Abstract
While the management of bone metastases requires multidisciplinary care, external beam radiotherapy (EBRT) remains an effective and efficient method by which to palliate pain and prevent pathologic fracture. Dose fractionation schemes ranging from 8 Gy in a single fraction to 30 Gy in ten fractions can provide equivalent relief with a minimal risk of side effects. Highly conformal or stereotactic body radiation therapy shows promise in the treatment of these patients, with its most appropriate niches to be determined through continued accrual to ongoing clinical trials. Treatment guidelines and quality measures have been developed to better define the use of EBRT in the setting of painful bone metastases.
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References
Galasko CS (1981) Then anatomy and pathways of bone metastasis. In: Weiss L, Gilbert A (eds) Bone metastasis. GK Hall, Boston, pp 49–63
Coleman RE (1997) Skeletal complications of malignancy. Cancer 80(8 Suppl):1588–1594
Kamby C, Vejborg I, Daugaard S et al (1987) Clinical and radiologic characteristics of bone metastases in breast cancer. Cancer 60(10):2524–2531
Chow E, Harris K, Fan G et al (2007) Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25(11):1423–1436
van der Linden YM, Lok JJ, Steenland E et al (2004) Single fraction radiotherapy is efficacious: a further analysis of the Dutch bone metastasis study controlling for the influence of retreatment. Int J Radiat Oncol Biol Phys 59(2):528–537
WHO (2010) World Health Organization pain ladder. http://www.who.int/cancer/palliative/painladder/en/. Accessed 9 Feb 2013
van der Linden YM, Steenland E, van Houwelingen HC et al (2006) Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: results on survival in the Dutch bone metastasis study. Radiother Oncol 78(3):245–253
Nielsen OS, Munro AJ, Tannock IF (1991) Bone metastases: pathophysiology and management policy. J Clin Oncol 9(3):509–524
Springfield D (2001) Pathologic fractures. In: Rockwood and Green’s fractures in adults, 5th edn. Lippincott Williams Wilkins, Philadelphia
Koswig S, Budach V (1999) Remineralization and pain relief in bone metastases after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study. Strahlenther Onkol 175(10):500–508
Townsend PW, Smalley SR, Cozad SC et al (1995) Role of postoperative radiation therapy after stabilization of fractures caused by metastatic disease. Int J Radiat Oncol Biol Phys 31(1):43–49
Hartsell WF, Scott CB, Bruner DW et al (2005) Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 97(11):798–804
Fairchild A, Barnes E, Ghosh S (2009) International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys 75(5):1501–1510
Foro Arnalot P, Fontanals AV, Galceran JC et al (2008) Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30 Gy in 10 fractions compared with 8 Gy in single fraction. Radiother Oncol 89(2):150–155
Hartsell WF, Desilvio M, Bruner DW et al (2008) Can physicians accurately predict survival time in patients with metastatic cancer? Analysis of RTOG 97-14. J Palliat Med 11(5):723–728
Van der Linden YM, Dijkstra PD, Kroon HM et al (2004) Comparative analysis of risk factors for pathological fracture with femoral metastases. J Bone Joint Surg Br 86(4):566–573
Roos DE, Turner SL, O’Brien PC et al (2005) 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 75(1):54–63
Hartsell W, Scott C, Bruner DW et al (2003) Phase III randomized trial of 8 Gy in 1 fraction vs. 30 Gy in 10 fractions for palliation of painful bone metastases: preliminary results of RTOG 97-14. Int J Radiat Oncol Biol Phys 57(Supplement):124
Loblaw DA, Wu JS, Kirkbride P et al (2007) Pain flare in patients with bone metastases after palliative radiotherapy–a nested randomized control trial. Support Care Cancer 15(4):451–455
Chow E, Hoskin P, Mitera G et al (2012) Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys 82(5):1730–1737
Huisman M, van den Bosch MA, Wijlemans JW et al (2012) Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys 84(1):8–14
Chow E, Hoskin PJ, Wu J et al (2006) A phase III international randomised trial comparing single with multiple fractions for re-irradiation of painful bone metastases: National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) SC 20. Clin Oncol (R Coll Radiol) 18(2):125–128
Lo SS, Fakiris AJ, Chang EL et al (2010) Stereotactic body radiation therapy: a novel treatment modality. Nat Rev Clin Oncol 7(1):44–54
Jaffray D, Kupelian P, Djemil T et al (2007) Review of image-guided radiation therapy. Expert Rev Anticancer Ther 7(1):89–103
Allen AM, Pawlicki T, Dong L et al (2012) An evidence based review of proton beam therapy: the report of ASTRO’s emerging technology committee. Radiother Oncol 103(1):8–11
Sahgal A, Larson DA, Chang EL (2008) Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 71(3):652–665
Wang XS, Rhines LD, Shiu AS et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13(4):395–402
Garg AK, Shiu AS, Yang J et al (2012) Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer 118(20):5069–5077
Jhaveri PM, Teh BS, Paulino AC et al (2012) A dose-response relationship for time to bone pain resolution after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC) bony metastases. Acta Oncol 51(5):584–588
RTOG (2006) RTOG 0618: a phase II trial of Stereotactic Body Radiation Therapy (SBRT) in the treatment of patients with operable stage I/II non-small cell lung cancer. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CDYQFjAB&url=http%3A%2F%2Fwww.rtog.org%2FClinicalTrials%2FProtocolTable%2FStudyDetails.aspx%3Faction%3DopenFile%26FileID%3D4650&ei=9b4TUaD7B6yE2QXYooCgCA&usg=AFQjCNH3XRG72GBwcAqbx2WYC37kQV-SoQ&sig2=M25iWW62dHbnx_PJnOTUtQ
Lo SS, Sahgal A, Chang EL, Mayr NA, Teh BS, Huang Z, Schefter TE, Yao M, Machtay M, Slotman BJ, Timmerman RD (2013) Serious complications associated with stereotactic ablative radiotherapy and strategies to mitigate the risk. Clin Oncol (R Coll Radiol) 25(6):378–387. doi: 10.1016/j.clon.2013.01.003. Epub 1 Feb 2013
Lo SS, Lutz ST, Chang EL et al (2013) ACR Appropriateness Criteria((R)) spinal bone metastases. J Palliat Med 16(1):9–19
Lutz S, Berk L, Chang E et al (2011) Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 79(4):965–976
Lutz ST, Lo SS, Chang EL et al (2012) ACR Appropriateness Criteria(R) non-spine bone metastases. J Palliat Med 15(5):521–526
NQF (2012) #1822 External beam radiotherapy for bone metastasis
ABIM (2012) Choosing Wisely
Bone Pain Trial Working Party (1999) 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(2):111–121
Steenland E, Leer JW, van Houwelingen H et al (1999) The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch bone metastasis study. Radiother Oncol 52(2):101–109
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Johnstone, C., Lutz, S.T. (2014). External Beam Radiotherapy and Bone Metastases. In: Vassiliou, V., Chow, E., Kardamakis, D. (eds) Bone Metastases. Cancer Metastasis - Biology and Treatment, vol 21. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7569-5_9
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