Radiotherapy for painful bone metastases

Abstract

Bone metastases are a frequent cause of morbidity in patients with malignant disease. Pain is the commonest symptom; it can be treated successfully in the majority of patients by local external beam irradiation. Controversy exists over which regimen should be used, with a single dose necessitating only one treatment visit to the radiotherapy department, or a fractionated course requiring several visits. Many radiotherapists continue to use fractionated regimens despite the current evidence that single fractions are as effective. Many reasons exist for this, including departmental policy and training, fears of recurrence, problems with retreatment of previously treated areas, fears of increased early and late morbidity, and attempts at promoting recalcification. The majority of these reasons are theoretical and have yet to be substantiated. In many patients, symptomatic bone metastases are widespread, and hemibody irradiation, although more toxic, should be considered in order to avoid the need for repeated courses of local treatment.

Did the Pattern of Practice in the Prescription of Palliative Radiotherapy for the Treatment of Uncomplicated Bone Metastases Change between 1999 and 2005 at the Rapid Response Radiotherapy Program?

“…KPS scores were analysed as a continuous variable. The distance travelled from residence to cancer clinic was summarised: (1) continuously; (2) as an ordinal categorical variable as: near (0 to !40 km), intermediate (O40 to !80 km), distant (O80 to !120 km), and very distant (O120 km); and (3) as a dichotomous variable as: near (0 to !45 km) and distant (O45 km). Irradiated bone metastases sites were grouped into five categories: (1) spine; (2) pelvis; (3) ribs, scapula, sternum and clavicle (chest); (4) limbs, hips, and shoulders; and (5) skull and hemi-body irradiation.…”

Der maligne Knochenschmerz

“…Die Symptomreduktion beruht wahrscheinlich auf einer Inhibition von algetischen Mediatoren und sekundär auf der Tumorverkleinerung an sich [51]. Folge der Therapie ist eine Tumornekrose mit Kollagenbildung und Rekalzifizierung.…”

The impact of radiation treatment planning technique on unplanned hospital admissions

“…These complications can be so severe that they result in UHAs for dehydration, inability to take in adequate nutrition, or uncontrolled pain. 8 …”

“…For instance, if a radiation treatment plan is able to spare dose to normal organ structures, then side effects caused by inflammatory responses within these organs may be averted. 8 The dose to surrounding normal structures is often higher with conventional nonconformal (2-dimensional) techniques compared with more conformal planning techniques. 9 , 10 , 11 Yet, given the scarcity of compelling data supporting the advantages of 3-dimensional or other highly conformal planning for limiting toxicity during treatment of bone metastases, 12 conformal planning is often not reimbursed by payers.…”