Radiation therapy for painful bone metastases

Bone metastases cause pain and impair quality of life, and they can lead to serious complications that require immediate treatment. Urgent surgical treatment followed by postoperative radiotherapy should be considered in bone metastases with an impending or existing pathologic fracture or spinal cord compression. Patients who are unable or unwilling to undergo surgery should be referred for urgent radiotherapy. Patients with painful bone metastases without an impending or existing pathologic fracture and no spinal cord compression, regardless of the size of the metastatic lesion, are treated pharmacologically first, complemented by palliative irradiation. In palliative radiation, low total doses are prescribed and delivered in a single fraction or in short fractionation regimens. Patients with insufficient pain relief or pain relapse after initial radiation can be safely reirradiated. We conducted a retrospective review of palliative bone irradiations between 2018 - 2021 at the Institute of Oncology Ljubjana. Annually, we treat 800 bone metastases and we are seeing a decline in the number of irradiations. The most common fractionation is 5 x 4 Gy, with only 10% of patients receiving single-dose treatment. Palliative irradiation for painful bone metastases is effective, inexpensive, and safe. It is critical to select patients who will benefit from radiation therapy and present them in a multidisciplinary team meeting. Radiation treatment can be made easier to use by simplifying the procedure for the patient and prescribing the dose in one fraction.