Use of bone scintigraphy to select patients with multiple myeloma for treatment with strontium-89

Strontium-89 is an effective agent for palliation of pain due to bony metastases from breast and prostate carcinoma. As a functional analog of calcium, 89Sr is taken up by bone in areas of osteoblastic activity. Since patients with multiple myeloma frequently have osteolytic metastases, 89Sr might not be considered to be a therapeutic option. However, metastases which appear osteolytic by radiographs may demonstrate osteoblastic activity on bone scans. Consequently, the bone scan may be used to identify a subset of patients with osteolytic metastases who may benefit from 89Sr treatment. This report describes a patient with severe rib pain due to multiple myeloma whose chest radiograph showed multiple lucent lesions throughout the bones of the chest wall but whose bone scan showed marked osteoblastic activity. The patient was treated with 89Sr and received substantial pain relief. Bone scans may be useful in selecting myeloma patients or other cancer patients with osteolytic radiographic lesions who may benefit from 89Sr therapy.