in 20% of patients [9,10]. On the other hand, systemic radionuclide therapy represents a better approach for patients who have multiple bone metastatic sites. In recent years it has been employed with increasing frequency [11-14]. The advantages of tar- geted radionuclide therapy are the simultaneous treatment of all affected areas and the fact that it shows tumor specificity with relative sparing of the surrounding tissue. Patients can usually benefit from a single injection and pain relief may be obtained within the first week of treatment, which lasts for Manuscript accepted for publication August 13, 2010 a Ankara University School of Medicine Department of Radiation Oncology, Turkey b Ankara University School of Medicine Department of Nuclear Medicine, Turkey c Ankara Oncology Hospital, Department of Radiation Oncology, Ankara, Turkey d Corresponding author: Ankara University School of Medicine Department of Radiation Oncology, Cebeci Hospital, Dikimevi, Ankara, 06100 Turkey. E-mail: asonmez@medicine.ankara.edu.tr doi:10.4021/wjon235w 158