SpringerLink
Log in

The Role of Radiation Therapy in Controlling Painful Bone Metastases

  • Cancer Pain (DA Marcus, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient. Patients with bone metastases may require interventions including surgical decompression, osteoclast inhibitors, radiopharmaceuticals, and kyphoplasty or vertebroplasty, though EBRT should be included in the care of most of these patients, as well. Recent treatment-guideline publications for bone metastases greatly define the appropriate use of EBRT for this patient group, and they create a means by which treatment approaches may serve as quality measures of radiotherapy departments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as:• Of importance•• Of major importance

  1. Coleman R. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12:6243s–9s.

    Article  PubMed  Google Scholar 

  2. The University of Texas Health Science Center at San Antonio. Healthy bone remodeling. Available at: http://teachhealthk-12.uthscsa.edu/curriculum/bones/pa12pdf/1203D-all.pdf. Most recently accessed February 18, 2002.

  3. Goblirsch M, Zwolak P, Clohisy D. Biology of bone cancer pain. Clin Cancer Res. 2006;12:6231s–5s.

    Article  PubMed  CAS  Google Scholar 

  4. Chow E, Harris K, Fan G, et al. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007;25:1423–36.

    Article  PubMed  Google Scholar 

  5. World Health Organization: Cancer—WHO’s pain relief ladder. http://www.who.int/cancer/palliative/painladder/en/. Most recently accessed February 18, 2012.

  6. Vakaet L, Boterberg T. Pain control by ionizing radiation of bone metastasis. Int J Dev Biol. 2004;48:599–606.

    Article  PubMed  CAS  Google Scholar 

  7. Lutz S, Berk L, Chang E, et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 79(4):965–976. These guidelines highlights important controversies in radiotherapy for bone metastases, separating them into those that may be addressed by available data and those that require additional study to develop standards.

    Article  PubMed  Google Scholar 

  8. American College of Radiology ACR Appropriateness Criteria® NON-SPINE BONE METASTASES Expert Panel on Radiation Oncology—Bone Metastases: Lutz S, Lo S, Howell D, et al. J Pal Med 2011; in press. This publication provides guidelines in a format that presents common clinical case scenarios and offers levels of appropriateness for relevant clinical interventions.

  9. Lutz S, Spence C, Chow, et al. Survey on use of palliative radiotherapy in hospice care. J Clin Oncol. 2004;22:3581–6.

    Article  PubMed  Google Scholar 

  10. Chow E. 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. 2006;18:125–8.

    Article  CAS  Google Scholar 

  11. Grosu A, Andratschke N, Nieder C, et al. Retreatment of the spinal cord with palliative radiotherapy. Int J Radiat Oncol Biol Phys. 2002;53:1288–92.

    Article  Google Scholar 

  12. Nieder C, Grosu A, Andratschke N, 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.

    Article  PubMed  Google Scholar 

  13. Patchell RA, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  PubMed  Google Scholar 

  14. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.

    PubMed  Google Scholar 

  15. Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect. 1986;35:357–81.

    PubMed  CAS  Google Scholar 

  16. Brown JE, Cook RJ, Lipton A, Costa L, Coleman RE. Prognostic factors for skeletal complications from metastatic bone disease in breast cancer. Breast Cancer Res Treat. 2010;123(3):767–79.

    Article  PubMed  Google Scholar 

  17. Van Poznak C, Temin S, Yee G, et al. American Society of Clinical Oncology executive summary of the clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. J Clin Oncol 2011; 29(9):1221–1227. This publication provides the only existing guidelines for the use of bone-modifying agents in the care of patients with metastatic bone disease.

    Article  PubMed  Google Scholar 

  18. Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:433–41.

    Article  PubMed  Google Scholar 

  19. Oosterhof G, Roberts J, de Reijke T, et al. Strontium (89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: a phase III study of the European Organisation for Research and Treatment of Cancer, Genitourinary Group. Eur Urol. 2003;44:519–26.

    Article  PubMed  CAS  Google Scholar 

  20. Serafini A, Houston S, Resche I, et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol. 1998;16:1574–81.

    PubMed  CAS  Google Scholar 

  21. Bashir F, Parry J, Windsor P. Use of a modified hemi-body irradiation technique for metastatic carcinoma of the prostate: report of a 10-year experience. Clin Oncol. 2008;20:591–8.

    Article  CAS  Google Scholar 

  22. Cheung G, Chow E, Holden L, et al. Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: a prospective study using quality-of-life assessment. Intervent Ratiol. 2006;57:13–21.

    Google Scholar 

  23. Dudeney S, Lieberman I, Reinhardt M, et al. Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol. 2002;9:2282–7.

    Google Scholar 

  24. Sahgal A, Larson D, Chang E. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys. 2008;71:652–65.

    Article  PubMed  Google Scholar 

  25. Chang E, Shiu A, Mendel, et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg. 2007;7:151–60.

    Google Scholar 

  26. Sahgal A, Ames C, Chou D, et al. Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys. 2009;74:723–31.

    Article  PubMed  Google Scholar 

  27. Fairchild A, Barnes E, Ghosh S, et al. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys 2009;75:1501–1510. This survey defines the variability in worldwide radiotherapy practice patterns for bone metastases and therefore justifies the subsequently completed bone metastases treatment guidelines.

    Article  PubMed  Google Scholar 

  28. National Quality Forum. Available at: http://www.qualityforum.org/Home.aspx. Most recently accessed February 18, 2012.

Download references

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, 15990 Medical Drive South, Findlay, OH, 45840, USA

    Stephen Lutz

Authors
  1. Stephen Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen Lutz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lutz, S. The Role of Radiation Therapy in Controlling Painful Bone Metastases. Curr Pain Headache Rep 16, 300–306 (2012). https://doi.org/10.1007/s11916-012-0271-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-012-0271-1

Keywords

Search

Navigation