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Radiation therapy for the management of painful bone metastases

INTRODUCTION

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 cancers develop painful bone metastases to the spine, pelvis, and extremities during the course of their disease [1].

The goals of palliative treatment of bone metastases are pain relief, preservation of function, and maintenance of skeletal integrity. Local field external beam radiation therapy (EBRT) is one well-recognized and effective palliative modality.

When bone pain is limited to a single or a limited number of sites, EBRT to a local field can provide pain relief in 80 to 90 percent of cases, with complete pain response obtained in 50 to 60 percent [1-3]. 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 side effects of analgesic medications [4].

Consensus statements from the National Comprehensive Cancer Network on Cancer Pain, the Second Workshop on Palliative Radiotherapy and Symptom Control, and the Ontario Guidelines for Palliative Pain all advocate the use of EBRT in palliating painful bone metastases [5-7]. If symptomatic lesions are widespread, hemibody radiation or radiopharmaceuticals may provide useful palliative alternatives.

The use of external beam and hemibody irradiation will be reviewed here. Other approaches to the management of pain from bone metastases are discussed in detail elsewhere. (See "Pharmacologic therapy of cancer pain" and "Nonpharmacologic therapy of cancer pain" and "Assessment and management of bone metastases in advanced prostate cancer", section on 'Bone-targeted radioisotopes'.)
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