Palliation of skeletal metastases with rhenium (Re-186 HEDP)

The sufficient therapy of painful skeletal metastases is the primary treatment option in patients with advanced malignancies. Not life prolongation, but quality of life is essential in these patients. In an open, not randomized study we investigated the efficacy and tolerance of a systemic radionuclide therapy with Rhenium 186 hydroxyethylidene diphosphonate (Re-186 HEDP) for pain relief due to multilocated skeletal metastases. 50 analgesics taking patients (prostate cancer: n=19; breast cancer: n=28; others: n=3) received one injection of 1295 MBq Re-186 HEDP for pain palliation. Evaluation of clinical response was assessed by the visual analogous score (VAS), verbal rating score (VRS) and need of pain medication. 64% (32/50) of the patients responded to Re-186 HEDP and as many as 9/32 responders became free without taking any analgesic intake. 36% (18/50) did not respond to radionuclide therapy. Median duration of clinical response was 5,5 weeks. No major complications could be observed. 14 patients reported of an initial pain increase (flare up) after systemic application. A mild and reversible hemotoxicity (WHO I) was observed in 10 patients. In conclusion the systemic Re-186 HEDP therapy appears to be a useful and effective compound for palliation of painful, disseminated skeletal metastases. Due to the mild hemotoxicity retreatment is possible. Disadvantage is a hospitalisation for Z days due to the radiologic safety precaution in Germany.