The role of radiotherapy in bone metastases: A critical review of current literature

Abstract

Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.

¹²⁵I seed brachytherapy versus external beam radiation therapy for the palliation of painful bone metastases of lung cancer after one cycle of chemotherapy progression

“…For patients with painful bone metastases, QOL is the main health-related factor that is affected 24. According to the comparison of QOL scores (including quality of sleep, appetite, mental state, and fatigue), there was a significant difference between 125 I brachytherapy and EBRT at T 2 and T 4 ( P <0.01).…”

Comparison of Single Versus Multifraction Radiotherapy in Palliation of Painful Bone Metastases

“…The treatment modality of choice for palliation of metastatic bone metastases is considered to be local site radiotherapy [10]. There are various fractionation schedules of radiotherapy used for the palliation of bone metastases.…”

“…Various studies conducted worldwide have shown single session radiotherapy to be equally effective as multifraction radiotherapy in palliation of bone metastases [11-13]. A recent meta-analysis to find the role of radiotherapy in bone metastases have shown no statistically difference in complete response or overall response to radiotherapy among various fractionations but found higher retreatment rates in the single fraction arms [10]. …”

Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

“…Radiotherapy is used to treat approximately 80% of patients with head and neck cancer and undeniably achieves favorable disease control in the great majority of head and neck patients [2]. For other types of cancer, radiotherapy also has a clear benefit for both long-term survival and local recurrence rate [3][4][5].…”