Zhongguo aizheng zazhi (Aug 2023)
A meta-analysis of the efficacy of 99Tc-MDP alone and in combination with 89SrCl2 in the treatment of bone metastases
Abstract
Background and purpose: Bone metastatic tumor is a common disease of tumor bone metastasis, and the prognosis of patients is poor, with a variety of serious complications, including bone pain, fracture, spinal cord compression and other skeletal related events, affecting the quality of life of patients. At present, radionuclide therapy still has positive clinical effects in patients with bone metastasis, and it still plays an important role in relieving bone pain. This study aimed to evaluate the efficacy of technetium [99Tc] methylene diphosphonate injection (99Tc-MDP) alone or in combination with strontium chloride (89SrCl2) in the treatment of bone metastases. Methods: Databases were used to search for studies published between January 2000 and July 2022 on the efficacy of 99Tc-MDP in combination with 89SrCl2 and 99Tc-MDP alone in the treatment of bone metastases. All included literature was extracted and evaluated for quality, and Meta-analysis was performed using RevMan 5.3 software. Results: Twenty-seven publications met the inclusion criteria, and a total of 2564 patients were included in this study. The results demonstrated that 99Tc-MDP combined with 89SrCl2 improved bone pain relief (RR=1.22, 95% CI: 1.18-1.27, P<0.001) and bone metastasis healing (RR=1.35, 95% CI: 1.25-1.47, P<0.001). However, when compared with 89SrCl2 alone, it could not be concluded that 99Tc-MDP alone increased the rate of bone pain relief (RR=0.98, 95% CI: 0.90-1.06, P=0.57) and bone metastasis healing (RR=0.93, 95% CI: 0.82-1.06, P=0.27), and the difference between the two groups was not statistically significant. The common adverse effects of 99Tc-MDP treatment alone or in combination with 89SrCl2 were decreased leukocyte and platelet counts, however, the difference in the incidence of adverse effects between 99Tc-MDP treatment alone and in combination with 89SrCl2 was not statistically significant (89SrCl2 vs 99Tc-MDP in combination with 89SrCl2: RR=0.83, 95% CI: 0.53-1.30, P=0.42; 89SrCl2 vs 99Tc-MDP: RR=0.93, 95% CI: 0.76-1.13, P=0.45). Conclusion: 99Tc-MDP combined with 89SrCl2 treatment was effective in relieving pain in patients with bone metastases, and the bone pain relief rate and bone metastasis healing rate of 99Tc-MDP combined with 89SrCl2 treatment for bone metastases were better compared with the 89SrCl2 monotherapy group, with no significant increase in adverse reactions after typical dosing. Due to the limitations of the quality and quantity of literature included in this study, higher quality randomized controlled studies are needed.
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