Intervention Review

Radioisotopes for metastatic bone pain

  1. Marta Roqué i Figuls1,*,
  2. Maria José Martinez-Zapata1,
  3. Martin Scott-Brown2,
  4. Pablo Alonso-Coello3

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 6 JUL 2011

Assessed as up-to-date: 10 JUN 2011

DOI: 10.1002/14651858.CD003347.pub2

How to Cite

Roqué i Figuls M, Martinez-Zapata MJ, Scott-Brown M, Alonso-Coello P. Radioisotopes for metastatic bone pain. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD003347. DOI: 10.1002/14651858.CD003347.pub2.

Author Information

  1. 1

    CIBER Epidemiología y Salud Pública (CIBERESP), Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Catalunya, Spain

  2. 2

    Gray Institute for Radiation Oncology & Biology, Oxford, UK

  3. 3

    Biomedical Research Institute Sant Pau (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Catalunya, Spain

*Marta Roqué i Figuls, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Sant Antoni Maria Claret 171, Edifici Casa de Convalescència, Barcelona, Catalunya, 08041, Spain.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 6 JUL 2011




  1. Top of page
  2. Abstract
  3. Plain language summary


This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates.


To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival.

Search methods

We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010.

Selection criteria

Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope.

Data collection and analysis

We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis.

Main results

This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 (89Sr) with Samarium-153 (153Sm), Rhenium-186 (186Re) and Phosphorus-32 (32P). We observed no significant differences between treatments. Similarly, we observed no differences when we compared different doses of 153Sm (0.5 versus 1.0 mCi).

Authors' conclusions

This update adds new evidence on efficacy of radioisotopes versus placebo, 89Sr compared with other radioisotopes, and dose-comparisons of 153Sm and 188Re. There is some evidence indicating that radioisotopes may provide complete reduction in pain over one to six months with no increase in analgesic use, but severe adverse effects (leucocytopenia and thrombocytopenia) are frequent.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Radioisotopes to ease metastatic bone pain

Pain is commonly experienced by people whose cancer has spread to their bones. There are several ways to treat this pain, including the administration of radioisotopes, which are chemical elements that emit radiation and act on the bone to reduce the effects of the cancer. This review looked at the effectiveness of radioisotopes for relieving pain, reducing patients' needs for conventional pain-killers, improvements in quality of life, and increased survival. There is some evidence that radioisotopes may give pain relief over one to six months, but the treatment also seemed to be associated with adverse effects, notably reducing blood cells (leucocytes). When comparing different radioisotopes or different doses of a radioisotope, we identified no conclusive differences.