RADIONUCLIDE THERAPY

Most patients with advanced cancer develop metastatic bone disease; this untreatable evolution of the disease weights heavily on cancer-related mortality and morbidity. Although bone metastases are often clinically silent, some conditions may support bone pain. Therapeutic strategies for pain palliation could include treatments directed at the source of the pain as well as may focus on comprehensive care of patient. Among the different, mostly palliative, therapies used to treat bone metastases, bone-targeted approaches using bisphosphonates, radiopharmaceuticals, or endothelin receptor antagonists currently hold great promise in terms of efficacy and tolerability. The use of bone-seeking radiopharmaceuticals for pain palliation continues to represent an irreplaceable tool in critical pain conditions. The systemic radionuclide therapy has gained full consideration, with its efficacy being widely accepted. It offers the prospective of pain relief with negligible side effects. Recently, it has been also implemented in combination with other therapeutic modalities. Future considerations for systemic metabolic radiotherapy include its use at an earlier stage in high-risk patients who are likely to develop bone metastases. In addition, this therapy could be implemented in asymptomatic patients with positive bone scans.