Comparison of Rhenium-188, Rhenium-186-HEDP and Strontium-89 in palliationof painful bone metastases

Aim: Several radiopharmaceuticals were compared previously with regard to t he efficiency in pain palliation of bone metastases. Furthermore, first res ults were reported on the suitability for such kind of therapy of the gener ator produced radionuclide rhenium-188. Method: Influence of Rhenium-188-HE DP (Re-188), Rhenium-186-HEDP (Re-186) and Strontium-89 (Sr-89) on pain sym ptoms and bone marrow function were obtained in 44 patients (pts). These we re 16 pts. with Re-188 (2943 +/- 609 MBq), 13 pts. with Re-186 (1341 +/- 16 1 MBq) and 15 pts. with Sr-89 (152 +/- 18 MBq) (6 women with breast cancer and 38 mens with prostata cancer). Results: 81 of pts. after Re-188, 77% af ter Re-186 and 80 % after Sr-89 reported relief of pain. The Karnofsky-Inde x established by pts. increased from 74 +/- 9% to 85 +/- 11% after Re-188, from 70 +/- 11% to 76 +/- 11% after Re-186 and from 62 +/- 10% to 69 +/- 10 % after Sr-89. However, the difference between the pre- and the post-therap eutic value is only statistically significant in the core of Re-188 therapy (p = 0.001). A decrease of platelets of 30 +/- 14% after 2.8 +/- 0.7 for p ts. treated with Re-188, of 39 +/- 20% after 3.7 +/- 1.0 weeks for pts. tre ated with Re 186 and of 34 +/- 26% after 4.4 +/- 1.0 weeks for pts. treated with Sr-89 compared to the value before therapy was observed. The differen ce was not significant between the 3 groups of pts. (p = 0.125 to 0.862). C onclusion: All tried radiopharmaceuticals were effective in pain palliation . The various radionuclides had no significant difference in the pain relie f or the bone marrow impairment. If only the Karnofsky-Index after Re-188 H EDP seems to be a little more increase.