Treatment Indications

While these radiopharmaceuticals are capable of reducing or relieving the pain of any bone metastasis with an osteoblastic component causing increased uptake on a bone scan, most patients with a single painful site will receive teletherapy, avoiding the mild to moderate myelosuppression of these radiopharmaceuticals. Multiple painful metastases with an osteoblastic component (documented on bone scan) represent the chief indication for the use of the commercially available beta emitters in the table. After teletherapy to the spine and other sites for meta-static disease with recurrent pain, these radiopharmaceuticals may be safely employed when additional external beam radiotherapy is contraindicated because of the concern of radiogenic necrosis.

While there exist data that patients with poorer performance status do not respond well to these radiopharmaceuticals, there is no humane reason for excluding these patients from a treatment which can reduce the detrimental effects of high doses of narcotic analgesics. The belief that a patient may die in a month or so is also no reason to deny such treatment if there is a chance it can make any contribution to the patient's quality of life in his final weeks. Persistent radiation in a patient who has died can be handled with simple radiation safety precautions.

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