The role of radiation therapy in bone metastases management (original) (raw)
Related papers
Radiotherapy for Bone Metastases
Journal of Pain and Symptom Management, 1999
Pain from bone metastases is a common problem in patients with advanced cancer, and radiotherapy plays an important role in its palliation. Single fraction treatments are often prescribed, but there is no clear consensus on this issue and clinical practice shows significant variability. This situation is unsatisfactory for all parties—the patient, the clinician, and the health care administrator. Randomized trials may use poor outcome measures and this contributes to practice variability. The credibility of outcome studies is often reduced due to poor study design, small sample sizes, and the use of endpoints that are both unreliable and unsuitable. The endpoints used have been narrowly defined, the patient’s perspective has generally been overlooked, and quality of life has only once been used as an endpoint. A review of the current literature suggests that instruments specific to bone metastases are required. These must be based on patient experience, and rely on self-report. In addition, there is a need to understand the relative priority that patients attribute to treatment outcomes. The use of better instruments and methodologies in future trials will enhance the credibility of results and reduce practice variations.
CONTROVERSIES IN RADIOTHERAPY OF METASTATIC BONE DISEASE
Metastatic bone (MB) disease is a common manifestation of advanced cancer. Although bone metastases can be asymptomatic, in more than two thirds of patients they cause pain, as well as a wide spectrum of complications, including pathological fractures, spinal cord and nerve root compressions, hypercalcaemia and mobility impairment; greatly reducing the patients' quality of life. Radiotherapy has since long proved to be an effective modality for treatment of bone metastases, resulting in palliation in up to 80% patients. Despite the extensive research in this area, many controversial issues still remain. The authors conducted a critical review of the publications on several of these issues, including the mechanisms of action of radiotherapy, dose-response relationship, optimal fractionation regimens, irradiation techniques, response assessment. The conclusion was drawn that in line with the current clinical evidence, there are no substantial differences between various fractionation schedules in terms of analgesic effect. However, in consideration of other endpoints, MF regimens may provide better effect than SF; this is a subject for future clinical research. Currently, besides the clinical evidence, the routine practice in radiotherapy departments is strongly influenced by other disease-non-specific factors, including the factors that are physician-related (country of training, location, and type of practice, professional membership affiliation, etc.) and policy/community-related (type of reimbursement, available recourses). A brief description of the practice in palliative radiotherapy for bone metastases in the Radiotherapy Department of the National Center of Oncology is presented.
European Surgical Orthopaedics and Traumatology, 2014
Bone metastases are only apparently similar lesions, considering the large varieties of istotypes and the spread of the primary tumour. Although these metastases develop early and are not terminal events, they have to be considered as severe complications. When possible, surgical treatment can improve the history of the patient in terms of life expectancy and quality of life. The approach to these lesions should be multidisciplinary in collaboration with oncologists and radiotherapists. In fact the average of survival of these patients has increased in recent years. The evolution of anesthesiological techniques permits surgical treatments that once were considered prohibitive. The application of new adjuvant therapies increases the effectiveness for surgical treatment. Controversy exists over the most appropriate treatment for patients with bone metastatic disease. The purpose was to determine the best sequential process to arrive at the most appropriate treatment considering the individual general conditions and the parameters of the metastases. As the number of treatment options for metastatic bone disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.
New Paradigms of Radiotherapy for Bone Metastasis
Radiotherapy, 2017
Proper care of patients with bone metastasis requires interdisciplinary treatments. Radiotherapy (RT) plays a central role in the management of painful bone metastasis. External beam RT can provide rapid successful palliation of painful bone metastasis in 50-80% of patients, is associated with very few adverse effects and leads to complete pain relief at the treated site in up to one-third of patients. Intensity-modulated RT (IMRT) or stereotactic body RT (SBRT) enables the delivery of higher doses to the target tumor while minimizing the dose to adjacent organs. Reirradiation using IMRT or SBRT is a valuable option for the management of bone metastases. A multidisciplinary team, especially one consisting of a spinal surgeon and rehabilitation physician, is particularly useful for treating patients with spinal bone metastases characterized by spinal instability. Rehabilitation intervention which increases the physical activity level and prevents deconditioning is important. Future developments in surgical procedures and RT will likely improve the management protocols for bone metastases and technology to reduce metal artifacts in radiation planning might improve the efficacy and safety of combination therapy.
