Correa-Gonzalez, L., Arteaga de Murphy, C., Pichardo-Romero, P., Pedraza-Lopez, M., Moreno-Garcia, C., & Correa-Hernandez, L. (2014). (153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies. Archives of Medical Research, 45, 301–308.

To evaluate the effect of ¹⁵³Sm–ethylenediamine tetramethylene phosphonate (Sm-EDTMP) for relief of pain from bone metastases

Consecutive patients referred to nuclear medicine who met eligibility criteria (life expectancy greater than six months, no chemotherapy within the previous four weeks, and acceptable blood values) were entered into the study. Each patient was asked to evaluate his or her pain daily using a visual analog and a verbal rating scale. Pain palliation was assessed using the patient’s mean scores. Sm-EDTMP was given intravenously in a solution of 37 MBq per kilogram body weight. Patients had blood work daily, and a TcMDP bone scan was done on the fifth day.

• N = 277  
• MEAN AGE = 64 years (range = 24–92 years)
• MALES: Not reported, FEMALES: Not reported
• KEY DISEASE CHARACTERISTICS: The majority of patients had prostate cancer.

• SITE: Single-site    
• SETTING TYPE: Not specified    
• LOCATION: Mexico

• PHASE OF CARE: Late-effects and survivorship
• APPLICATIONS: Palliative care

Observational

• Visual Analogue Scale (VAS)
• Verbal Rating Scale (VRS)

Pain was reduced in patients with prostate cancer by 74%, in breast by 67%, in renal by 78%, in thyroid by 67%, in lung by 75%, in cervical by 80%, in colon and rectum by 73%, and by 100% in patients with osteosarcoma. There were no significant changes in blood work values of leukocyte counts, hemoglobin, or platelets at 3 or 12 weeks after treatment. Pain scores were significantly reduced at 3 and 12 weeks (p = .001). There was a relatively high variability in pain score differences.

Sm-EDTMP was effective in reducing pain from bone metastases from multiple tumor types over a 12-week period.

• Risk of bias (no control group)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement/methods not well described
• Other limitations/explanation: No information was provided regarding other medications, etc., used for pain control or any changes in medications during the study. It is not clear if the VRS or VAS was used for analysis, and it was not stated whether the scale was a 10-point or 100-point VAS. The study duration was relatively brief. The sample sizes of patients with various tumor types were not stated.

Radiopharmaceuticals such as Sm-EDTMP may be effective for the management of pain from bone metastases. Further research comparing various pain control approaches is warranted with longer follow-up.