Metastatic Osseous Pain Control: Radiation Therapy

Abstract

Metastatic disease to the bone is a common manifestation of advanced cancer, and can result in pain, pathologic fractures, hypercalcemia, and overall functional compromise. External beam radiation is a proven, highly efficacious, and noninvasive therapy that can provide symptomatic relief from painful osseous lesions. When deciding upon the best treatment regimen, it is important to consider patient factors such as overall life expectancy, performance status, disease burden, and site of osseous metastatic pain. Determination of best treatment ideally requires multidisciplinary input from radiologists, medical oncologists, surgeons, pain management, and palliative care specialists together with radiation oncologists.

Team Approach: Management of Pathologic Fractures

“…Single 8 Gy fraction treatments and short courses of 10 fractions have been described 29,30 . The ideal patient scenario for single-fraction therapy would be short life expectancy and metastatic disease without patho-logic fracture 31 . Conversely, patients with longer predicted survival and a more complex skeletal presentation may benefit from a more protracted fractionation and possibly dose intensification with stereotactic body radiotherapy (SBRT) 31 .…”