Do unsealed radioisotopes improve survival in metastatic prostate cancer?

From Cancer Guidelines Wiki

Do unsealed radioisotopes improve survival in metastatic prostate cancer?

Six RCTs report survival outcomes. Results were conflicting for the four strontium 89 trials. The trial comparing strontium 89 alone with placebo reported a statistically significant improvement in survival in patients receiving strontium 89.[1] This was one old trial with small sample size (n=44) and only actuarial survival was reported. In contrast, the addition of strontium to local radiotherapy appeared to provide no survival benefit.[2][3] The larger (n=203) trial comparing strontium 89 with local external beam radiotherapy reported a statistically significant improvement in survival in patients receiving radiotherapy[4], whereas the smaller trial comparing strontium 89 with local (n=111) or hemibody (n=106) external beam radiotherapy showed a beneficial but not statistically significant improvement in survival with strontium 89.[5] No survival benefit was seen with samarium 153.[6][7]

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Evidence summary and recommendations

Evidence summary Level References
Men with hormone refractory prostate cancer and painful bone metastases

The trials examining the effect of unsealed radioisotopes on overall survival have been heterogeneous in study design, contained small patient numbers and provided conflicting results. As such no firm conclusions can be made. The role of radioisotopes in the context of modern-day systemic therapy (chemotherapy and bisphosphonates) has not been defined.

II [1], [5], [8], [3], [4], [6], [7]
Evidence-based recommendationQuestion mark transparent.png Grade
The impact of unsealed radioisotopes on overall survival in men with castrate-resistant metastatic prostate cancer is undefined. The relative roles of unsealed radioisotopes and the newer chemotherapeutic agents (e.g. taxanes) and bisphosphonates have also not been defined.
D


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References

  1. 1.0 1.1 Buchali K, Correns HJ, Schuerer M, Schnorr D, Lips H, Sydow K. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma. Eur J Nucl Med 1988;14(7-8):349-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2460352.
  2. Porter AT, McEwan AJ. Strontium-89 as an adjuvant to external beam radiation improves pain relief and delays disease progression in advanced prostate cancer: results of a randomized controlled trial. Semin Oncol 1993 Jun;20(3 Suppl 2):38-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7684865.
  3. 3.0 3.1 Porter AT, McEwan AJ, Powe JE, Reid R, McGowan DG, Lukka H, et al. Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys 1993 Apr 2;25(5):805-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8478230.
  4. 4.0 4.1 Oosterhof GO, Roberts JT, de Reijke TM, Engelholm SA, Horenblas S, von der Maase H, et al. Strontium(89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: a phase III study of the European Organisation for Research and Treatment of Cancer, Genitourinary Group. Eur Urol 2003 Nov;44(5):519-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14572748.
  5. 5.0 5.1 Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, et al. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol 1994 Apr;31(1):33-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7518932.
  6. 6.0 6.1 Sartor O, Reid RH, Hoskin PJ, Quick DP, Ell PJ, et al. Samarium-153-Lexidronam complex for treatment of painful bone metastases in hormone-refractory prostate cancer. Urology 2004 May;63(5):940-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15134985.
  7. 7.0 7.1 Resche I, Chatal JF, Pecking A, Ell P, Duchesne G, Rubens R, et al. A dose-controlled study of 153Sm-ethylenediaminetetramethylenephosphonate (EDTMP) in the treatment of patients with painful bone metastases. Eur J Cancer 1997 Sep;33(10):1583-91 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9389919.
  8. Porter GA, Baxter NN, Pisters PW. Retroperitoneal sarcoma: a population-based analysis of epidemiology, surgery, and radiotherapy. Cancer 2006 Apr 1;106(7):1610-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16518798.

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Appendices