Download PDF
Semin intervent Radiol 2017; 34(04): 322-327
DOI: 10.1055/s-0037-1608703
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Metastatic Osseous Pain Control: Radiation Therapy

Josephine Kang
1   Department of Radiation Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
,
Silvia C. Formenti
1   Department of Radiation Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
14 December 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Metastatic disease to the bone is a common manifestation of advanced cancer, and can result in pain, pathologic fractures, hypercalcemia, and overall functional compromise. External beam radiation is a proven, highly efficacious, and noninvasive therapy that can provide symptomatic relief from painful osseous lesions. When deciding upon the best treatment regimen, it is important to consider patient factors such as overall life expectancy, performance status, disease burden, and site of osseous metastatic pain. Determination of best treatment ideally requires multidisciplinary input from radiologists, medical oncologists, surgeons, pain management, and palliative care specialists together with radiation oncologists.

Keywords

palliative - radiation therapy - bone metastasis - interventional radiology
 

  • References

  • 1 Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25 (11) 1423-1436
    CrossrefPubMedGoogle Scholar
  • 2 Gripp S, Mjartan S, Boelke E, Willers R. Palliative radiotherapy tailored to life expectancy in end-stage cancer patients: reality or myth?. Cancer 2010; 116 (13) 3251-3256
    CrossrefPubMedGoogle Scholar
  • 3 Patel A, Dunmore-Griffith J, Lutz S, Johnstone PA. Radiation therapy in the last month of life. Rep Pract Oncol Radiother 2013; 19 (03) 191-194
    PubMedGoogle Scholar
  • 4 Kapadia NS, Mamet R, Zornosa C, Niland JC, D'Amico TA, Hayman JA. Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer. Cancer 2012; 118 (17) 4339-4345
    CrossrefPubMedGoogle Scholar
  • 5 Huang J, Wai ES, Lau F, Blood PA. Palliative radiotherapy utilization for cancer patients at end of life in British Columbia: retrospective cohort study. BMC Palliat Care 2014; 13 (01) 49
    CrossrefPubMedGoogle Scholar
  • 6 Tsao MN, Lloyd N, Wong RK. , et al. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 2012; 4 (04) CD003869
    PubMedGoogle Scholar
  • 7 Fairchild A, Harris K, Barnes E. , et al. Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol 2008; 26 (24) 4001-4011
    CrossrefPubMedGoogle Scholar
  • 8 van der Linden YM, Lok JJ, Steenland E. , et al; Dutch Bone Metastasis Study Group. 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 2004; 59 (02) 528-537
    CrossrefPubMedGoogle Scholar
  • 9 Steenland E, Leer JW, van Houwelingen H. , et al. 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 1999; 52 (02) 101-109
    CrossrefPubMedGoogle Scholar
  • 10 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 (05) 1501-1510
    CrossrefPubMedGoogle Scholar
  • 11 Lutz S, Berk L, Chang E. , et al; American Society for Radiation Oncology (ASTRO). Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 79 (04) 965-976
    CrossrefPubMedGoogle Scholar
  • 12 Lutz S, Balboni T, Jones J. , et al. Palliative radiation therapy for bone metastases: update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2017; 7 (01) 4-12
    CrossrefPubMedGoogle Scholar
  • 13 Hahn C, Kavanagh B, Bhatnagar A. , et al. Choosing wisely: the American Society for Radiation Oncology's top 5 list. Pract Radiat Oncol 2014; 4 (06) 349-355
    CrossrefPubMedGoogle Scholar
  • 14 Fischberg D, Bull J, Casarett D. , et al; HPM Choosing Wisely Task Force. Five things physicians and patients should question in hospice and palliative medicine. J Pain Symptom Manage 2013; 45 (03) 595-605
    CrossrefPubMedGoogle Scholar
  • 15 Raman S, Chow R, Hoskin P, Chow E. How should radiation oncologists interpret the ASTRO evidence-based guideline and ASTRO Choosing Wisely campaign for the treatment of uncomplicated bone metastases?. Pract Radiat Oncol 2017; 7 (01) 13-15
