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External Beam Radiotherapy and Bone Metastases

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Bone Metastases

Part of the book series: Cancer Metastasis - Biology and Treatment ((CMBT,volume 21))

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

  1. Galasko CS (1981) Then anatomy and pathways of bone metastasis. In: Weiss L, Gilbert A (eds) Bone metastasis. GK Hall, Boston, pp 49–63

    Google Scholar 

  2. Coleman RE (1997) Skeletal complications of malignancy. Cancer 80(8 Suppl):1588–1594

    Article  PubMed  CAS  Google Scholar 

  3. Kamby C, Vejborg I, Daugaard S et al (1987) Clinical and radiologic characteristics of bone metastases in breast cancer. Cancer 60(10):2524–2531

    Article  PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. WHO (2010) World Health Organization pain ladder. http://www.who.int/cancer/palliative/painladder/en/. Accessed 9 Feb 2013

  7. 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

    Article  PubMed  Google Scholar 

  8. Nielsen OS, Munro AJ, Tannock IF (1991) Bone metastases: pathophysiology and management policy. J Clin Oncol 9(3):509–524

    PubMed  CAS  Google Scholar 

  9. Springfield D (2001) Pathologic fractures. In: Rockwood and Green’s fractures in adults, 5th edn. Lippincott Williams Wilkins, Philadelphia

    Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  CAS  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. Jaffray D, Kupelian P, Djemil T et al (2007) Review of image-guided radiation therapy. Expert Rev Anticancer Ther 7(1):89–103

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. 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

  31. 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

    Google Scholar 

  32. Lo SS, Lutz ST, Chang EL et al (2013) ACR Appropriateness Criteria((R)) spinal bone metastases. J Palliat Med 16(1):9–19

    PubMed  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. Lutz ST, Lo SS, Chang EL et al (2012) ACR Appropriateness Criteria(R) non-spine bone metastases. J Palliat Med 15(5):521–526

    Article  PubMed  Google Scholar 

  35. NQF (2012) #1822 External beam radiotherapy for bone metastasis

    Google Scholar 

  36. ABIM (2012) Choosing Wisely

    Google Scholar 

  37. 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

    Article  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Candice Johnstone .

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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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