Recent developments in nuclear medicine in the management of bone metastases: a review and perspective

To review recent developments and to examine the role of nuclear medicine-based radionuclide therapy in the management of bone metastases.

Recent developments in the use of radionuclides were broadly reviewed in the context of treatment paradigms, radionuclide toxicity, cost, and overall outcomes, and an impression of the use of radionuclides in metastatic bone disease was derived.

Through a number of studies, radionuclide therapy has been shown to be an efficacious and cost-effective means of alleviating bone pain in metastatic disease. Moreover, its early use in pain therapy may limit cancer progression by inhibiting oligometastases. Thus, radionuclides can significantly decrease patient morbidity, increase patient survival, and perhaps attenuate the aggressiveness of cancer. Nonetheless, in comparison with analgesics, external beam radiotherapy, or surgery, it still appears to have lower priority among medical oncologists.

Bone pain palliation is critical for cancer patients afflicted with bone metastases, but radionuclides remain underutilized in such treatments. The authors propose that physician education regarding radionuclide therapy be improved and additional investigations to evaluate newer radionuclides and treatment paradigms (eg, higher activities, repetitive or cyclic administration, chemosensitization, or chemosupplementation) be strongly encouraged. A comprehensive and an interdisciplinary clinical approach toward increasing the use of radionuclides in alleviating metastatic bone pain is proposed. Data from clinical collaborations will help optimize radiopharmaceutical therapy for pain palliation, increase its awareness among oncologists, and contribute effectively to patient palliation and quality-of-life improvements.