‘Who’, ‘when’ and ‘how’ in re-irradiation of recurrent painful bone metastases

Abstract

Re-irradiation of painful bony metastases is increasingly performed since patients are receiving better systemic treatments and having longer life expectancy, and may also be due to the increase use of initial single fraction radiotherapy. However, randomized control trial on the efficacy of re-irradiation is lacking. A recent meta-analysis concluded with a 58% response rate for pain relief by re-irradiation of symptomatic bone metastases. In this review, the effectiveness of re-irradiation in terms of clinical and economical aspects, and clinical questions on who, when, and how to re-irradiate would be discussed. A brief review of other treatment options and comparison with re-irradiation of bone metastases would be performed.

The Role of Orthopaedic Surgeons in the Management of Fractures in Cancer Patients

“…10 For nonresponding or recurrent painful bone metastases, re-irradiation is recommended for its high response rate. 11 For painful spinal metastases, stereotactic body radiation therapy gives better pain relief and local control than conventional external beam radiation therapy. 12 Nearly 50% of patients with bone metastases develop one or more complications collectively termed skeletal-related events (SREs) including pathological fracture (20.7%), metastatic spinal cord compression (0.9%), radiation to bone (8.0%), surgery to bone (1.2%) and hypercalcaemia.…”

Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: a systematic review and meta-analysis

“…Re-irradiation of recurrent painful bone metastases is an available option but also increases the risk of radiation-induced adverse effects like pathologic fractures and myelopathy. As such, re-irradiation therapy is limited by radiation dose limits of the bone and its surrounding tissue [10][11][12].…”