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EANM Procedure Guidelines for Treatment of Refractory Metastatic Bone Pain

• EANM procedure guideline for treatment of refractory metastatic bone pain (2008)
  
  The purpose of this guideline is to assist nuclear medicine practitioners in:
  
  1. Evaluating patients who might be candidates for treatment to palliate refractory, metastatic bone pain using ⁸⁹Sr (approved in Europe for prostate cancer), ¹⁵³Smlexidronam (¹⁵³Sm-EDTMP; approved in Europe for osteoblastic metastases) or ¹⁸⁶Re-etidronate (¹⁸⁶Re- HEDP; approved in some European countries).
  2. Providing information for performing these treatments.
  3. Understanding and evaluating the consequences of therapy.
  
  Bone-seeking radiopharmaceuticals are one of the therapeutic tools available for palliation of bone pain and should be used within a multidisciplinary approach to choose the best option for each patient in a correct sequence. Substantial advantages of bone palliation radionuclide therapy include the ability to simultaneously treat multiple sites of disease with a more probable therapeutic effect in earlier phases of metastatic disease, the ease of administration, the repeatability, and the potential integration with the other treatments.