Indications for primary radionuclide therapy:
• Patients with multiple osteoblastic, painful bone metastases who have exhausted treatment with external-beam irradiation.
Contraindications for radionuclide therapy as sole treatment:
(1) patients with fractures or impending fractures
(2) patients with spinal cord or nerve root compression
(3) those whose index lesions have inadequate uptake on bone scan
(4) those whose lesions have an extraosseous component or large area of bone destruction and tumor mass such that tumor cells may be more than a few millimeters from the radioactivity in new bone
Unsuitable candidates:
(1) inadequate hemogram (Katin et al used WBC < 3,000 per µL, platelet count < 60,000 per µL)
(2) poor renal function
(3) poor hepatic function
(4) life expectancy of < 6 weeks
(5) urinary incontinence
(6) hypercalcemia
(7) use of calcium containing drugs (discontinue for at least 2 weeks before treatment)
