Effects of Pamidronate Use on the Palliative Radiotherapy of Bone Metastases
William Levin, MD
OncoLink Assistant Editor
Last Modified: October 24, 2000
Presenter: M.N. Yavux
Affiliation: Karadeniz University, Trabzone, Turkey
- Between 15-70% of all cancer patients are found to have bone metastases over the course of their lifetime.
- These lesions are frequently painful, cause a decrease in mobility, and negatively impact on the quality of life.
- While radiation therapy can provide symptomatic relief for the majority of patients, more efficacious treatments are still needed.
- Pamidronate is a osteoclast inhibitor used for the treatment of bone metastases.
Materials and Methods:
- 50 patients with bone metastases were randomized to receive either PRT alone or PRT + pamidronate.
- The most common primary cancer sites included: breast, lung, multiple myeloma, and prostate.
- PRT consisted of 3Gy/day to a total dose of 30Gy
- Planned PAM therapy was a 90mg infusion every 3 weeks for a total of 9 months.
- Primary endpoints were pain and analgesia assessment, performance status, and quality of life score.
- Endpoints were evaluated right before and just after PRT, and on follow-up exam, thereafter.
- No significant differences were detected in the changes of pain and analgesia, performance status, quality of life, serum calcium, alkaline phosphatases, and mineral bone density between the two groups.
- In PRT and PRT-PAM arms, median time to progression in the PRT field was 26 weeks and 68 weeks, respectively (log rank p = 0.05).
- Median time to new bone metastases was 23 and 59 weeks, respectively (log rank p = 0.05).
- The addition of PAM to PRT was of no significant advantage, in terms of quality of life, symptomatic palliation, and bone mineralization in the early post-RT period (first 5 months).
- The addition of PAM may, however, be of benefit, regarding time to progression in the irradiated field and the occurrence of new bone metastases.
- The effective treatment of painful bone metastases remains a significant challenge for the clinician.
- New drug therapies should continue to be investigated in an attempt to maximize the efficacy of bone metastasis palliation.