[A case of thyroid medullary carcinoma with multiple painful bone metastases successfully treated with strontium-89 chloride].

A 70-year-old man was diagnosed as thyroid medullary carcinoma with multiple bone metastases. He underwent total thyroidectomy and cervical lymph node dissection. After one year, the pain from his bone lesions was becoming severe. To relieve the pain, he was administered opioids and external-beam radiation therapy. However, he continued to have substantial multiple bone pain. We used combination therapy of strontium-89 chloride for the treatment of widespread multiple bone pain and external-beam radiation therapy for localized pain. That combination therapy was effective and improved the QOL of the patient. We used strontium-89 chloride four times within one year, and no serious side effects occurred during therapy. Our thoroughly investigated case suggests that strontium-89 therapy is one of the effective and safe therapies for patients with painful bone metastases of thyroid medullary carcinoma.

[Initial report of strontium-89 chloride treatment for painful osseous metastases at Sakai Municipal Hospital].

Strontium-89 chloride has been available at our hospital for painful osseous metastases since October 2008. Of the 17 patients(22 treatments)seen until September 2010, response to initial treatment of 13 patients was analyzed. These included cancers of the lung(5 patients, 6 treatments), breast(4 patients), thyroid(2 patients, 5 treatments), liver, 1, and prostate, 1. Other treatments patients received within 1 month of Sr-89 injection were; chemotherapy, 5 patients; radiotherapy, 3 patients; and bisphosphonate, 9 patients. The treatment effects were assessed 1 month after injection, and for 11 of the 13 patients, pain-relief was obtained in a mild and gradual manner. Transient flare was frequently observed, some of which made assessment of pain-relief in 6 patients difficult. We recognized that the bone marrow function before treatment was well above the 'Optimal Treatment Manual Japan ' criteria. After treatment, bone marrow functions kept above the value of grade 2(CTCAE), and even in 5 patients with recent or concomitant chemotherapy, it remained above grade 3 of the CTCAE criteria. These results led us to the conclusion that the indication and inclusion criteria for strontium-89 chloride treatment should be patients with an earlier bone metastasis burden that is currently manifested, without too much attention to bone marrow function criteria.