Radiation therapy for the management of painful bone metastases
- Lisa A Kachnic, MD
Lisa A Kachnic, MD
- Chair and Professor
- Department of Radiation Oncology
- Vanderbilt University School of Medicine
- Steven J DiBiase, MD
Steven J DiBiase, MD
- Professor of Radiation Oncology
- Tulane University School of Medicine
- Medical Director, Department of Radiation Oncology
- Tulane Cancer Center
Bone metastases are a common manifestation of distant relapse from many types of solid cancers, especially those arising in the lung, breast, and prostate. As many as 80 percent of patients with solid tumors will develop painful bone metastases to the spine, pelvis, and extremities during the course of their illness .
The goals of palliative treatment of bone metastases are pain relief, preservation of function, and maintenance of skeletal integrity. When bone pain is limited to a single or limited number of sites, local field external beam radiation therapy (RT) to the painful sites can provide pain relief in approximately 60 to 85 percent of cases, with complete pain response reported in 15 to 58 percent . If symptomatic lesions are widespread, radiopharmaceuticals or hemibody radiation may provide useful palliative alternatives. Although treatment can be effective for patients with mild, moderate, or severe pain, early intervention may be useful in maintaining quality of life and minimizing the side effects of analgesic medications .
The use of RT for palliation of painful bone metastases will be reviewed here. An overview of bone metastases is presented separately, as are other aspects of cancer pain management, including the management of patients with epidural spinal cord compression and the use of image-guided thermal ablation for patients with pain from bone metastases that persists or recurs after RT. (See "Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis" and "Cancer pain management: General principles and risk management for patients receiving opioids" and "Treatment and prognosis of neoplastic epidural spinal cord compression, including cauda equina syndrome" and "Image-guided ablation of skeletal metastases".)
EXTERNAL BEAM RT
For patients with a single or limited number of areas of painful bone metastases, we recommend external beam RT (EBRT). RT is effective in partially or completely relieving pain in a majority of patients with bone metastases, although a transient worsening of pain may occur in some patients . This typically occurs in the first few days after RT, and the flare in pain generally lasts one to two days.
Single-dose versus fractionated treatment — For most patients, we suggest using a single fraction of 8 Gy to the involved area. This approach provides equal palliation with improved patient convenience and cost-effectiveness compared with fractionated schedules, although retreatment is needed more frequently. For patients with a relatively long life expectancy (such as six months or more), a fractionated regimen (such as 30 Gy in 10 fractions or 20 Gy in five fractions) is a reasonable alternative because of the reduced need for retreatment.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EXTERNAL BEAM RT
- Single-dose versus fractionated treatment
- Dose of single-fraction radiation
- Time course of relief and incidence of pain flare
- Need for surgery
- STEREOTACTIC RT
- TREATMENT OF RECURRENT OR PERSISTENT PAIN
- MANAGEMENT OF PATIENTS WITH DIFFUSE BONE PAIN
- Bone-targeted radioisotopes
- Hemibody irradiation
- SUPPORTIVE CARE
- SUMMARY AND RECOMMENDATIONS