Radiation for bone metastases: conventional techniques and the role of systemic radiopharmaceuticals.

Abstract:

:Pain management often is difficult in patients with bone metastases. Metastatic disease represents >40% of oncologic practice, and >70% of patients with metastatic disease have uncontrolled cancer-related pain. Significant morbidity caused by pathologic fracture and spinal cord compression can result from untreated bone metastases. Representing both a manifestation of systemic disease as well as causing localized symptoms, bone metastases require a multidisciplinary therapeutic approach. Radiation therapy provides both localized and systemic treatment options in addition to chemohormonal therapies and surgery. External beam irradiation provides palliation in >70% of patients through tumor regression of a localized lesion. Systemic radiopharmaceuticals treat multifocal disease either alone or as an adjuvant to external beam irradiation. Efficient and comprehensive management of bone metastases is imperative because of the associated symptoms, prior therapies, complex underlying medical problems, and clinical presentations that often require emergent interventions. Intensification of pain may be observed with hormonal therapy and systemic radiopharmaceuticals. Symptomatic relief from antineoplastic therapies generally requires 4-12 weeks and may be related to reossification. Symptoms, occurring due to the disease and/or while awaiting response to therapy, must be aggressively managed. Persistent or recurrent pain after therapy may be due to bony instability or fracture before reossification occurs. An Interdisciplinary Bone Metastases Clinic, with representatives from Diagnostic Radiology, Medical Oncology, Nuclear Medicine, Orthopedic Surgery, Pain and Symptom Management, Physical Medicine and Rehabilitation, and Radiation Oncology, was developed that allows coordinated evaluation, treatment, and symptom management of these complex clinical presentations.

journal_name

Cancer

journal_title

Cancer

authors

Janjan NA

doi

10.1002/(sici)1097-0142(19971015)80:8+<1628::aid-c

subject

Has Abstract

pub_date

1997-10-15 00:00:00

pages

1628-45

issue

8 Suppl

eissn

0008-543X

issn

1097-0142

pii

10.1002/(SICI)1097-0142(19971015)80:8+<1628::AID-C

journal_volume

80

pub_type

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