Efficacy and Safety of Bone-Targeting Radioisotopes in Patients with Bone Metastases: A Meta-Analysis

Abstract

Background: Radionuclides such as Strontium-89, Samarium-153, and Radium-223 are commonly used for the treatment of bone metastases (BM) and they have shown efficacy in previous studies. The aim of this meta-analysis is to compare the curative performance of different types of radionuclides in patients with BM, and to provide evidence for further future research and clinical practice.Methods: The electronic databases of PubMed, Web of Science, Embase, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure (CNKI) were searched. Studies using radionuclides therapy to cure patients were included. Pooled overall response rate, occurrence rates of common adverse events, hazard ratio (HR), and their respective 95% confidence interval (CIs) were calculated.Results: A total of 28 articles with 33 studies patients were identified for inclusion in this meta-analysis. The types of radionuclides used in the studies contained 89Sr, 153Sm, 223Ra, 186Re, and 188Re. The overall response rate was 72% [66%, 77%]. The respective overall response rates of 89Sr, 153Sm, and 223Ra were 72% [64%, 79%], 80% [75%, 84%], and 54% [32%, 75%]. In the survival analysis, the pooled HR was 0.85 [0.67, 1.08]. The pooled occurrence rate of leucocyte hematological toxicity of any grade was 5% [2%, 8%]. The pooled occurrence rate of thrombocytopenia of any grade was 7% [5%, 8%]. With regard to anemia, the pooled occurrence rate of any grade was 15% [11%, 19%].Conclusion: The results of this meta-analysis indicate that radionuclides therapy is efficacious in patients, type of radionuclides and history of patients should be considered to prevent potential adverse events.