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Use of Bone Scintigraphy to Select Patients with Multiple Myeloma for Treatment with Strontium-89

Emory University School of Medicine, Department of Radiology, Division of Nuclear Medicine, Atlanta;
and Intercommunity Cancer Center at Rome, Rome, Georgia

Correspondence: For correspondence or reprints contact: Andrew Taylor, Jr., MD, Emory University Hospital, Department of Radiology, 1364 Clifton Road, NE, Atlanta, GA 30322.

ABSTRACT

Strontium-89 is an effective agent for palliation of pain due to bony metastases from breast and prostate carcinoma. As a functional analog of calcium, ⁸⁹Sr is taken up by bone in areas of osteoblastic activity. Since patients with multiple myeloma frequently have osteolytic metastases, ⁸⁹Sr might not be considered to be a therapeutic option. However, metastases which appear osteolytic by radiographs may demonstrate osteoblastic activity on bone scans. Consequently, the bone scan may be used to identify a subsetof patients with osteolytic metastases who may benefit from ⁸⁹Sr treatment. This report describes a patient with severe rib pain due to multiple myeloma whose chest radiograph showed multiple lucent lesions throughout the bones of the chest wall but whose bone scan showed marked osteoblastic activity. The patient was treated with ⁸⁹Sr and received substantial pain relief. Bone scans may be useful in selecting myeloma patients or other cancer patients with osteolytic radiographic lesions who may benefit from ⁸⁹Sr therapy.

Key Words: strontium-89 • multiple myeloma • bone scintigraphy • pain palliation • lytic metastases

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