Radionuclide treatment of bone metastases--current concepts and trends.

Painful bone metastases are an important problem in oncology and occur in 50–75% of patients with breast and prostate cancer [1, 2]. Radionuclide treatment was introduced in the early 1940s [3, 4], but this mode of treatment has been more widely implemented in the last two decades. In recent years three trends could be seen in the development of radionuclide treatment of bone metastases: — a re-consideration of clinical indications for this treatment: there is a shift from radionuclide palliation in patients with multiple, generalised and painful bone metastases towards an early application of this treatment in not very painful and not numerous metastases; — a re-approach to the question of radiotoxicity, with particular emphasis on the question of myelotoxicity; — an increasingly broader range of new radionuclides applied in this therapy, with a shift to short half-life and low-energy isotopes; however, also a return to radioactive phosphorus-32 in the treatment has recently been proposed.