Top

Published in:

01-08-2012 | Cancer Pain (DA Marcus, Section Editor)

The Role of Radiation Therapy in Controlling Painful Bone Metastases

Author: Stephen Lutz

Published in: Current Pain and Headache Reports | Issue 4/2012

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.

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

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.

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

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

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

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

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. PubMedCrossRef

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.

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

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.CrossRef

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.CrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

15.

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

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.PubMedCrossRef

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. PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

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.CrossRef

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.

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.

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.PubMedCrossRef

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.

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.PubMedCrossRef

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. PubMedCrossRef

28.

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

Title: The Role of Radiation Therapy in Controlling Painful Bone Metastases
Author: Stephen Lutz
Publication date: 01-08-2012
Publisher: Current Science Inc.
Published in: Current Pain and Headache Reports / Issue 4/2012
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-012-0271-1

2024 ASCO Annual Meeting

Springer Medicine

The Role of Radiation Therapy in Controlling Painful Bone Metastases

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2012

Erratum to: Complex Regional Pain Syndrome: What Specialized Rehabilitation Services Do Patients Require?

Expectations of Pain and Accompanying Symptoms during Cancer Treatment

How to Investigate and Treat: Migraine in Patients with Temporomandibular Disorders

Spinal Cord Stimulation in the Treatment of Cancer-Related Pain: “Back to the Origins”

Headache and Temporal Arteritis: When to Suspect and How to Manage

The Role of Corticosteroids in the Treatment of Pain in Cancer Patients