Radiopharmaceuticals for Painful Bone Metastases: Perspective from Radiation Oncology

Cancer-related bone pain is a significant cause of morbidity and reduces quality of life for patients with bone metastases. Management should be conducted in a multidisciplinary setting with a multimodality approach. Radionuclides are an effective treatment option for patients with multifocal osteoblastic metastases, which are typically seen in patients with prostate cancer. Radionuclides can be given on an outpatient basis with simple radioactive precautions and do not require a visit to a radiotherapy center. However, the use of radiopharmaceuticals has been consistently reported as underutilized in the literature. Reasons for underutilization include lack of knowledge and awareness by community practitioners, misconceptions on the toxicity of treatment, and lack of health policy support. There is worry about delayed myelosuppression preventing administration of chemotherapy. In addition, radionuclides are usually administered by nuclear medicine physicians, who are not involved in the direct clinical care of cancer patients.