[Systemic radiotherapy options in the treatment of metastatic skeletal involvement].

Objective: To evaluate the efficiency of treatment using various systemic radiotherapies for metastatic skeletal involvement in patients with breast or prostate cancer.

Material And Methods: The case histories of 350 patients treated at the Department of Radiation Medicine in 2006 to 2010 for multiple metastatic skeletal involvement in cancers at various sites were analyzed. The efficiency of treatment for pain syndrome and the magnitude of a myelosuppressive effect were estimated in the use of various systemic radiotherapies. For this, the authors compared: 1) two patient groups treated by 89Sr chloride monotherapy in the standard activity of 150 MBq or by that in combination with teleradiotherapy (TRT); 2) two patient groups treated by the monotherapy in the standard activity of 150 MBq or by 89Sr chloride fractional injection.

Results: The efficiency of treatment using various systemic radiotherapies was estimated. That was comparatively evaluated in the patient groups having various treatments. Algorithms of indications were elaborated to choose a systemic radiotherapy option depending on the clinical situation. An 89Sr chloride injection procedure was developed for patients with significant myelosuppression.

Conclusion: 1. Various systemic radiotherapies as second-line therapy may be used to treat metastatic skeletal involvement in patients with cancer at various sites. 2. The most pronounced analgesic effect was found when 89Sr chloride in the standard activity of 150 MBq had been injected in combination with TRT (a 36% reduction in the intensity of pain syndrome); a less pronounced effect was produced by 89Sr chloride monotherapy (27%). The lowest analgesic effect was observed when 89Sr chloride had been fractionally injected (14%). 3. The levels of white blood cells and platelets were decreased in all the groups. 4. 89Sr chloride fractional injection is the method of choice when its single administration is impossible in patients with evident leukocyto- and thrombocytopenia.