Role of Beta-Emitter Sm-153 in Combined and Complex Therapy of Skeletal Metastases

In spite of significant progress in the diagnosis and management of solid tumors, the incidence of bone metastasis is still high, and the use of bone-targeted agents does not prevent the development of their complications such a skeletal related events. While the most current bone targeting medications act on the bone microenvironment and the osteolytic bone metastasis. The beta-emitters radiopharmaceuticals such as Samarium-153-ethylene diamine tetramethylene phosphonate and Sm-153 oxabifore target osteoblastic bone lesions by irradiating nerve fibers that innervate the skeleton and cancer cells which may lead to the termination of growth factorsthat stimulates cancer cell dissemination to the skeleton. However, their role usually is limited by palliative treatment for painful bone metastases. Recently it is demonstrated that the combination of radionuclide therapy with bisphosphonates or chemotherapy is potentially more effective as compared to use in isolation. The synergetic approach of bone metastasis therapy is perspective; however, chemotherapy is generally contraindicated in combination with radionuclide therapy due to possible synergetic myelotoxicity. Vertebral fracture and impending cord compression are other contraindications for radionuclide therapy. In this book chapter, we presented possible combined/complex therapy approach including best timing of radionuclide/bisphosphonate administration, combined therapy with monoclonal antibody Denosumab its effectiveness and metabolic response, radionuclide therapy in combination with percutaneous vertebroplasty, possibility to use Sm-153 therapy in combination with bisphosphonates, hormonal therapy, chemotherapy and targeted therapy in breast cancer patients, side effects, survival rate and incidence of SRE in patients who received combined/complex therapy and the possibility to use of lactate dehydrogenase level as an indicator of disease progression.