Therapeutic Use of Radionuclides in Bone and Joint Disease

Clinically, bone metastases are manifested by pain and the loss of mechanical stability. Standard treatment options for bone metastases include external beam radiotherapy and analgesics. The use of radionuclides provides an alternative modality for controlling pain. The currently routinely employed agents such as Sr-89, Sm-153, and Re-186 have only mild side effects and response rates of 70–89% can be achieved. The novel radionuclides, such as Lu-177 and Ra-223, have also been reported to have good response rates and low side effects. It was reported that treatment with alpha-emitter Ra-223 also improves survival. Radionuclide therapy provides an attractive alternative to surgical synovectomy in the management of patients suffering from chronic inflammatory joint disease. It is noninvasive and easily accepted by the patient, and the side effects are related to the leakage of radioactivity from the joint requiring special care and follow-up. Other applications of radionuclide therapy for bone tumors such as osteogenic sarcoma and multiple myeloma are still being investigated. The combination of I-131 MIBG with other modalities improves the therapeutic response in patients with refractory or relapsed neuroblastoma. Novel Lu-177 somatostatin analogs appear to be promising in the treatment of relapsed or primary refractory high-risk neuroblastoma. Luteium-177 (Lu-177) PSMA ligand therapies have demonstrated good results in a significant proportion of men with metastatic prostate cancer who have failed other therapies and is being used clinically in many institutions. Clinically, bone metastases are manifested by pain and the loss of mechanical stability. Standard treatment options for bone metastases include external beam radiotherapy and analgesics. The use of radionuclides provides an alternative modality for controlling pain. The currently routinely employed agents such as Sr-89, Sm-153, and Re-186 have only mild side effects, and response rates of 70–89% can be achieved. The novel radionuclides, such as Lu-177 and Ra-223, have also been reported to have good response rates and low side effects. It was reported that treatment with alpha-emitter Ra-223 also improves survival. Radionuclide therapy provides an attractive alternative to surgical synovectomy in the management of patients suffering from chronic inflammatory joint disease. It is noninvasive and easily accepted by the patient, and the side effects are related to the leakage of radioactivity from the joint requiring special care and follow-up. Other applications of radionuclide therapy for bone tumors such as osteogenic sarcoma and multiple myeloma are still being investigated. Combination of I-131 MIBG with other modalities improves the therapeutic response in patients with refractory or relapsed neuroblastoma. Novel Lu-177 somatostatin analogs appear to be promising in the treatment of relapsed or primary refractory high-risk neuroblastoma. Luteium-177 (Lu-177) PSMA ligand therapy is an effective treatment in metastatic castration-resistant prostate cancer good results in a significant proportion of men with metastatic prostate cancer who have failed other therapies and is being used clinically in many institutions.