Nuclear Medicine Offers Therapeutic Options for Multiple Bone Metastases

Abstract

The authors rightly point out the importance of interdisciplinary cooperation when dealing with patients with bone metastases (1). Independently of the fact that even a solitary bone metastasis means palliative care, surgical therapy and radiotherapy are oncologically useful only in patients with few metastases (3). For the large number of patients with multiple bone metastases, medication treatment is the only option (including antibody therapy and receptor therapy). Such patients often complain of pain caused by the metastases, which can be alleviated only by administering highly potent analgesia (with all its side effects) or not at all. Percutaneous radiotherapy with symptomatic intent is highly effective but in a scenario of multiple metastases its applicability is limited because of the response rates and potential side effects (bone marrow function) (2). In this setting, radionuclide therapy is the treatment of choice, which has been tried and tested for decades. Every standard nuclear-medical practice is able to provide this treatment cost-efficiently in ambulant care and on a short notice. It is equally as effective as percutaneous radiotherapy (response rate 65–80%) and has few side effects compared with medical treatment (3). If required it can be repeated. Its effects last for at least 3 months, mostly for longer than 6 months (2, 3), and it reduces the need for analgesia (including the side effects). The indication should be defined considering earlier (or planned) therapies. We agree that good interdisciplinary collaboration, as requested by the authors (1), is the best basis from which to deploy this therapy in a targeted and effective fashion.