Palliative treatment of painful disseminated bone metastases with 186rhenium-HEDP in patients with lung cancer

Aim The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with Re-186-HEDP and to discuss the criteria useful for selecting those patients. Methods. Twenty-four patients were included in this study and they received 1295 MBq Re-186-HEDP. All patients underwent Tc-99m-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean = 18.7 +/- 17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of Re-186-HEDP and over the following 8 weeks. The possible myelotoxicity of Re-186 was assessed. Results. The mean VAS score was 6.9 +/- 2.5 before the application and 3.2 +/- 2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life. Conclusion The application of a standard dose of Re-186-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the Re-186-HEDP application can be expected if combined estimation of the Tc-99m-MDP bone scan and the CT scan is used.