Metastasic bone pain management with radioactive isotopes

Pain is the commonest clinical manifestation of bone metastases. Its treatment is palliative in nature, and consists of chemotherapy, radiotherapy, hormonotherapy, diphosphonates, and drug therapy (i. e., opiates). Radioactive isotopes represent an appealing alternative to conventional treatment modalities. Among the different types of isotopes, wide clinical experience with 153Sm has been obtained in this laboratory. In the present study, 94 patients (mean age = 65 years), who had been diagnosed of having breast, prostate and other malignant tumors, were evaluated. These patients were treated with 37 MBq/Kg 153Sm-EDTMP. All of them complained of bone pain and had scintigraphic evidence of metastatic bone dissemination. Treatment efficacy was evaluated both objectively and subjectively. Eighty-five per cent (85 percent) of the patients reported pain relief, and analgesia was reduced by 55 percent. Twenty-two per cent (22 percent) had a complete response. Bone marrow toxicity was not a concern, with mild transient hematologic derangements in 30 percent of the patients. It was concluded that 153Sm-EDTMP results in relief or cessation of metastatic bone pain in a majority of patients.

A dor é a manifestação clínica mais comum da metástase óssea. Seu tratamento é, por natureza, paliativo e consiste de quimioterapia, radioterapia, hormonoterapia, difosfonatos, e terapia medicamentosa (i.e.opiáceos). Isótopos radioativos representam uma alternativa atraente para as modalidades covencionais de tratamento. Entre os diferentes tipos de isótopos, temos grande experiência clínica com 153Sm. Neste estudo, nós avaliamos 94 pacientes na faixa de 65 anos com diagnóstico de cânceres de próstata, de mamas e outros tumores malignos. Esses pacientes foram tratados com 37 MBq/Kg de 153Sm-EDTMP. Todos eles reclamavam de dor nos ossos e apresentavam evidências de disseminação de metástase óssea. O tratamento foi analisado objetivamente e subjetivamente. Oitenta e cinco (85 por cento) dos pacientes relataram alívio da dor, e a analgesia foi reduzida em 55 por cento. Vinte e dois (22 por cento) tiveram uma resposta completa. A toxicidade na medula óssea não foi um câncer e sim um transitório desequilíbrio hematológico em 30 por cento dos pacientes. Concluímos que o 153Sm-EDTMP resultou em alívio ou total erradicação da dor metastática na maioria dos pacientes.

[Cost-effectiveness analysis of samario-153 (Quadramet) for the treatment of patients with prostate cancer and bone metastases]. / Análisis coste-efectividad de samario-153 (Quadramet) en el tratamiento del dolor en pacientes con cáncer de próstata y metástasis óseas.

OBJECTIVE: To evaluate the cost-effectiveness of samarium [153Sm-EDTMP] (Quadramet) compared to conventional therapy in the treatment of pain in patients with prostate cancer and bone metastases. METHOD: A decision tree model for the treatment of bone pain due to metastases was adapted to the Spanish context. The model represents the standard treatment patterns in Spain for the study population. The time-course of the model is 4 months and it computes an estimate for the cost of pain control per patient. The effectiveness data for the model derive from a randomised trial. The current treatment patterns have been established according to the consensus opinions of a group of medical experts. RESULTS: The cost of pain control per patient is euro 12,515.39 for conventional therapy and euro 5,595.52 for samarium-153 (Quadramet) therapy. The incremental cost-effectiveness analysis shows that samarium-153 (Quadramet) is a dominant therapy. It presents lower costs and higher efficacy than the conventional strategy. The sensitivity analyses showed these results to be robust. CONCLUSION: Samarium-153 (Quadramet) is cost-effective in treating pain in patients with prostate cancer and bone metastases.

Análisis coste-efectividad de samario-153 (Quadramet®) en el tratamiento del dolor en pacientes con cáncer de próstata y metástasis óseas / Cost-effectiveness analysis of samario-153 (Quadramet®) for the treatment of patients with prostate cancer and bone metastases

Objetivo. Realizar un análisis coste-efectividad de samario [153Sm-EDTMP] (Quadramet®) respecto a la terapia convencional, para el tratamiento del dolor causado por metástasis óseas en pacientes con cáncer de próstata. Metodología. Se ha adaptado un modelo de árbol de decisión, que representa el tratamiento del dolor óseo metastásico, al contexto español. El modelo muestra las opciones terapéuticas habituales en el contexto sanitario español para la población del estudio. El horizonte temporal del modelo es de 4 meses y calcula el cociente coste-efectividad por paciente controlado. Los datos de eficacia del modelo provienen de un ensayo clínico aleatorizado. Las pautas de tratamiento habituales en España han sido indicadas por varios especialistas médicos. Resultados. El coste por paciente controlado para la terapia convencional es de 12.515,39 € y para la terapia con samario-153 (Quadramet®) es de 5.595,52 €. El análisis coste-efectividad incremental muestra que samario-153 (Quadramet®) es una terapia dominante, es decir, que presenta una mayor eficacia y un menor coste que la terapia convencional. Los resultados obtenidos han demostrado ser robustos en un extenso análisis de sensibilidad. Conclusiones. La terapia con samario-153 (Quadramet®) es eficiente en el tratamiento del dolor de pacientes con cáncer de próstata y metástasis óseas

Objective. To evaluate the cost-effectiveness of samarium [153Sm-EDTMP] (Quadramet®) compared to conventional therapy in the treatment of pain in patients with prostate cancer and bone metastases. Method. A decision tree model for the treatment of bone pain due to metastases was adapted to the Spanish context. The model represents the standard treatment patterns in Spain for the study population. The time-course of the model is 4 months and it computes an estimate for the cost of pain control per patient. The effectiveness data for the model derive from a randomised trial. The current treatment patterns have been established according to the consensus opinions of a group of medical experts. Results. The cost of pain control per patient is €12,515.39 for conventional therapy and € 5,595.52 for samarium-153 (Quadramet®) therapy. The incremental cost-effectiveness analysis shows that samarium-153 (Quadramet®) is a dominant therapy. It presents lower costs and higher efficacy than the conventional strategy. The sensitivity analyses showed these results to be robust. Conclusion. Samarium-153 (Quadramet®) is cost-effective in treating pain in patients with prostate cancer and bone metastases