What is the evidence that quality of life is improved with unsealed radioisotopes in prostate cancer?
There are four low- to medium-quality RCTs testing the effect of treatment with Strontium-89 that assess a ‘quality of life endpoint’. The assessed quality of life endpoints were different, in no trial was a validated instrument used, and in only one trial was assessment solely patient reported. Neither study comparing strontium 89 with external beam radiation showed statistical evidence of effect. In the study comparing strontium 89 with placeboand the study examining the effect of addition of strontium 89 to local external beam radiation, the strontium treatment appeared to have modest but inconsistent beneficial effects on quality of life endpoints.
Evidence summary and recommendations
| Men with hormone refractory prostate cancer and painful bone metastases
There are few studies examining the effect of strontium 89 on quality-of-life endpoints and these are generally dissimilar in design and the examined endpoint. The design of these studies is not high quality. In studies that show some beneficial effect, the effects are modest at best, with many patients also exhibiting a worsening of quality-of-life endpoints.
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|It is not known what effect unsealed radioisotopes have on quality of life for men with metastatic prostate cancer.||C|
- 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.
- 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.
- Lewington VJ, McEwan AJ, Ackery DM, Bayly RJ, Keeling DH, Macleod PM, et al. A prospective, randomised double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone. Eur J Cancer 1991;27(8):954-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1716935.
- 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.
- 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.