Bone/Spine Cancers

  • Daniel M. TrifilettiEmail author
  • Nicholas G. Zaorsky
  • Daniel E. Spratt


This chapter discusses the general management of patients with bone and spine tumors, with special focus on principles that guide radiotherapy and radiosurgery management. Several key components of trimodality care and palliative care are discussed.


Bone metastases Palliative Cord compression Radiosurgery 


  1. 1.
    Martinez-Monge R, Gomez-Iturriaga A, Cambeiro M, et al. Phase I-II trial of perioperative high-dose-rate brachytherapy in oral cavity and oropharyngeal cancer. Brachytherapy. 2009;8:26–33.Google Scholar
  2. 2.
    Cook B DT: Wikibooks Radiation Oncology. Accessed April 2018.
  3. 3.
    Edge S, Byrd D, Compton C, et al. AJCC cancer staging manual. New York: Springer; 2010.Google Scholar
  4. 4.
    Hansen E, Roach M. Handbook of evidence-based radiation oncology. 2nd ed. New York: Springer; 2010.CrossRefGoogle Scholar
  5. 5.
    Hristov B, Lin SH, Christodouleas JP. Radiation oncology – a question based review. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  6. 6.
    Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.CrossRefGoogle Scholar
  7. 7.
    Rades D, Lange M, Veninga T, et al. Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression. Int J Radiat Oncol Biol Phys. 2009;73:228–34.CrossRefGoogle Scholar
  8. 8.
    Rades D, Rudat V, Veninga T, et al. Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression. Cancer. 2008;113:1090–6.CrossRefGoogle Scholar
  9. 9.
    Rades D, Stalpers LJ, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol. 2005;23:3366–75.CrossRefGoogle Scholar
  10. 10.
    Vecht CJ, Haaxma-Reiche H, van Putten WL, et al. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology. 1989;39:1255–7.CrossRefGoogle Scholar
  11. 11.
    Laufer I, Rubin DG, Lis E, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18:744–51.CrossRefGoogle Scholar
  12. 12.
    Versteeg AL, Verlaan JJ, Sahgal A, et al. The spinal instability neoplastic score: impact on oncologic decision-making. Spine (Phila Pa 1976). 2016;41(Suppl 20):S231–s237.CrossRefGoogle Scholar
  13. 13.
    Pollono D, Tomarchia S, Drut R, et al. Spinal cord compression: a review of 70 pediatric patients. Pediatr Hematol Oncol. 2003;20:457–66.CrossRefGoogle Scholar
  14. 14.
    Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35:E1221–9.CrossRefGoogle Scholar
  15. 15.
    Rades D, Heidenreich F, Karstens JH. Final results of a prospective study of the prognostic value of the time to develop motor deficits before irradiation in metastatic spinal cord compression. Int J Radiat Oncol Biol Phys. 2002;53:975–9.CrossRefGoogle Scholar
  16. 16.
    Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial. Int J Radiat Oncol Biol Phys. 1992;24:301–6.CrossRefGoogle Scholar
  17. 17.
    Loblaw DA, Mitera G, Ford M, et al. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol Biol Phys. 2012;84:312–7.CrossRefGoogle Scholar
  18. 18.
    Rades D, Veninga T, Conde-Moreno AJ, et al. Results of a multicenter study investigating the potential impact of the overall treatment time on outcomes of radiation therapy alone with 5x4 Gy for metastatic epidural spinal cord compression. Pract Radiat Oncol. 2017;7:137–44.CrossRefGoogle Scholar
  19. 19.
    Rades D, Janssen S, Conde-Moreno AJ, et al. Role of the overall treatment time of radiotherapy with 10 x 3 Gy for outcomes in patients with metastatic spinal cord compression. J Med Imaging Radiat Oncol. 2017;61:388–93.CrossRefGoogle Scholar
  20. 20.
    Nieder C, Grosu AL, Andratschke NH, et al. Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys. 2006;66:1446–9.CrossRefGoogle Scholar
  21. 21.
    8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. Radiother Oncol. 52:111, 1999–21.Google Scholar
  22. 22.
    Chow E, Harris K, Fan G, et al. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007;25:1423–36.CrossRefGoogle Scholar
  23. 23.
    Gerszten PC, Burton SA, Ozhasoglu C, et al. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976). 2007;32:193–9.CrossRefGoogle Scholar
  24. 24.
    Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97:798–804.CrossRefGoogle Scholar
  25. 25.
    Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989:256–64.Google Scholar
  26. 26.
    Townsend PW, Rosenthal HG, Smalley SR, et al. Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol. 1994;12:2345–50.CrossRefGoogle Scholar
  27. 27.
    Van der Linden YM, Dijkstra PD, Kroon HM, et al. Comparative analysis of risk factors for pathological fracture with femoral metastases. J Bone Joint Surg Br. 2004;86:566–73.CrossRefGoogle Scholar
  28. 28.
    Roos DE, Turner SL, O'Brien PC, et al. Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05). Radiother Oncol. 2005;75:54–63.CrossRefGoogle Scholar
  29. 29.
    Chow E, Meyer RM, Ding K, et al. Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol. 2015;16:1463–72.CrossRefGoogle Scholar
  30. 30.
    Howell DD, James JL, Hartsell WF, et al. Single-fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases-equivalent efficacy, less toxicity, more convenient: a subset analysis of Radiation Therapy Oncology Group trial 97–14. Cancer. 2013;119:888–96.CrossRefGoogle Scholar
  31. 31.
    Hird A, Chow E, Zhang L, et al. Determining the incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: results from three Canadian Cancer Centers. Int J Radiat Oncol Biol Phys. 2009;75:193–7.CrossRefGoogle Scholar
  32. 32.
    Loblaw DA, Wu JS, Kirkbride P, et al. Pain flare in patients with bone metastases after palliative radiotherapy--a nested randomized control trial. Support Care Cancer. 2007;15:451–5.CrossRefGoogle Scholar
  33. 33.
    Gomez-Iturriaga A, Cacicedo J, Navarro A, et al. Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study. BMC Palliat Care. 2015;14:48.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Daniel M. Trifiletti
    • 1
    Email author
  • Nicholas G. Zaorsky
    • 2
  • Daniel E. Spratt
    • 3
  1. 1.Mayo ClinicJacksonvilleUSA
  2. 2.Penn State Cancer InstituteHersheyUSA
  3. 3.University of MichiganAnn ArborUSA

Personalised recommendations