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Palliative Radiation for Bone Metastases

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Radiation therapy can be very helpful in treating painful bone metastases or those at risk for causing a fracture due to compromise of bone strength. Dr. Vivek Mehta reviews the basics of this approach.

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Unfortunately, sometimes cancer spreads to the bone, and when cancer spreads to the bone, two things can happen. One is, as a patient, you could have a lot of pain. Another thing that could happen is that, the cancer, when it spreads to the bone, can actually destroy the cortical structure of the bone, so you’re at risk for fracture, and you can often fracture those bones.

It doesn’t actually take a lot of cancer in the bone to cause a lot of pain. I tell patients that, you know, sometimes even a small amount of cancer in the bone can cause a lot of pain. It’s much like [how] a little pebble in your shoe can cause a huge annoyance — you hope and hope that you can get around without it, but eventually you have to take your shoe off and shake it out, and a tiny little pebble comes out. 

In any case, when we find cancer in the bone, one of the best treatments that we have for alleviating that pain, is radiation. Radiation seems to work better at alleviating that pain than pain medication does, and for reasons that we may not completely understand, radiation seems to work better than chemotherapy at alleviating that pain. 

The radiation for disease in the bone is a short course of radiation directed just at where the tumor is within that bone. It’s not designed to cure the patient, it’s simply designed to eradicate enough of the cancer to improve their quality of life and reduce that pain.  How many treatments that somebody needs for a palliative course of radiation is open to question; one course could be to do as simple as a single fraction of radiation, or three or four treatments, or ten treatments. The days where we used to give more than 20 treatments for a bone metastasis have probably come and gone — we’ve learned that we can get rid of that pain and control this disease with far fewer treatments. 

The side effects associated with the palliative course of radiation tend to be related to where that bone is, relative to the internal organs or other tissues that are going to be exposed to radiation. So, if you have a long bone or extremity, your side effects might be minimal to none, or might be related simply to a mild skin irritation. If the bone that we’re talking about is a vertebral body, and it’s next to your stomach or your intestines, you might have bowel dysfunction from that particular treatment.

So, in any case, palliative radiation to treat bone metastasis is a very effective treatment — it seems to work very well, and it controls that cancer.


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