Pamidronate and Metastatic Breast Cancer

To the Editor: I am disturbed by the design of the trial reported by Hortobagyi et al. (Dec. 12 issue). 1 The standard of care for painful lytic metastases is radiation therapy or surgery, especially for lesions involving a risk of pathologic fracture. 2 These treatments are extremely effective if implemented in a timely manner. In large series, a rate of pain relief approaching 90 percent has been reported for radiation therapy, 3 and surgery usually results in prompt relief as well. 4 With such effective treatments readily available, it is arguably unethical to have a placebo arm in the trial; the two arms . . .