    CrossrefPubMedGoogle Scholar
  • 16 Sze WM, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. Cochrane Database Syst Rev 2004; (02) CD004721
    PubMedGoogle Scholar
  • 17 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 (11) 798-804
    CrossrefPubMedGoogle Scholar
  • 18 Sze WM, Shelley MD, Held I, Wilt TJ, Mason MD. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy--a systematic review of randomised trials. Clin Oncol (R Coll Radiol) 2003; 15 (06) 345-352
    CrossrefPubMedGoogle Scholar
  • 19 Foro Arnalot P, Fontanals AV, Galcerán JC. , et al. 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 2008; 89 (02) 150-155
    CrossrefPubMedGoogle Scholar
  • 20 Lutz S, Spence C, Chow E, Janjan N, Connor S. Survey on use of palliative radiotherapy in hospice care. J Clin Oncol 2004; 22 (17) 3581-3586
    CrossrefPubMedGoogle Scholar
  • 21 Bone Pain Trial Working Party. 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. Radiother Oncol 1999; 52 (02) 111-121
    CrossrefPubMedGoogle Scholar
  • 22 Chang S, Cardinale BS, Morrison RS, Rosenzweig K, Dharmarajan KV. A palliative radiation oncology consult service's impact on care of advanced cancer patients with symptomatic bone metastases. J Clin Oncol 2015; 33 (29) 110
    PubMedGoogle Scholar
  • 23 Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 2007; 32 (02) 193-199
    CrossrefPubMedGoogle Scholar
  • 24 Sahgal A, Larson DA, Chang EL. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 2008; 71 (03) 652-665
    CrossrefPubMedGoogle Scholar
  • 25 Group RS. . Available at: https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0631
    PubMed
  • 26 Westhoff PG, de Graeff A, Monninkhof EM. , et al; Dutch Bone Metastasis Study Group. An easy tool to predict survival in patients receiving radiation therapy for painful bone metastases. Int J Radiat Oncol Biol Phys 2014; 90 (04) 739-747
    CrossrefPubMedGoogle Scholar
  • 27 Bickel KE, McNiff KK, Buss MK. , et al. Defining high-quality palliative care in oncology practice: an ASCO/AAHPM Guidance Statement. J Clin Oncol 2015; 33 (29) 108
    PubMedGoogle Scholar
  • 28 McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM. National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J 2007; 13 (02) 130-137
    CrossrefPubMedGoogle Scholar
  • 29 Westhoff PG, Verdam MGE, Oort FJ. , et al; Dutch Bone Metastasis Study Group. Course of quality of life after radiation therapy for painful bone metastases: a detailed analysis from the Dutch Bone Metastasis Study. Int J Radiat Oncol Biol Phys 2016; 95 (05) 1391-1398
    CrossrefPubMedGoogle Scholar
  • 30 Li D, Prigerson HG, Kang J, Maciejewski PK. Impact of radiation therapy on aggressive care and quality of life near death. J Pain Symptom Manage 2017; 53 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 31 Chow E, Loblaw A, Harris K. , et al. Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a pilot study. Support Care Cancer 2007; 15 (06) 643-647
    CrossrefPubMedGoogle Scholar
  • 32 Lam TC, Uno H, Krishnan M. , et al. Adverse outcomes after palliative radiation therapy for uncomplicated spine metastases: role of spinal instability and single-fraction radiation therapy. Int J Radiat Oncol Biol Phys 2015; 93 (02) 373-381
    CrossrefPubMedGoogle Scholar
  • 33 Huisman M, van den Bosch MA, Wijlemans JW, van Vulpen M, van der Linden YM, Verkooijen HM. Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys 2012; 84 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 34 Chow E, van der Linden YM, Roos D. , et al. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol 2014; 15 (02) 164-171
    CrossrefPubMedGoogle Scholar
  • 35 Chow E, Meyer RM, Chen BE. , et al. Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomized trial. J Clin Oncol 2014; 32 (34) 3867-3873
    CrossrefPubMedGoogle Scholar
  • 36 Roos DE, Turner SL, O'Brien PC. , et al; Trans-Tasman Radiation Oncology Group, TROG 96.05. 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 (01) 54-63
    CrossrefPubMedGoogle Scholar