Bone metastases

Abstract

The treatment of bone metastases comprises a large part of the radiotherapy daily practice. Palliative radiotherapy has proven to be successful in treating pain caused by metastatic lesions in any bone and in treating neurological complaints caused by compression of the spinal cord due to lesions in the spinal column. In most prospective randomized trials on radiotherapy for bone pain, responses up to 70 % were reported. However, when survival was prolonged, recurrent pain was reported in up to 50 % of patients. It is to be expected for the future, since patients are living longer with disseminated disease, that symptoms may recur and therefore retreatment of bone metastases for palliative reasons will increase. In this chapter, the evidence-based outcomes for response and duration of response to initial and subsequent radiotherapy will be presented. Guidelines will be formulated for retreatment in bone metastases, with a focus on timing, expected complications, and preferred radiotherapy techniques. More intensive radiation techniques like intensity-modulated and stereotactic radiotherapy will be discussed for their role in retreatment of bone metastases.