Surgical therapy of bone metastases
Seminars in oncology, 2007
The treatment of patients with cancer epitomizes the importance of using a collaborative team approach to optimize patient care. Physician team members most commonly are radiation oncologists, general surgeons, surgical oncologists, thoracic surgeons, neurosurgeons, and orthopedic surgeons. When patients are receiving chemotherapy, their medical oncologist frequently takes responsibility for coordinating care among the various team members and initiating consultations with necessary providers. When patients develop bone metastases or chemotherapy-induced bone loss (CTIBL), the orthopedic surgeon may be able to improve the patient's quality of life greatly. Procedures orthopedists perform most commonly include open reduction and internal fixations and arthroplasties (joint replacement surgery). Less invasive procedures currently being tested include stereotactic radiosurgery, radiofrequency ablation (RFA), and percutaneous cementoplasty. By understanding the options available to ...
Tumori
Radiotherapy has an established palliative role for bone metastases but despite the large number of patients treated there is still controversy surrounding the optimal radiotherapy schedule to prescribe. The aim of this survey was to determine the decision patterns of Italian radiation oncologists in four different clinical cases of patients with bone metastases. During the latest national meeting of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to attending radiation oncologists. The cases were different with respect to the histology of the primary tumor, performance status, pain before and after analgesics, tumor site, and radiological characteristics of the metastatic lesions. For each clinical case the respondents were asked to give an indication for treatment; prescribe doses, volumes and treatment field arrangements; decide whether to prescribe prophylactic supportive therapy or not; and provide information about factors that particul...
Radiation therapy for the management of painful bone metastases: Results from a randomized trial
Reports of Practical Oncology & Radiotherapy, 2014
The aim of this study was to compare the effectiveness of two radiotherapy schedules in patients with bone metastases. Background: We analyzed the need for re-irradiation, rates of pain control, pathological fractures, and functionality in patients randomized to single-fraction (8 Gy 1×) or multiplefraction radiotherapy (3 Gy 10×) with at least 12 months follow-up, during five years. The hypothesis was that the two radiotherapy schedules are equally effective. Materials and methods: Ninety patients with painful skeletal metastases were randomized to receive single fraction (8 Gy) or multiple fraction (3 Gy 10×) radiotherapy. Results: In the single-fraction group, seven pathological fractures occurred (15.5%) versus two (4.4%) in the multiple-fraction group. There was no statistically significant difference between the time it took to suffer a pathological fracture in both groups (p = 0.099). Patients in the single-fraction group received twelve re-irradiations (26.6%), four in the multiplefraction group (8.8%), with no significant difference between time elapsed before the first re-irradiation (p = 0.438). Conclusion: This study shows no difference between the two groups for the majority of patients with painful bone metastases. Patients were followed up during five years, and the trial showed no disadvantage for 8 Gy 1× compared to 3 Gy 10×. Despite the fact that the pathological fracture rate is 3.75 times higher in the single-fraction group, this schedule is considered more convenient for patients and more cost-effective for radiotherapy departments.
Treatment of painful bone metastases
Nature Reviews Clinical Oncology, 2010
Bone metastases are the most common cause of cancer-related pain. Radiotherapy is a safe and effective therapy and is well established for such a situation. A fractionation regimen with a short overall treatment time (≤1 week) would be preferred if it was as effective as longer courses (2-4 weeks). Randomized clinical trials and meta-analyses have demonstrated that single-fraction radiotherapy with 1 × 8 Gy is as effective for pain relief as multi-fraction regimens such as 5 × 4 Gy in 1 week or 10 × 3 Gy in 2 weeks. Re-irradiation for recurrent pain in the irradiated region is required more often after single-fraction radiotherapy than multi-fraction radiotherapy; however, re-irradiation following single-fraction radiotherapy is safe and effective. Thus, 1 × 8 Gy is considered the standard regimen for uncomplicated painful bone metastases without pathological fractures or spinal cord compression. Multi-fraction radiotherapy results in significantly better remineralization of the osteolytic bone than single-fraction radiotherapy. Remineralization is important for preventing or treating pathological fractures. Multi-fraction long-course radiotherapy results in fewer recurrences of spinal-cord compression within the irradiated spinal region. Thus, long-course multi-fraction radiotherapy should be reserved for patients with a relatively favorable survival prognosis.
Management of metastatic bone disease
Metastatic bone disease is a common cause of pain and disability for patients with advanced cancer. Early detection and appropriate management can limit pain, reduce disability and prevent complications such as hypercalcaemia, pathological fracture and spinal cord compression. In specific cases surgical resection of an isolated bone metastasis may improve survival. This article provides an evidence-based overview of the investigation and management of patients with metastatic bone disease.