title: [Advances in radiation oncology for metastatic bone disease].
abstract: BACKGROUND
  Irradiation of bone metastases primarily aims at alleviating pain, preventing fracture in the short term. The higher doses and more conformal dose distribution achievable while saving healthy tissue with new irradiation techniques have induced a paradigm shift in the management of bone metastases in a growing number of clinical situations.
  
  
  METHODS
  A search of the English and French literature was conducted using the keywords: bone metastases, radiotherapy, interventional radiology, vertebroplasty, radiofrequency, chemoembolization. RESULTS-DISCUSSION: Stereotactic irradiation yields pain relief rates greater than 90% in Phase I/II and retrospective studies. IMRT (static, rotational, helical) and stereotactic irradiation yield local control rates of 75-90% at 2 years. Some situations previously evaluated as palliative are currently treated more aggressively with optimized radiation sometimes combined modality interventional radiology.
  
  
  CONCLUSIONS
  A recommendation can only be made for stereotactic irradiation in vertebral oligometastases or reirradiation. In the absence of a sufficient level of evidence, the increasing use of conformal irradiation techniques can only reflect the daily practice and the patient benefit while integrating economic logic care. The impact of these aggressive approaches on survival remains to be formally demonstrated by interventional prospective studies or observatories including quality of life items and minimal 2-year follow-up.
authors.affiliation: Centre Antoine-Lacassagne - Institut universitaire de la face et du cou, université Nice-Sophia-Antipolis, department of radiation oncology, 33, avenue Valombrose, 06300 Nice Cedex 2, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.forename: Danièle
authors.initials: D
authors.lastname: Fric
authors.forename: Christine
authors.initials: C
authors.lastname: Kerr
authors.forename: Axel
authors.initials: A
authors.lastname: Leysalle
authors.forename: Gaelle
authors.initials: G
authors.lastname: Angellier
authors.forename: Catherine
authors.initials: C
authors.lastname: Dejean
authors.forename: Titien
authors.initials: T
authors.lastname: Tuillier
authors.forename: René-Jean
authors.initials: RJ
authors.lastname: Bensadoun
authors.forename: Jean-Léon
authors.initials: JL
authors.lastname: Lagrange
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D010146:Pain / Q000209:etiology / Q000532:radiotherapy; D059408:Pain Management / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods; D016634:Radiosurgery / Q000379:methods; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000379:methods; D013117:Spinal Cord Compression / Q000532:radiotherapy / Q000601:surgery; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery
keywords: ablative; bone; cancer; cementoplasty; curative; irradiation; local control; local treatment; metastases/metastatic; oligometastases; oligometastasis; osseous; palliative; quality of life; surgery; survival