Treatment of painful bone metastases.
Bone metastases are the most common cause of cancer-related pain. Radiotherapy is a safe and effective therapy and is well established for such a situation. A fractionation regimen with a short overall treatment time (< or =1 week) would be preferred if it was as effective as longer courses (2-4 weeks). Randomized clinical trials and meta-analyses have demonstrated that single-fraction radiotherapy with 1 x 8 Gy is as effective for pain relief as multi-fraction regimens such as 5 x 4 Gy in 1 week or 10 x 3 Gy in 2 weeks. Re-irradiation for recurrent pain in the irradiated region is required more often after single-fraction radiotherapy than multi-fraction radiotherapy; however, re-irradiation following single-fraction radiotherapy is safe and effective. Thus, 1 x 8 Gy is considered the standard regimen for uncomplicated painful bone metastases without pathological fractures or spinal cord compression. Multi-fraction radiotherapy results in significantly better remineralization of the osteolytic bone than single-fraction radiotherapy. Remineralization is important for preventing or treating pathological fractures. Multi-fraction long-course radiotherapy results in fewer recurrences of spinal-cord compression within the irradiated spinal region. Thus, long-course multi-fraction radiotherapy should be reserved for patients with a relatively favorable survival prognosis.
Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany. rades.dirk@gmx.net
Dirk
D
Rades
Steven E
SE
Schild
Janet L
JL
Abrahm
D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016001:Confidence Intervals; D004164:Diphosphonates / Q000627:therapeutic use; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D058498:Kyphoplasty; D010014:Osteolysis; D010146:Pain / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D011878:Radiotherapy; D012306:Risk
D004164:Diphosphonates